Here, the GMC’s Chief Executive Charlie Massey looks at what needs to change to make regulation lighter and more agile in the 21st century.
It’s quite a piece of work, the legislation that gives the General Medical Council its powers. The Medical Act was first enacted in 1858, and has been amended 19 times in 150 years as developments in society and medicine called for changes to the way medical practitioners are regulated.
The surprising thing is the amount that hasn’t changed. Let me give you one small but – in 2017 – quite absurd example of how legislation has failed to keep up:
Section 30 (5): The Registrar may, by letter addressed to any person registered in the register at his address on the register, inquire whether he has changed his address and, if no answer is received to the inquiry within six months from the posting of the letter, may erase from the register any entry relating to that person.
I’ll clarify that for you. It means that if the Registrar (me) believes a doctor no longer has a valid postal address, then we can erase them from the register. But only after we send another letter to the address from which we’ve had no response, and then only six months after the doctor doesn’t respond to that final letter.
In an age when we have never been better connected, it’s a minor but telling illustration of how legislation designed for a different era is too prescriptive and rigid for what we and patients need now. More concerning are the requirements the Act places on us that make dealing with fitness to practise matters a slow, inflexible and heavy-handed process.
The Medical Act requires us to formally investigate any allegation of impaired fitness to practise. It also sets out the specific steps that must be carried out during the investigation.
Even when there are no complications, completing the process required by the legislation must take a minimum of six months. Six months in which anxious patients and doctors are expected to sit by while we wade through a set of steps that may or may not be necessary for that investigation. Can you imagine the stress if that patient was your father, or sister? Or if that doctor was?
We are expected to continue to follow that process even when criminal proceedings establish that a doctor has committed terrible crimes. We need not look too far back in recent history for examples; in each case we must still carry out a tribunal hearing even when it is apparent the doctor should not be on the register, and even if the doctor agrees that that’s the right course of action.
These are clunky and outdated laws that don’t do patients or doctors any good, and one of my key priorities is to find ways to lighten our touch wherever we can. The medical profession as a whole is under considerable pressure and it is vital we don’t add to that.
What if the law gave us more discretion and flexibility about what to investigate? Under current legislation, there are cases we are required to investigate that could be better dealt with locally, now that employers’ systems for managing concerns about doctors are much stronger.
What could we do if we had discretion over what happens when new information emerges suggesting a case is not as serious as first thought? We could stop an investigation, instead of having to follow it through to the end, dragging medics and patients with us.
The UK Government, devolved administrations and indeed all the main political parties have stated their commitment to reforming the outdated legislation which governs regulation. We now need them to bring forward concrete plans for fundamental reform and to introduce legislation as soon as possible.
In the meantime, we will keep doing what we can within the confines of the law to modernise. We’re making investigations more streamlined, supportive and proportionate to those involved, and building on the progress we made last year and through our work with Professor Louis Appleby.
We’ve committed to a raft of measures to reduce the stress and time taken to investigate. Our ongoing pilot to make use of early enquiries is reducing the number of full investigations about one-off clinical incidents, and we’re exploring with medical defence organisations how we and doctors can have conversations early in an investigation to improve our understanding of what happened and resolve cases more quickly.
What kind of regulator?
We spend 60 per cent of doctors’ annual retention fee investigating complaints. Fitness to practise will always be important in protecting the public, but with changes in the law we could put some of this money to better use, taking a more evidence-based approach to our work and focusing energy more proactively on helping doctors become and stay good doctors throughout their careers.
We’re already applying that approach to the wealth of data that we hold, tailoring our support to those doctors and issues where we know it’s most needed. For example, we introduced our Welcome to UK Practice programme (our free half-day learning session for doctors new or returning to practice or to the UK) in the light of data showing that these groups of doctors often faced significant challenges in getting to grips with the UK context around consent, confidentiality and other ethical issues.
The insight we have can go some way to helping others; we make information widely available through publications such as our annual state of medical education and practice report, and website data tools like our National training survey results. In the future we want to make data about practice even more accessible and current, making maximum use of digital technology.
We can and will do as much of that as we can without legislation, but the step-change we want to achieve can’t happen unless Government makes good on its promise to overhaul the Medical Act. We need a Medical Act for the digital age, even if it has to be printed on vellum…