Showing papers by "General Medical Council published in 2001"

The assessment of poorly performing doctors: the development of the assessment programmes for the General Medical Council's Performance Procedures.

Abstract: Background Modernization of medical regulation has included the introduction of the Professional Performance Procedures by the UK General Medical Council in 1995. The Council now has the power to assess any registered practitioner whose performance may be seriously deficient, thus calling registration (licensure) into question. Problems arising from ill health or conduct are dealt with under separate programmes. Methods This paper describes the development of the assessment programmes within the overall policy framework determined by the Council. Peer review of performance in the workplace (Phase 1) is followed by tests of competence (Phase 2) to reflect the relationship between clinical competence and performance. The theoretical and research basis for the approach are presented, and the relationship between the qualitative methods in Phase 1 and the quantitative methods in Phase 2 explored. Conclusions The approach is feasible, has been implemented and has stood legal challenge. The assessors judge and report all the evidence they collect and may not select from it. All their judgements are included and the voice of the lay assessor is preserved. Taken together, the output from both phases forms an important basis for remediation and training should it be required.

The General Medical Council's Performance Procedures: peer review of performance in the workplace.

Abstract: The General Medical Council procedures to assess the performance of doctors who may be seriously deficient include peer review of the doctor's practice at the workplace and tests of competence and skills. Peer reviews are conducted by three trained assessors, two from the same speciality as the doctor being assessed, with one lay assessor. The doctor completes a portfolio to describe his/her training, experience, the circumstances of practice and self rate his/her competence and familiarity in dealing with the common problems of his/her own discipline. The assessment includes a review of the doctor's medical records; discussion of cases selected from these records; observation of consultations for clinicians, or of relevant activities in non-clinicians; a tour of the doctor's workplace; interviews with at least 12 third parties (five nominated by the doctor); and structured interviews with the doctor. The content and structure of the peer review are designed to assess the doctor against the standards defined in Good Medical Practice, as applied to the doctor's speciality. The assessment methods are based on validated instruments and gather 700-1000 judgements on each doctor. Early experience of the peer review visits has confirmed their feasibility and effectiveness.

The General Medical Council's Performance Procedures: the development and implementation of tests of competence with examples from general practice.

Abstract: Objective This paper describes the development of the tests of competence used as part of the General Medical Council’s assessment of potentially seriously deficient doctors. It is illustrated by reference to tests of knowledge and clinical and practical skills created for general practice. Subjects and tests A notional sample of 30 volunteers in ‘good standing’ in the specialty (reference group), 27 practitioners referred to the procedures and four practitioners not referred but who were the focus of concern over their performance. Tests were constructed using available guidelines and a specially convened working group in the specialty. Methods Standards were set using Angoff, modified contrasting group and global judgement methods, as appropriate. Results Tests performed highly reliably, showed evidence of construct validity, intercorrelated at appropriate levels and, at the standards employed, demonstrated good separation of reference and referred groups. Likelihood ratios for above and below standard performance based on competence were large for each test. Seven of 27 doctors referred were shown not to be deficient in both phases of the performance assessment.

The Changing Relationship between the Public and the Medical Profession

Abstract: I started medical school in 1953, almost 50 years ago. The new National Health Service (NHS) was just getting underway, and its founding principle—all citizens should enjoy good medical and health care free at the time of need and irrespective of their ability to pay—had caught the public imagination and the professional idealism of many doctors. Now, 50 years on, we have a crisis in the NHS and we need to understand why. There are two main issues. There are deep-seated flaws in the culture and regulation of the medical profession and serious deficiencies in the management and capacity of the NHS1,2. The cultural flaws in the medical profession show up, in individual cases, as excessive paternalism, lack of respect for patients and their right to make decisions about their care, and secrecy and complacency about poor practice. These all contribute to a picture which leads the public to believe that many doctors put their own interests before those of their patients3. The deficiencies in the management and capacity of the NHS have their outward visible signs in the lack of institutional attention to quality and safety—in unacceptable waiting times for treatment, medical and non-medical care of indifferent or poor quality, dirty hospitals, inflexible systems, defensive complaints procedures and so on. There is a serious shortage of doctors. No wonder there is general anxiety about whether the NHS can deliver a service of acceptable quality. These concerns are shared fully by doctors. I cannot remember a time when so many doctors have felt so angry, undervalued and disillusioned. Public and government criticism of the profession, together with fears of litigation, have added to the demoralizing effect of the treadmill4 — the relentlessly rising volume of service demands that leaves no proper time for establishing effective relationships with patients or for reflective practice review, both of which are fundamental to good quality. The General Medical Council (GMC) has been rightly criticized for failings that are of its own making, and has acted as a lightning conductor for more general criticisms of doctors' attitudes. Less justifiably, it has been used as a proxy for some of the underlying institutional failings in the NHS. The `blame game' is unhelpful, as is the present tendency to seek simple solutions to complex problems. A recent example was the Government's inappropriate linkage of the new National Clinical Assessment Authority with the detection of murder—the Shipman case. So we have wholesale change again, as the Government, managers and the health professions get to grips with the situation. Such is the plethora of new proposals that many doctors and the public have difficulty making sense of it all. Here I deal with two issues that are fundamental to the way forward. These are: The need to implement the culture and practice of continuous quality improvement and quality assurance across our healthcare system The professionalism of doctors—their attitudes and regulation, and how these must change to meet the public's expectations today. Things do not happen in isolation, so let me begin with the background.

Professionally led regulation in medicine

Abstract: The power of any profession to regulate itself is a privilege given by the state through parliament and not a right.1 If society loses its confidence in the ability of the profession to exercise that right responsibly the possibility of alternative methods of regulation naturally arises. Recent high profile cases of serious professional misconduct or seriously deficient performance by doctors in the UK in recent months have dented that confidence somewhat, and sensationalised reporting in the media has done nothing to help the situation.2 It is encouraging, however, that in a recent public opinion poll conducted by MORI on behalf of the BMA, 87% of those polled said they would generally trust doctors to tell the truth. Only 7% of members of the public responding were dissatisfied with the way doctors do their jobs.3 A number of advantages accrue from a regulatory system that is controlled by the medical profession. Most people are reassured to know that doctors not only have contractual obligations to any employer but also professional obligations to live up to the standards of conduct, performance, and behaviour set by their peers, as these are invariably more demanding than any contractual ones. For self employed doctors, professional accountability is perhaps even more important. Doctors are also likely to have more confidence in a regulatory body for which they feel a degree of ownership than in external regulation; the teaching profession provides an example of the effect of externally imposed regulation on morale. Doctors are in a good position to define the standards that they expect of themselves and their colleagues, and these standards have been clearly expressed by the General Medical Council (GMC) in its document Good Medical Practice .4 There is, however, widespread recognition by the profession that strong non-medical input is …

Training the assessors for the General Medical Council's Performance Procedures.

Abstract: From July 1997, the General Medical Council (GMC) has had the power to investigate doctors whose performance is considered to be seriously deficient. Assessment procedures have been developed for all medical specialties to include peer review of performance in practice and tests of competence. Peer review is conducted by teams of at least two medical assessors and one lay assessor. A comprehensive training programme for assessors has been developed that simulates the context of a typical practice-based assessment and has been tailored for 12 medical specialties. The training includes the principles of assessment, familiarization with the assessment instruments and supervised practice in assessment methods used during the peer review visit. High fidelity is achieved through the use of actors who simulate third party interviewees and trained doctors who role play the assessee. A subgroup of assessors, selected to lead the assessment teams, undergo training in handling group dynamics, report writing and in defending the assessment report against legal challenge. Debriefing of assessors following real assessments has been strongly positive with regard to their preparedness and confidence in undertaking the assessment.