Improving medical regulation: much has been achieved, though there is still more to doBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h624 (Published 11 February 2015) Cite this as: BMJ 2015;350:h624
- Niall Dickson, chief executive and registrar, General Medical Council
The General Medical Council’s chief executive, Niall Dickson, reflects on recent improvements to medical regulation and the need for ongoing improvement and legislative changes
In recent weeks there has been much discussion about complaints and raising concerns in the medical profession. The Health Select Committee made an important contribution to this debate with their report,1 and Bourne et al published research in BMJ Open showing the impact of complaints on doctors.2 In their BMJ Careers article “A turning point for medical regulation,” Hilarie Williams and Christoph Lees made a number of points about the role and work of the General Medical Council,3 and some of these must be addressed.
It is misleading to suggest that we have not shown insight into the impact of investigations on doctors. Being under investigation is stressful for doctors, just as it is for other health professionals. It is hard to see how that can be avoided altogether, but we recognise that this is an issue we can and should do something about. That is why we commissioned an independent review of doctors who committed suicide while under investigation—to see what lessons we can learn and how we can better support vulnerable doctors in our procedures.
We also have in place a comprehensive set of reforms to speed up our processes, reduce the stress of our investigations, and better support doctors who have their fitness to practise called into question. These include reviewing the tone of our communications with doctors to make them clearer, simpler, and more sensitive. We also fund a confidential advice service providing emotional support for doctors under investigation, and an independent evaluation found that this delivered real benefits to the doctors who used it.
Lees and Williams criticise both the length of our investigations and the number that conclude without a doctor receiving a sanction. We are doing all we can to speed up the process, including changing how we manage less serious complaints and meeting with doctors at the end of an investigation to see if we can avoid the need for a hearing altogether. However, our investigations must be thorough and sometimes we have to investigate a complaint to conclude that there is no case to answer.
We do not “welcome” the huge increase in complaints from members of the public, as Lees and Williams suggest, not least because there is nothing we can do about most of them. Most complaints from the public are closed because they do not meet our threshold for investigation. This does not mean that those complaints are invalid but that the issues could and should be resolved at a local level.
The increase in complaints from members of the public is an issue for the health service as a whole, as the Health Select Committee said in their report. However, at the General Medical Council we are doing what we can to help patients raise their concerns with the organisation best able to resolve it.
What we do welcome is a more open and transparent culture where doctors are more willing to raise concerns about poor medical practice. There are barriers to raising concerns and even the most self confident professional can be hesitant, but the risks to patients of failing to act must outweigh these concerns. Once again, this is not an issue that professional regulation can deal with alone, but we are determined to do what we can to help create this more open and transparent culture across the medical profession.
We have commissioned Anthony Hooper to undertake an independent review of how we can better support doctors who raise concerns in the public interest. Hooper’s review, which will be published later this year, will include advice and recommendations for the General Medical Council to help us improve our work in this area.
There is much we have done and much still for us to do. However, the law that governs professional regulation is outdated and we are prevented from going further. The legislative reform we have been campaigning for, in the shape of the Law Commission’s Regulation of Health and Social Care Professionals Bill, would allow us to be more independent and responsive to the needs of patients and the profession, and to change our procedures without resorting to parliament. The current legislation is no longer fit for purpose. It needs to be swept away because it is cumbersome, inflexible, and far too difficult to reform.
As Lees and Williams point out, doctors are among the most trusted professionals. Our consultation on professional sanctions is about how we can uphold that trust and make sure that the action we take is fair to doctors, while never losing our focus on protecting patients.
Lees and Williams call for an “overhaul” in medical regulation, but they overlook the progress we have made to date and the important changes we are implementing to improve our procedures. We have revolutionised how we engage with doctors and their responsible officers so that concerns can be dealt with earlier and in some cases resolved without being referred to the national regulator. We are also making better use of our data to see what more we can do to support doctors at risk of receiving a complaint.
The work that we and the Medical Practitioners Tribunal Service do is essential to protect patients, and we are ourselves subject to robust regulation to ensure the highest standards. In their most recent performance review, the Professional Standards Authority, which oversees professional health regulation in the United Kingdom, found that we met all the standards of good regulation and welcomed our innovation in a number of areas. The Professional Standards Authority also audited our fitness to practise work and found that it protects the public.
However, we are not complacent. Instead of a “radical overhaul” of medical regulation, as Lees and Williams propose, we will continue to improve our work better to protect patients, resolve their complaints faster, and better support doctors in our procedures.
Competing interests: I have read and understood the BMJ’s policy on declaration of interests and have no relevant interests to declare.