Fitness to practise overhaul must not be reduced to a cost-cutting exercise

Government plans to overhaul fitness to practise investigations are a welcome opportunity to create a fair, proportionate system that doctors trust, argues Medical Protection adviser Dr Pallavi Bradshaw. But ministers must avoid the temptation to focus on cutting costs.

Senior medicolegal adviser at Medical Protection Dr Pallavi Bradshaw
Senior medicolegal adviser at Medical Protection Dr Pallavi Bradshaw

The first reference to medical regulation in the UK dates to the 15th century when physicians petitioned parliament to prevent ‘quacks’ from practising medicine. The Medical Act 1858 saw the first incarnation of the GMC, which has evolved from protecting the public and profession from unqualified practitioners, to holding registrants to account and ensuring fitness to practise. The GMC holds the medical register, oversees education and training for doctors, sets the standards that doctors need to follow and takes action when they are not met.

The 2004 Shipman inquiry was a watershed moment in medical regulation. The GMC was given interim powers to suspend, more doctors were being investigated and sanctioned, revalidation was introduced and in 2012 the Medical Practitioners Tribunal Service was established as an impartial adjudicator for fitness to practise cases, tasked with making decisions on the action needed.

Medical Protection and the GMC have both sought an overhaul in the regulation of healthcare professionals for some years. While the government supports reform, it has not until now been seen as a political priority, as demonstrated by the unwieldly and now shelved Law Commission Bill published in 2014. Now, the DH is consulting on the amalgamation of several health regulators, and as part of that, proposals to give the regulators greater flexibility in the way cases are handled.

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How DH plans to overhaul fitness to practise investigations

It is clear that the GMC feels constrained by the legal framework of the Medical Act 1983, and that the government wants to make it easier to protect patients, bring about consistency and make efficiencies. Its ambition to create a regulator, or small group of regulators, that is proportionate and responsive is clearly welcomed, but this must not be at the expense of fairness to the professionals they regulate, nor to transparency.

The safeguards that legislation brings to registrants, whose careers and livelihoods are at stake, must not be forgotten. Any flexibility in processes must meet the needs of patients and the profession, and be based on the principles of fairness, consistency, transparency and proportionality. MPS supports hundreds of GPs and other healthcare professionals through GMC fitness to practice investigations every year; providing advice and legal representation from the outset right through to the hearing.

We see the physical and psychological impact they have, particularly when they are handled poorly, and it is apparent that more still needs to be done to ensure the process is underpinned by those vital principles of good regulation.

Robust regulation

Accountability is also paramount - there is a need to satisfy the public and profession that the regulators themselves, and their effectiveness, are scrutinised and held to account. Such accountability has to be inherent with good regulation - from triage, investigation, decisions, through to conduct - and a robust system is currently lacking.

All that said, despite these shortfalls, some improvements have been made by the GMC and it is regarded as leading the way for others.

Any amalgamation exercise should avoid loss or dilution of these improvements. The specific expertise of each profession’s regulator must also not be lost.  Any new ‘super’ regulators, replacing the existing nine, would need to be able to distinguish between the hugely differing roles within the many professions they would oversee, and have an appreciation of the different pressures across the professions.

We are at a point in time now more than ever, where the regulators need to be sensitive to these pressures and I am encouraged that the DH acknowledges this. It is imperative that regulators take into account how their actions affect the morale of the wider profession, and indeed question whether the standards they set for doctors - both within clinical practice and within their private lives – are realistic in modern practice and society.

The emphasis has to be on patient safety, but there must be an acknowledgement that it is also in the public interest to only investigate and sanction those doctors who truly pose a threat to patients.

The greatest failure of all would be to simply see this consultation as an exercise to drive cost efficiencies and not address the real problems in the current system. We have an opportunity to look at how the needs of all can be met in an effective, fair and proportionate way, and create a system that patients, healthcare professionals and the government alike can have confidence in. It is an opportunity that should be seized.

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