GMC fires warning shot to protect doctors’ training

Forgotten tribe

Massey says that, in times of strain, it is important that the GMC uses its data, knowledge, and understanding and works with other regulators, such as the Care Quality Commission, NHS Improvement, and Health Education England, to improve matters for trainees. The GMC should “anticipate where problems might be arising and to get a bit more ahead of the curve,” he says. “If there is any organisation that is going to stand up and support trainee doctors and make sure that they have got the training experience that they should have, it’s going to be the GMC.”

Until the dispute over changes to the contract for junior doctors in England “trainees were a bit of a forgotten tribe,” he says. “They were relied upon hugely, perhaps too hugely, to provide services, and we know through the National Training Survey that those facing the heaviest workloads were sometimes having their training jeopardised as a result. It is incumbent on all of us in the system, but especially the GMC, to recognise that the training of doctors is absolutely critical to provide the quality of medical professionalism that we need in the NHS for the next 20 to 30 years.”

Appointment not welcomed by all

Despite his enthusiasm for safeguarding doctors of the future, his appointment to GMC chief executive was not universally welcomed by the profession.2 “I would say that my role was misunderstood by many in terms of that aspect of being a civil servant,” he says. “The thing I would add, for the avoidance of doubt, is that I have resigned from the civil service. It is really important that the GMC is independent and is perceived to be independent, so I am not bound, in any shape or form, to government. What I would ask of doctors is that they judge me by my track record in this role, rather than what they may perceive me to have done in my previous roles.”

As well as his experience at the Department of Health (box), which included leading the response to Robert Francis’s inquiry into failings at Mid Staffordshire NHS Foundation Trust, Massey says that his previous regulatory experience will also help him in his new role. “I think it has been incredibly helpful coming here,” he says.

While the GMC is frustrated by the lack of movement towards the legislative change needed for the organisation to be able to make big differences to the way it works, some changes are expected this year. It has recently launched a consultation on a national medical licensing assessment for all doctors who wish to practise in the UK.

“The medical licensing assessment is really important for us because we don’t, at the moment, have any clear way we can assess the consistency of standards that people achieve graduating from UK medical schools,” Massey says.

Brexit opportunities

Since the medical licensing assessment was first proposed in 2005, the GMC has been keen for it to apply to all doctors who come to work in the UK, including those from the European Union. However, current rules on freedom of movement across the European Economic Area make this difficult.3

“We think there is an opportunity afforded by Brexit to apply the medical licensing assessment to European doctors who want to practise in the UK too,” Massey says. “We’re not singling out European doctors as being particularly problematic, but what we want is to have an MLA [medical licensing assessment] that would apply to all doctors, whether they come from the European Union, outside the EU, or UK medical schools.”

With the introduction of the assessment the question of whether the point of full registration with the GMC should be moved from the end of the first year of foundation training to the point of graduation may again rear its head.

Massey says that the GMC has always been agnostic on this question but that once the assessment is introduced it would be easier for the point of registration to be moved. However, he also says that such a move would be unlikely with the government’s focus now shifted firmly on Brexit.

“From a wider perspective,” Massey adds, “the fact that you have got the point of registration half way through the foundation programme creates some oddities in terms of how you select people to the foundation programme when they only have a provisional registration. So there is something about a cleaner break if it were aligned with graduation from medical schools.”