Terence Stephenson speaks at GMC Conference 2016

Dear colleague,

I write to you once again at the start of the year, as health services across the UK are working harder than ever to deal with the fierce pressures of winter, and when it’s being reported that emergency departments and primary care services are struggling to cope with demand.

This challenges our ability to provide the high standard of care we want for our patients. It’s in these moments – when our skills, compassion and endurance are tested to the limits – that I feel huge pride to be a member of this profession.

Every week I see colleagues go above and beyond what is expected of them for their patients. There will no doubt be more challenges ahead. However, I want to thank you personally for your ongoing commitment and professionalism.

The GMC has no role in the funding or delivery of healthcare but we have voiced our concern about the current situation. Such circumstances place the professionalism of doctors at risk, forcing you to make difficult decisions about care and squeezing the already constrained time you have for training and development.

The standards we set for doctors’ education, training and support must be met – in good times and bad – and we will engage with employers who do not meet them. We expect those responsible for running services to listen and respond to what you tell them. If you have concerns about the safety of your patients, I urge you to raise them. If you are not sure how to do so, please use our guidance tool about raising concerns.

Screenshot of the GMC's raising concerns decision tool

Lightening our touch

Although regulation provides public assurance that the profession is safe, I am clear that the GMC must continue to question the burden regulation creates for those being regulated.

Two weeks ago we published Sir Keith Pearson’s independent review of revalidation. Although this shows revalidation is beginning to impact positively on doctors’ clinical practice and professional behaviour, it is still relatively new and we know some of you face difficulties with appraisals that we must work with others to address.

Sir Keith reported that some doctors are asked to provide evidence or carry out activities above and beyond what we require for the purposes of revalidation – something I have experienced myself. In evidence to the House of Lords last year, I said: ‘I qualified as a doctor in 1983. Nobody was expecting me… to do online training on different colours of fire extinguishers. Now, it is mandatory training.’

Everyone needs to be clear on what’s necessary for revalidation – and, importantly, what isn’t. In the coming months we will work with the medical royal colleges and employers to address this problem. Now more than ever doctors need the time and space to reflect on their practice.

This year, we also want some much needed progress on reforming our legislation. The Medical Act is now over thirty years old, and it frequently slows us down and piles unnecessary stress on doctors and patients. We understand the UK Government will soon consult on the future of professional regulation; this cannot come soon enough.

We can’t make the big reforms to our fitness to practise procedures – as well as other aspects of our work – without legislative changes which require parliamentary time. Too many doctors undergo GMC investigations that result in no action because we find no concerns about their practice. We can stop many of these unnecessary investigations, but only if the law is changed.

Protecting and improving medical education

We will soon set out our proposals for a medical licensing assessment to be taken by doctors both inside and outside the UK before they are granted entry onto the medical register. In part this will address the current arrangements experienced by UK medical students – where 35 medical schools set their own assessments, which are completely different from all subsequent postgraduate examinations.

Academic diversity is a good thing. It’s one of the reasons why UK medical education is so highly regarded around the world. However, research [PDF] shows that this diversity is accompanied by variations in how adequately prepared medical students feel they are for practice as doctors. We believe a single assessment, integrated with medical school exams, will reduce this variation and give the public much greater assurance. Please look out for our consultation when it is launched.

March will see the launch of our annual national training surveys. Last year’s survey highlighted increased workloads for some doctors in training as well as concerns about poorly designed rotas. We’ve listened to what doctors in training have told us and this year we will include new questions in the survey to help us pinpoint where these rota gaps exist. Once we have that information we’ll work with postgraduate training bodies and employers to take the necessary action.

Day workload by specialty, National training survey 2016 key findings report, p. 7
Day workload by specialty, National training survey 2016 key findings report, p. 7

The other key issue we want to tackle this year is the inflexible nature of postgraduate training. You may remember that the GMC was tasked by the UK Government to come up with proposals for making training more flexible. We expect to deliver our recommendations – for all four Governments’ consideration – at the end of March. We hope they will be accepted and that they lead to real change for doctors in the near future.

Supporting your professionalism

When I became Chair I promised to make our guidance for doctors more relevant and accessible. I’m pleased to say we’re making good progress with this. Last month we launched our new app – My GMP – which gives you access to all our guidance on mobile devices, even offline. The app makes it quicker and easier for you to find advice on an issue you are facing, there and then. I hope you’ll download it soon.

We also have a new tool to help you make decisions in situations where a patient may lack capacity, including decisions in end of life care.

These are just two examples of how we are stepping up our support for you and your professionalism. There are many other initiatives like these on their way. Later this year we’ll release a range of resources to help you apply our new Confidentiality guidance to your practice.

Helping you become – and stay – a good doctor is where we want to invest more of our time and resources in the future. In the long run we believe this will be far better for patients and hopefully far better for you.

With best wishes,

Professor Terence Stephenson
Chair, General Medical Council