Last month marked the 10-year anniversary of the government white paper ‘Enabling Excellence’, which set out ambitious plans to radically reform the way health professionals are regulated, including fundamental reform of the GMC’s legal powers so it can take a more proportionate approach to investigating concerns about doctors.
This white paper recognised that the current system of regulation is 'complex, expensive and requires continuous government intervention to keep it up to date'.
Sadly, very little progress has been made in the past decade. Subsequent consultations have come and gone without significant changes being made.
Latest white paper
A further white paper published this February, which sets out proposals for a new Health and Care Bill that will promote greater integration, was no exception. Instead of outlining reforms that would see improvements in how health professionals are regulated, there is instead a focus on making it easier for the government to merge or abolish regulators and to bring the health profession in or out of regulation should it decide to do so at some point in the future.
This latest white paper promises that further proposals will be unveiled in the future which would help to ensure regulators’ processes are proportionate and not overly bureaucratic. But no further detail is provided on when and how. After so many years of delay, long overdue reforms should not be absent in the forthcoming Bill.
If something as important as the regulation of healthcare professionals cannot be reformed now, as part of widespread reform of the NHS, when can it be?
Why is reform needed?
Medical Protection has long argued for reforms to the Medical Act to enable the GMC to streamline its processes, improve efficiency, reduce the number of investigations into less serious allegations, and conclude investigations in a more timely manner.
The vast majority of GMC investigations are closed without action, the end result being that far too many doctors go through a stressful process each year, while many complainants also endure a lengthy process with a disappointing outcome. The status quo serves neither doctors nor patients and the GMC, through changes to the Medical Act, needs to be given discretion to not take forward investigations where allegations clearly do not require action.
To be fair to the GMC, they have made progress in streamlining their processes in order to reduce the burden on doctors. But their current powers were framed more than 30 years ago – when a far smaller number of complaints were received, and it could investigate each one thoroughly.
More than 8,000 doctors are now referred to the regulator every year, with very few coming close to the threshold of serious concern that the GMC was established to address.
Power of appeal
The GMC’s power to appeal decisions made by the Medical Practitioners Tribunal Service (MPTS) also needs to be addressed. Medical Protection has called on the government to remove this as it is detrimental to the interests of healthcare professionals and unnecessary as the Professional Standards Authority has the authority to appeal decisions.
The government agreed that the GMC should be stripped of the power in summer 2018, following the Professor Sir Norman Williams review into gross negligence manslaughter in healthcare, which was prompted following the high profile case of Dr Hadiza Bawa-Garba. However, until the relevant legislative changes are made, the GMC can and do continue to challenge decisions.
Legislation to implement this must be put forward with urgency. While we understand there are currently other priorities for the government, it will be soon be three years since it committed to this much needed change.
There has never been a more important time to address the shortcomings of the current processes. COVID-19 has sparked discussion about the extent to which individuals are held to account when working in pressurised and extreme circumstances, and now more than ever, the GMC needs to be able to operate in a way that restores and instils confidence amongst patients and doctors. The government must keep this in sharp focus.
- Dr Hendry is medical director at Medical Protection