Performance bill will give GMC new powers

BMJ 1995; 310 doi: (Published 25 March 1995) Cite this as: BMJ 1995;310:759

Doctors in Britain who fall foul of new performance disciplines to be exercised by the General Medical Council (GMC) could face retraining costs of up to £22000, according to figures in the Medical (Professional Performance) Bill, now before the House of Commons. The government rejected advice from the GMC that it should bear the costs of retraining general practitioners. For doctors employed by the NHS, health authorities and trusts will decide whether to pay for retraining.

The financial memorandum to the bill states that an individual doctor may incur between £6000 and £22000 in remedial training costs. The cost to the NHS is put at up to £530000 a year. An extra £8 is expected on the GMC's annual retention fee for every general practitioner.

The health minister Gerald Malone said on publication of the bill last week that retraining costs would fall on the public purse only when doctors were employed by the NHS. General practitioners and others would be required to pay. The bill, with six clauses, amends the Medical Act 1983 to give the GMC new jurisdiction over the professional competence of doctors in addition to its existing statutory powers to deal with misconduct and ill health. It enables the GMC to investigate cases in which a doctor's standard of professional performance is alleged to be seriously deficient. The aim is to remedy the deficiencies, under threat of the suspension of registration.

The bill introduces two new statutory committees of the GMC—the assessment referral committee and the committee on professional performance. The latter will be able to suspend registration. The bill also allows the GMC to remove from the register a doctor who requests this. Local assessment panels will be empowered to inspect records and obtain warrants to enter premises. Obstruction will be a criminal offence, subject to a fine of up to £1000.

The proposed performance procedure will have four stages: screening; assessment; remedy; and, if the problem has not been resolved, sanctions. Initial screening will be by a medical member of the GMC. If assessment is recommended and the doctor refuses, the case will be referred to a committee comprising three members of the GMC, with power to direct the doctor to undergo assessment. Any doctor failing to comply will be referred to the committee on professional performance.

Assessments will be conducted by at least two medically qualified assessors with lay help and will cover the doctor's clinical skills, attitudes, and clinical record keeping as well as inquiries of third parties. The assessors will recommend counselling, remedial training, or changes to practice commitments, and the doctor will be invited to comply. The aim is cooperation rather than resort to statutory sanctions. Should sanctions prove necessary the performance committee could suspend a doctor's registration.

Mr Malone said that the apparently cumbersome procedures were to ensure fairness to doctors and to protect the public. Although the procedures would protect doctors' rights, the GMC would be able to take speedy action if there was grave danger to the public.

Mr Finlay Scott, chief executive of the GMC, gave as examples of underperformance pathologists who missed positive results of cervical smear tests or general practitioners whose attitude to patients was consistently rude.

The BMA described the legislation as an overdue measure to ensure that the professionalism of doctors was maintained. The bill has cross party support and should be passed within four months. A further 18 months will be needed for the GMC to set up and test assessment programmes. When the procedure is in place it is expected to apply to fewer than 100 doctors a year.–JOHN WARDEN, BMJ, parliamentary correspondent

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