Long-awaited reforms to the GMC could come into effect as soon as next spring if the government sticks to its timetable. The consultation by the DHSC, Regulating healthcare professionals, protecting the public, prioritises the GMC for reforms that aim to give the regulator greater flexibility to modernise its operations.
A reset is certainly overdue in the outdated fitness to practise process for doctors which has left many dedicated professionals feeling distraught and worse. While the GMC made efforts to ameliorate the process – the introduction of case examiners and undertakings, for example – progress was largely stymied by the Medical Act 1983, which limited its powers.
The consultation sets out proposals for reforming fitness to practise to allow for the 'safe and quick conclusion of many cases without the need for expensive and lengthy panel hearings'.
The MDU supports the creation of a three-tier fitness to practise process covering initial assessment, case examiner stage and panel hearing, which should allow more cases to be appropriately resolved at an earlier stage and reduce the stress for doctors.
We also welcome plans to remove the GMC’s ability to appeal against fitness to practise decisions. Not only has this been counter to the separate investigation and adjudicatory functions at the GMC – with the Medical Practitioner Tribunal Service (MPTS) fulfilling the later – but it has been unnecessary given that the Professional Standards Authority (PSA) already has this power.
And in the context of the medical misinformation swirling round during the pandemic, the government needs to look at ways to protect the hard-earned title of doctor. We are in favour of tougher penalties for those who falsely portray themselves as qualified and registered healthcare professionals, given the potential risk to patients and public trust.
Concerns about the changes
There is plenty that doctors can get behind in the consultation but the MDU has raised concerns about two proposals which we believe to be particularly unjust and which actually threaten to undermine measures to support sick doctors and those who have already taken steps to remediate.
First, the practical effect of plans to remove health as a category of impairment in fitness to practise cases will be to penalise doctors with health concerns whose cases would instead be considered under the category of ‘lack of competence’.
Of course, such cases should usually be dealt with outside a fitness to practise process as advocated by the consultation but this is not always possible.
In recent years, the GMC has established separate and supportive procedures for dealing with health concerns within the formal fitness to practice system, such as ensuring details about a doctor’s health are separated from other publicly available content.
Removing the health category risks undoing these advances. Worse still, the stigmatising label of ‘lack of competence’ will be attached to doctors who are already struggling with their physical or mental health.
Second, proposals to scrap the ‘five-year rule’ carries the risk that doctors could be routinely and punitively subjected to fitness to practise proceedings for historic complaints. This could happen even if there is no question of current impairment or risk to patients because the doctor has already reflected on their practise and addressed concerns.
The consultation asserts that the five-year rule means regulators 'cannot currently consider fitness to practise concerns which are more than five years old', but this is not the case. In fact, the GMC can still investigate allegations which date back more than five years if they correspond with a potential current impairment or risk to patient safety. There is detailed guidance on applying the five-year rule for GMC decision makers.
In this context, we believe the five-year rule is a valuable filter which should be extended to all the healthcare regulators to ensure the fitness to practise process focuses on what really matters: is a professional’s practice currently impaired and are conditions required on their registration to protect the public?
The GMC itself shares our concerns about these two proposals and we hope this will be taken into account when the government brings forward draft legislation later this year.
It is important that these much-anticipated reforms result in a fitness to practise process which allows concerns about doctors to be addressed in a fair, proportionate and timely way and also gives them the opportunity and support to remediate. After all, the role of the GMC is not to punish doctors but to protect the public.
- Dr Caroline Fryar is, head of advisory services at the MDU. Find out more about the MDU’s views on reforming healthcare regulation on its website here.