аЯрЁБс>ўџ /1ўџџџ.џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС[@ №ПAbjbj44 .&ViViAџџџџџџˆОООООООв2 вžјJJJJJJJJ$–RшvCОгJJггCООJJXWWWг ОJОJWгWWi:% ,ОО­ J> `63ЕжцЦн.Q n0ž[ R^ B^­ ввОООО­ ^ОС \J0z"WœИJJJCCввDM ввGood doctors, safer patients: Proposals to strengthen the system to assure and improve the performance of doctors and protect the safety of patients. A report by the Chief Medical Officer published in July with a deadline for comments of 10th November. This is a 200 page report that makes 44 recommendations. I have reduced it to a five page summary and urge members to read it or the original document and to make your views known. Main points include root and branch reform of the GMC, many of which will be welcomed. The devolution of power to local GMC affiliates who will be experienced, respected and specially trained and audited local practitioners engaged by each employing or contracting organisation, including locum agencies via the Healthcare Commission. GMC affiliates will be the first contact for complainants and will assess concerns and decide on what, if any action, to take. They will have the power to order “recorded concerns” to be placed on record and, if necessary, appropriate periods of supervised practice or suspension whilst remedial action is devised. If the doctor does not agree, or does not satisfy the GMC affiliate, or if the case is judged too serious, it will be passed to the central GMC The GMC to assess and investigate cases and to formulate remedial action but a new tribunal to judge the most serious cases. It will no longer be the recipient, assessor, prosecutor, judge, jury and executioner of complaints. The central GMC will also be able to order periods of supervision, suspension and remedial action. The most serious cases will be decided by a tribunal with medical, legal and lay members. The burden of proof in these most serious cases will change from the present criminal “beyond all reasonable doubt” to the civil “on the balance of probabilities.” This is because medical regulation is a “protective legislature” and should be active rather than reactive, not waiting for disaster to strike. A lay majority on the GMC to hold executive to account. All members to be appointed by the Public Appointments Commission. The GMC will also lose its role in setting the medical undergraduate syllabus but all students will be registered with the GMC and all medical schools will have a GMC affiliate. On revalidation the current GMC proposals have been superseded on the intervention of Dame Janet Smith, chairman of the Shipman Inquiry who described the system based on current appraisal as, “an expensive rubber stamping exercise that would mislead the public.” Instead, the CMO proposes a two stage process of regular re-licensure and recertification. Not less than 5 yearly re-licensure based on such measures as 360 degree appraisal and GMC affiliate assessment. The GMC affiliate and the CEO of the contracting or employing organisation will then issue an affirmative statement, not simply record an absence of concerns. Regular recertification to enable continuation on the specialist register – a process that will be explicitly one of judgement of individual practice against standards laid down by the relevant Royal College, the RCGP. These standards will also be incorporated into all contracts which will make clear our individual accountability to our PCTs. There are also proposals to change the way complaints can be made and practices will have to advertise these widely. There should be a system whereby, if a patient registers with a new GP without changing address, the PCT should offer a confidential interview at a place of the patient’s choice in order to capture “a potentially vital source of information on patient experience…” PCTs will have unfettered access to all medical records. For all the talk of encouraging a culture without blame where mistakes and short comings can be cheerfully admitted and learned from, where assessment is not synonymous with the threat of passing or failing, but with an opportunity for improvement there is an undoubted authoritarian tone in this document. Many will be concerned by Sir Liam’s conclusion, “that lighter-touch regulation of doctors - whether on grounds of cost,… ideology or professional acceptability - would mean the …acceptance of risks to patients being tolerated...” This document requires a considered but uncompromising reply from the medical profession and provides what might be the last opportunity to define and defend the best of what remains of independent professionalism in tomorrow’s NHS. So please let us have your opinions, for better or worse, as this is too important to leave to somebody else. I believe that that this report has the potential to change our practice as much as practice based commissioning will. 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