DOCTORS MUST EMBRACE REGULATION CHANGES, UK

Discussion in 'Fibromyalgia Main Forum' started by tansy, Jul 23, 2006.

  1. tansy

    tansy New Member

    DOCTORS MUST EMBRACE REGULATION CHANGES
    (Editorial: Regulation and revalidation of doctors)
    http://bmj.com/cgi/content/full/333/7560/161

    Doctors should accept the main proposals to change regulation of the medical
    profession as the best way of restoring public confidence, according to an
    editorial in this week's BMJ by a leading member of the GMC.

    Professor Mike Pringle, a GMC member and professor of general practice, writes
    about his strong belief that the recommendations of the Department of Health to
    update medical regulation are taking the right approach.

    The chief medical officer's review of medical regulation published last week
    proposed that doctors face MoT style revalidation checks every five years and
    that the GMC should no longer have the role of judging whether a doctor is fit
    to practise in cases of serious complaints - a role that will be passed to an
    independent tribunal panel.

    Professor Pringle agrees, writing: 'A profound loss of public, and to a lesser
    extent professional, confidence has cast a dark shadow over medical regulation
    and the GMC for the past few years."

    The separation of the GMC's responsibility to adjudicate in serious cases is
    overdue and will reassure the public, he adds, as it moves towards a system of
    "partnership regulation" rather than professionally-led regulation.

    "It would be a political disaster if the medical profession were to reject the
    main thrust of these recommendations which offer a coherent way forward for
    public confidence in medical regulation and the GMC," writes Professor Pringle.

    "Public and patients' confidence in the system should be greatly enhanced, and
    doctors will need to accept the rebalancing of interests that this entails."

    Contact:

    Mike Pringle, Professor of General Practice, Division of Primary Care, School of
    Community Health Sciences, University of Nottingham

    [This Message was Edited on 07/23/2006]
  2. findmind

    findmind New Member

    Tansy, is there a hidden agenda here? Who would be doing the regulating?

    Would this be a body that has actual disciplinary action?

    With the UKs public health service, this might be good; in the US, each state has this power, right?

    Of course, drs. regulating drs. seems to be a conflict of interest waiting to happen, but how could laymen do a better job?

    Lots of questions about intent here...

    findmind
  3. KelB

    KelB New Member

    Regular recertification for doctors is a great idea.

    I have a friend who is a commercial long-haul pilot and I think they have to revalidate their licence every two years. The tests seem to be a re-run of their initial commercial qualifications and are very tough. If I remember correctly, the day they fail the tests, they lose their commercial licence for good - no appeals, no arguments.

    It makes sense that doctors have to undergo the same sort of thing. It's madness that airline pilots currently have such rigorous revalidation, when doctors have none unless they're found guilty of some failing by their own professional body. Far more lives depend on doctors getting it right.
  4. tansy

    tansy New Member

    These are Rapid Responses on the British Medical Journal's web site

    Professor Sir Graeme Catto,
    President of the General Medical Council
    General Medical Council, NW1 3JN,

    **The report from the Chief Medical Officer for England has implications for all UK doctors and needs to be considered very carefully. Its aim is a system of medical regulation that puts patient safety first through the early detection, and where possible, remediation, of poor performance. If the report contributes to that aim, and commands public and professional support, it should be welcomed by everyone involved in healthcare.

    The Merrison report was the collective effort of Sir William Merrison and the other 14 members of his Committee of Inquiry, who took both oral and written evidence. A different process has been followed in this case. The Government, sensibly, has therefore decided on a period of consultation during which the recommendations can be properly debated, tested and costed. We have already said that we believe that the recommendations to divorce oversight of medical education from the other regulatory functions of standards, registration and fitness to practise are not in patients' best interests. We will now be consulting widely with our partners before we submit our considered response.

    It may be another 30 years before there is another opportunity such as this. We must seize it so that that future generations of patients can say that we did not fail them.

    Competing interests: President of the GMC**

    Brian D Keighley,
    General Practitioner
    Balfron, Stirlingshire, G63 0TS

    **Editor,
    Professor Pringle’s editorial (22 July) reinforces the GMC's corporate view that its prime function is, and always will be, the protection of the public by promoting the highest standard of medical care in the UK, something that is best delivered in partnership with others. A recent tracking survey demonstrating the support of 75% of the public for the GMC as the medical regulator is testament to that.

    Pringle welcomes the bipartite approach to revalidation, especially that element applying to career-grade doctors. This, however, is to adopt only one view of the intention of revalidation, to be as near an absolute guarantee of competence as can be devised. The alternative view is that such a process would be better managed in an incremental fashion with the first step to define the meaning of registration or the holding of a licence with the guarantee of competence developing as a by-product. No matter which system prevails – 50% of all doctors will remain below average.

    Interestingly, however, he describes the 2003 proposals for revalidation as being entirely those of the GMC, perhaps forgetting Sir Liam Donaldson’s own letter to Dame Janet Smith of 10 November 2004 (1) which led her to believe that they were in the joint ownership of the GMC and the Department of Health. Pringle fails to track Sir Liam’s shift of opinion.

    Pringle rightly challenges Donaldson’s lack of cogent reasoning to move the overview of undergraduate medical education to a PMETB often perceived as struggling to deliver its existing core responsibility and points to the contentious issue of the standard of proof within fitness to practise cases.

    The GMC will use this report as a catalyst to produce a better future despite Professor Pringle’s premature belief that it would be a political disaster for the medical profession to reject Donaldson’s proposals. He appears, however, to forget that the views of one, senior doctor are merely the basis for a four month period of consultation that will involve the public as much, if not more, than the Government and the medical profession. To say the direction is set is perhaps a perilous conclusion one week into that four months.

    Sincerely
    Brian D Keighley
    (1) Smith J. The Shpman Inquiry: fifth report;safeguarding patients: lessons from the past - proposals for the future. Page 1082. Chairman: Dame Janet Smith. Cmnd 6394. the Stationery Office, London, 2004

    Competing interests: Elected Medical Member of GMC for Scotland. involved in various revalidation working groups, GMC, GPC and RCGP**

    Adam J Pringle,
    General Medical Practitioner
    Lawley Medical Practice TF4 2LL

    **"The intellectual case for two levels of revalidation is compelling" as Mike Pringle states, may well be true. However, as Sir Liam states clearly in his report "There is little disagreement with the assertion that in 2006 every patient is entitled to a good doctor. Yet, there is no universally agreed and widely understood definition of what a good doctor is. Nor are there standards in order to operationalise such a definition and allow it to be measured in a valid and reliable way"

    An intellectual case alone, in the absence of any tried, tested and validated tools that actually measure the quality of medical practice, is not sufficient to make anything more than an expensive disaster. The rest of us stopped believing that just because we wanted something to happen we could make it happen in early childhood. If 1% of us are removed in error each year - a small error rate in such an ill-defined system, then 40% of doctors will suffer incorrectly at the hands of this system in our working lives.

    These eminent doctors are suggesting we reform our system of validation, and set it against a set of national standards that have yet to be written, aiming to measure something which cannot be measured.

    In a world where NICE cannot reach the same answers as the BHS, this can only be a recipe for disaster. Anybody pretending to intellectual validity and scientific rigour would test and validate their tools first, and design their system later. The evidence that the fashionable assessment tools of the day (360 degree feedback, and appraisal) are useful in identifying failing doctors is sorely lacking - indeed we have been clearly told that appraisal is not for that purpose, but is a formative process for personal development.

    Professor Pringle believes that all General Practitioners should be Memebers of the Royal College of General Practitioners - and intends to use these reforms to force this upon us. Yet there is no evidence that GPs who are not College members are bad GPs, so why should they be forced to do this - we do not yet live in a totalitarian state. I accept that he has declared his conflict of interest. (I am a member, so have no conflict to declare here).

    The plan proposed is for a single doctor in each area to be the GMCs local affiliate - which given the suicide rate amongst doctors is a level of power akin to life or death, and is the ideal post for the next aspiring Dr Shipman. Who would dare report their suspicions of someone who can despatch them to the gulag?

    We are to replace the GMC fitness to practice panels (a mix of doctors, lawyers, and lay members) with independent panels with an identical composition - do the Professors really have so little faith in the probity of their colleagues that they see membership of the GMC as a conflict of interest?

    I agree that the changes in appraisal are negative, and that the Postgraduate Medical Education and Training Board should not have more responsibility - it is at present failing to deliver its current responsibilities effectively, with qualified GPs waiting months for the certificates that allow them to work independently.
    He fails to recognise the consequences of a shift from 'beyond reasonable doubt' to 'balance of probabilities' - a shift that places careers in jeopardy, and lives at risk. This is unreasonable, given that we also face Criminal, Civil and Coroner's courts, together with Local, PCT, GMC and CHRE complaints hearings.
    It may be a political disaster to reject these reforms without proposing a better alternative - but it would be a greater disaster to burden us with this untried bureaucratic monolith.

    If I declare that of the first 1,788 doctors to read my criticisms of the CMOs report on doctors.net, 789 agreed strongly, and the rest, bar one, didn't comment, will Professors Pringle and Donaldson accept that it has been rejected by the profession, beyond reasonable doubt? Or, failing that, at least on the balance of probabilities?

    Competing interests: None declared**

    Adrian K Midgley,
    GP
    Exeter EX1 2QS

    ** Mike Pringle's opening could lead one to think that there has been a loss of confidence in doctors, if it is not carefully parsed or read with knowledge of the situation. Not so. He points out that GP membership of th RCGP is around half of the craft, some having felt obliged to pay for an exam but not wished to continue as members, some never having needed or perhaps wished to join.
    He neglects to draw the conclusion there, that as well as an increased willingness to disclose a lack of trust in the GMC - since its membership was diluted with quangoists lacking medical degrees, the RCGP as a body and its current heads also enjoy less conifdence of the GPs they would now like to regulate than they might hope.

    This looks more like a power grab than anything carrying professional respect and agreement.

    Meanwhile, the public continue to trust the doctors they have experience of considerably more than the bodies that wish to regulate them, and in the case of those political ones wishing to control the whole affair, with good instinct.

    Competing interests: None declared**

    ben dean,
    sho
    oxford

    **Like many initiatives launched with apparently good intentions by politicians and their kind, the CMO's report flatters to deceive in the eyes of many.

    There are many ways to criticise the report, despite its concise length of 200 pages plus. Dr Adam Pringle (1) has already critiqued the report very eloquently on doctors.net and seems to have a large amount of support from those in the profession.

    I would like to pose some questions to those who think the report is a good and practical base from which to work.
    The chain of events that has led to this overhaul of the medical profession seems to have been a certain Dr Shipman. A cynic would argue that the CMO's report does nothing to make a second Shipman less likely and instead uses the smokescreen of Shipman to drive through a series of politically motivated hammer blows to the dying freedom and independence of the medical profession. A cynic would also argue that the system was in place to detect a Shipman, it was only gross incompetence of a few individuals that let the system down. One has to accept that no system is perfect and certain individuals will always make costly mistakes, no matter how the system is changed. I feel by trying to improve a reasonable system, the CMO is likely to create an expensive shambolic bureaucratic nightmare.
    Doctors already face numerous tests of their fitness to practice on a daily basis with every patient they see, is revalidation going to improve patient care or make it worse?

    Who pays for the revalidation and what happens to the GMC subscription that doctors currently pay?

    What happens when a doctor fails revalidation, who finds out, can they continue to practice, who retrains them, who pays for the retraining and how are they re-assessed? (You see how this shambolic nightmare starts to appear)
    What happens as regards revalidation for doctors doing research, for doctors in politics (Sir Liam for example) and doctors in other areas of work?

    Why are no other professions required to undergo revalidation?

    Why are some professions such as politicians allowed large amounts of responsibility, with no education in their area of decision making, and minimal accountability for their decisions? (An example of this accountability is Patricia Hewitt's delegation of dealing with public petitions, as regards her decisions to cut services, to PCTs)
    Why reduce the burden of proof to a balance of probabilities? A doctor’s career will depend on this. There are so many other ways doctors can be held accountable: Criminal, Civil and Coroner's courts, together with Local, PCT, GMC and CHRE complaints hearings.

    Given Sir Liam's many references to the airline industry (2) and comparisons between this industry and our own- why can one industry be highlighted in such a biased fashion? Why not compare doctors to politicians, and then by the same faultless logic one could conclude that doctors require no formal training, no prior knowledge of medicine, minimal accountability and certainly no revalidation. One could also conclude that there would be no need for fitness to practice hearings at all, doctors could just ignore examples of their own negligence while lying through their teeth and ignoring the tricky questions. I digress, but seriously I feel encouraging an open and honest culture from above is the best way of dealing with errors, this seems to be a long way from the totalitarian centrally controlled system ruled by fear of present. Why not deal with this culture of intimidation and fear?

    The CMO's report, if allowed to come into effect, will be the death of a self-regulating medical profession putting yet more power in the hands of those currently in control. Like so much recent legislation such as the Criminal Justice Bill, recent Anti-Terrorism Bills, and the pending Legislative and Regulatory Reform Bill (3) - it is merely another measure that increases the power of an increasingly authoritarian regime.

    I hope the medical profession unites against it.

    Yours,
    Dr B Dean
    1. http://bmj.bmjjournals.com/cgi/eletters/333/7560/161 2. http://news.bbc.co.uk/1/hi/health/5201684.stm 3. http://www.timesonline.co.uk/article/0,,1072-2049791,00.html
    Competing interests: a dislike of politicians**