Executive Board meeting, 5 June 2017 - Home - GMC · Goodall - Welsh Government, Andrew Grant - Swansea University and Clare Jenkins ... Suggestions would be considered for future

Executive Board meeting, 5 June 2017

Agenda item: 11

Report title: External engagement update

Report by: Dale Langford, Governance Manager [email protected], 0161 240 8346

Action: To note

Executive summary This paper reports on recent meetings of advisory bodies and provides the formal mechanism for reporting the outcome of meetings to the executive. Meetings of the UK Advisory Forums took place in March 2017 in Wales, Scotland and Northern Ireland. The minutes set out details of the areas of interest or concern raised by UK Advisory Forum members and issues discussed in the meeting, including an update on the introduction of a Medical Licensing Assessment. The Revalidation Advisory Board held its final meeting on 7 March 2017. The meeting received progress reports from the GMC and other stakeholders and discussed future plans for implementation of the recommendations in Sir Keith Pearson’s report, Taking Revalidation Forward.

Recommendation The Strategy and Policy Board is asked to note the external engagement update on the UK Advisory Forums and Revalidation Advisory Board.

mailto:[email protected]

Executive Board meeting, 5 June 2017 Agenda item 11 – External engagement update

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Summary

1 A number of advisory bodies report formally to the Chief Executive via reports to the Executive Board. This paper reports on meetings of advisory bodies that have recently taken place, UK Advisory Forums and the Revalidation Advisory Board on this occasion.

UK Advisory Forums

2 The purpose of the UK Advisory Forums for Scotland, Wales and Northern Ireland is to provide advice to the GMC so that its activities and policies are of equal use and effectiveness across the UK. The forums provide the GMC with a platform to share its thinking on priorities and key challenges with key interest groups and delivery partners; and an opportunity to discuss with interest groups and partners any issues that they wish to raise in the context of the GMC’s work in their area. The Advisory Forums meet twice a year.

3 The minutes of the UK Advisory Forums that took place in March 2017 in Wales, Scotland and Northern Ireland are attached at Annexes A, B and C.

Revalidation Advisory Board

4 The final meeting of the Revalidation Advisory Board took place on 7 March 2017. At its meeting on 26 April 2017, the Council agreed to decommission the Revalidation Advisory Board. Future oversight of the implementation of the Taking Revalidation Forward recommendations will be undertaken by the Revalidation Oversight Group, established by the Strategy and Policy Board at its meeting on 22 March 2017.

5 The minutes of the Revalidation Advisory Board meeting on 7 March 2017 are attached at Annex D.

UK Advisory Forums - Wales

Summary note of the meeting on 14 March 2017

Attendees

Terence Stephenson, Chair Philip Banfield, British Medical Association Shane Carmichael, GMC Assistant Director – Strategy and Communication Kate Chamberlain, Healthcare Inspectorate Wales Peter Donnelly, Wales Deanery Chris Jones, Welsh Government Paul Jones, Swansea University Charlie Massey, GMC – Chief Executive Katie Laugharne, GMC – Head of Welsh Affairs Paul Myres, Academy of Medical Royal Colleges Wales Anthony Omo, GMC Director – Fitness to Practise Stephen Riley, Cardiff University Bethan Roberts, British Medical Association Geoff Ryall-Harvey, Board of Community Health Councils in Wales Vanessa Young, Welsh NHS Confederation

Others present

Ian Collings, Wales Deanery Oliver John, Academy of Medical Royal Colleges Wales Lucy Kiely, GMC – Governance Manager Sarah Sullivan, GMC – Welsh Office Administrator

3 - Annex A


Executive Board meeting, 5 June 2017 Agenda item 11 – External engagement Update

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Welcome and Chair’s Introduction

1 The Chair welcomed attendees to the eighth meeting of the UK Advisory Forum in Wales.

2 Apologies for absence were received from Ilora Finlay - House of Lords, Andrew Goodall - Welsh Government, Andrew Grant - Swansea University and Clare Jenkins and Alyson Thomas from The Board of Community Health Councils in Wales.

3 Forum members noted that Mr Steve Burnett, who took up office as GMC Council member representing Wales on 1 January 2017, was unable to attend and extended his apologies.

4 Professor Peter Donnelly was congratulated on his appointment as Interim Post Graduate Dean at Cardiff Medical School and welcomed to his first meeting as a Forum member.

Actions and feedback from October 2016 meeting

5 At the meeting on 5 October 2016, it was agreed that members would be updated on the circumstances of, and to what extent supporting information for trainees or for revalidation/appraisal would be released.

6 The Forum was informed that the Royal Colleges are the data controller for trainee portfolios and the Wales Deanery is the data controller for the Welsh appraisal system (MARS).

7 If a request for disclosure of portfolio material is received the portfolio owners/providers should take legal advice, prior to deciding whether to disclose. The GMC does not hold the information.

8 Forum members were thanked for feedback relating to the UK Advisory Forums meeting format. Suggestions would be considered for future meetings.

Updates on local priorities/areas of interest or concern from Forum members

9 Forum attendees were invited to provide updates on their priorities. During discussion, the Forum noted:

a That the Wales Deanery Education Contract is on track for rolling out to all specialities in August 2017, and the Education Contract Attendance System (ECAS) for doctors in training is working well.

b That the Healthcare Inspectorate Wales (HIW) Risk summit meetings are scheduled for 23 May 2017 and 17 October 2017, and that HIW appreciated input from the GMC at the 2016 summit meetings.


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c The Welsh Government’s work is ongoing to review the structures of health and social care in Wales (the Parliamentary Review) and to establish Health Education Wales. The Health and Wellbeing of Future Generations Act is being translated into specific strategies and further engagement around Prudent Healthcare is planned.

d That Cardiff and Swansea Universities are working collaboratively working to contribute to the retention of workforce and rural placements.

e That the Swansea University Physician Associates programme is working well with an increase in funded places, although the number of positions in health boards has not yet increased.

f The Academy of Medical Royal Colleges in Wales is exploring how to improve the primary / secondary care interface and potential concerns about the treatment of transgender patients in Wales, and continues to work on the ‘Choosing Wisely’ campaign.

g Difficulties highlighted by the Board of Community Health Care in Wales, in recruitment and the impact on waiting times for conditions such as pain management or joint replacements. The Forum was informed about the feedback drive called ‘Dementia: one simple thing’ designed to ask how the NHS can better support people with dementia and their families.

h That the Welsh NHS Confederation would contribute to the Parliamentary Review and support engagement activities around Prudent Healthcare. There are also opportunities for Chairs and Chief executives to share experiences and best practice to drive improvements in areas such as finance and performance.

i That the British Medical Association (BMA) Cymru Wales had concern regarding the Physician Associates role from students (regarding placements) and patients (confusion regarding the role). Also, the medical engagement survey and NHS staff survey showed systemic bullying within the NHS linked to SAS doctors and work. Welsh NHS work is currently being undertaken to try to embed core values and change the culture.

j That the GMC letter, in support of exception reporting in England, was welcomed by the Welsh Junior Doctors Committee who would value support to ensure that rota monitoring processes in Wales are effective. The Committee is working with the Wales Deanery and Welsh Government to secure whistleblowing protection for trainees.


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GMC update

The Forum received updates on key areas of our work as noted in the GMC Update report. These included:

Doctors in training

10 Forum members noted the need to ensure that doctors in training have time to train and that trainers also have time to provide training.

Flexible Training Review

11 It was noted that the GMC would report its findings of the flexible training review to all four governments by 31 March 2017. Recommendations include those relating to curriculum design; legislative context; a link to Generic Professional Capabilities; and Health Education England’s work around less than full time teaching and work/ life balance.

Pressure on the front line

12 This gives important context to what we do. There are four themes for us:

‘Call it’: when alerted to problems emerging from data, as incorporated in the State of Medical Education and Practice and National Training Survey reports.

Proportionality: reduce the burden where possible, for instance the recommendations within Taking Revalidation Forward and our response to those.

Accessibility: produce accessible guidance and tools for doctors to use on a day-to-day basis, such as the My GMP app. Create decision charts for when difficult decisions need to be made within a short time space.

Interpret data: consider how we use our data and intelligence in a smarter way to understand when problems may emerge and get ahead of the curve.

Taking revalidation forward

13 During 2017 we will look at how revalidation can be made more accessible to patients and the public. This is a priority in our response to Taking Revalidation Forward.


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Brexit

14 The Forum was informed that under the Recognition of Professional Qualifications Directive we are unable to test the competencies of doctors that come to the UK from European countries.

15 A survey was carried out of European doctors on the medical register and 60% of those who responded said they would consider leaving the UK, with 90% of this cohort stating that it was as a result of Brexit. It was noted that this would have considerable implications for recruitment in Wales, including shortages in some areas.

Regulatory reform

16 The Forum was informed that the Department of Health England will ‘imminently’ publish a consultation to look at regulatory reform; this will be signed off by all four UK governments.

17 A key issue for the GMC would be to what extent there could be greater autonomy in handling complaints and investigations. Should regulatory reform not progress, as anticipated, there could still be an opportunity to influence improvement. Preference would be to shift the balance to enable the GMC to invest more resources into Education, Training and Guidance rather than Fitness to Practice.

18 The Forum noted Welsh Government’s support of regulatory reform.

External agenda item – Welsh NHS Confederation: NHS Leadership Challenges

19 The Forum received a presentation from Vanessa Young on behalf of the Welsh NHS Confederation.

20 During extensive discussion the Forum considered a range of issues including whether there is a correlation between sickness absence and age profile. It was noted that the Welsh NHS Confederation had carried out extensive work with NHS leadership teams, the BMA and Workforce Directors on core principles, which had led to improved engagement.

21 The Forum agreed that in Wales there is a real opportunity to look at quality improvement and sustainability and to contribute to wider work around engagement and culture change.

Securing the licence to practise: Introducing a Medical Licensing Assessment

22 The Forum received a presentation from Katie Laugharne, GMC Head of Welsh Affairs on the Medical Licensing Assessment (MLA) consultation.

23 The Forum subsequently discussed a range of issues including the timing of the MLA, whether it should be integrated with Final exams and the extent to which core


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content would be required. Questions were raised in relation to what would happen if students pass one exam and fail the other and whether the MLA would actually improve patient safety, or whether the focus is more on fairness of opportunity for medical students. The Forum agreed that the GMC would need to ensure that the MLA is a valid and reliable test.

24 The Forum noted that it is not currently intended to use the MLA results as a ranking tool and that the GMC would need to consider what information it would be obliged to share under the Freedom of Information Act.

25 The Forum was reminded that the point of registration question is one for the UK governments, but that the MLA would need to be co-produced with governments to ensure that we are producing the doctors needed for the future.

26 The Forum noted work carried out on predicting future behaviour of doctors based on their behaviour at medical school - the Conscientiousness index.

27 Both Cardiff and Swansea Universities informed the Forum that they would respond to the MLA consultation and were interested to see how it would work in practice.

Any other business

28 The Forum noted that there is currently no devolved country representation on the MLA Expert Reference Group, since Derek Gallen’s retirement in December 2016. The GMC agreed this would be addressed.

UK Advisory Forums - Scotland

Summary note of the meeting on 21 March 2017

Attendees

Terence Stephenson, (Chair)

Charlie Massey, GMC Chief Executive

Peter Bennie, BMA Scotland

Jason Birch, Scottish Government

Shane Carmichael, GMC Assistant Director, Strategy & Communications

Victoria Carson, GMC Head of Scottish Affairs

Susan Goldsmith, GMC Chief Operating Officer

Dr Mike Higgins, Scottish Association of Medical Directors

Lucy Kiely, GMC Governance Manager (Observer)

Chris Kenny, Medical and Dental Defence Union Scotland

Paul Knight, GMC Council Member

Dr Gordon McDavid, Medical Protection Society

Anthea Martin, Medical and Dental Defence Union Scotland

Colin Melville, GMC Director, Education & Standards

Rami Okasha, Care Inspectorate

Professor Rona Patey, Board for Academic Medicine

Willie Paxton, GMC Employer Liaison Adviser

Dr Gregor Smith, Scottish Government

John Stevenson, SPSO, Complaints Standards Authority

Claire Sweeney, Healthcare Improvement Scotland

Elaine Tait, Scottish Academy of Medical Royal Colleges

Rebecca Weerakoon, Scottish Academy Trainee Committee

Dan Wynn, GMC Scottish Affairs Officer (Observer)

Welcome

1 The Chair welcomed attendees to the March 2017 meeting of the UK Advisory Forum

in Scotland and welcomed new attendees to their first UKAF meeting. The Chair

acknowledged the continued support for the Forum and re-stated that the objective

of these meetings is to ensure attendees have an opportunity to discuss the work of

3 - Annex B



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the GMC in Scotland and to highlight matters of particular importance or concern to them.

Chair’s introduction

2 The Chair highlighted the following:

a The Chief Medical Officer’s Annual Report, Realising Realistic Medicine. The GMC has undertaken to support the realisation of realistic medicine in Scotland through the review of its consent guidance and will work with UKAF members to do that.

b The GMC’s National Review of medical education and training in Scotland in 2017. The GMC will work with partners in Scotland to quality assure education and training and support improvement where that is needed.

3 The GMC’s Deputy Chief Executive updated attendees on actions taken from the meeting on 13 October 2016, and the feedback received.

a GMC’s Chief Operating Officer thanked members for completing the feedback questionnaire sent to them in December 2016. Some suggestions have already been implemented including the opportunity to suggest agenda items and more input from attendees. Members felt that the Forum facilitates a holistic understanding of the priorities of the GMC and medical staff in general.

b Attendance: The Forum has found it helpful for Scottish Government workforce colleagues to be present at the meeting and we have agreed to ensure they are invited to future meetings.

c Physician Associates: A query was raised in relation to the regulation of physician or nurse associates who had moved from one profession to another, whilst maintaining a connection to their previous regulatory body. Subsequent to the meeting the GMC investigated this and are of the opinion that, in general, individuals should not be dually registered or regulated unless there are required statutory reasons.

d Review of General Practice: The GMC undertook to share an update with the Scottish Government. This has been done. The GMC aims to publish its report in the summer.

e Quality: The GMC noted that definitions of quality are set by national NHS systems and create a challenging divergence. The GMC undertook to consider this in its thinking around the new GMC Corporate Strategy 2018. It also undertook to work collaboratively with Healthcare Improvement Scotland (HIS) on its new Quality of Care Reviews. The GMC and HIS have met to take this forward.


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f Workforce: The Forum asked how the GMC would respond if, following the UK’s departure from the EU, the EU, or EU countries, put barriers in place to dissuade or prevent UK doctors from working in EU countries. This matter is out with the GMC’s remit as the regulator of doctors in the UK.

g Flexible Training Review: Members sought clarification on how this review is complimentary to that of Health Education England (HEE). The GMC’s review is focused on how to make it easier for trainees to change the direction of their training, such as transferring to a different speciality. The HEE review is more concerned with making training circumstances more flexible in England. The reviews overlap around less than full time training.

h Regulatory reform: Scottish Government reaffirmed its commitment to UK consensus around regulation. Scottish Government also raised the importance of proportionality in regulation which the GMC noted in the context of its draft Corporate Strategy 2018.

Updates on local priorities/areas of concern from Forum members

4 Forum attendees were invited to update on their priorities. During discussion, the Forum noted:

a That there is ongoing discussion around the definition and purpose of credentialing.

b That the Scottish Government welcomes support for the Chief Medical Officer’s annual report, Realising Realistic Medicine, and that the report raises questions around the reshaping and purpose of the medical profession, and consent.

c That the Scottish Government looks forward to conducting joint research with the GMC into communications failures.

d That there is a desire for defence unions to work with the GMC and the Scottish Government to support training in professionalism, communication and interaction with patients.

e That the Lord Chancellors decision to change the discount rate for personal injury claims may lead to an increase in the number of claims following medical injury, the amount of compensation paid, and a concern by some that there will be an increase in defensive medicine.

f That HIS is testing the quality of care reviews.

g That HIS are publicising the need for independent clinics to register by 1 April 2017. The joint GMC - HIS training to HIS inspectors on the GMC’s guidance on


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cosmetic practice was noted. The GMC offered to follow up with HIS regarding any support it might offer regarding the 1 April deadline.

h That the National Care Standards, agreed jointly between the Scottish Government and the Care Inspectorate are being implemented, that the Care Inspectorate is reviewing its approach to scrutiny, and working with HIS on strategic commissioning and joint inspection with a particular interest in leadership and management in social care partnerships.

i That colleges and trainees would welcome certainty of what training will look like and that this might assist with recruitment and retention.

j That there are discussions to be had about some recommendations in the Pearson report into revalidation, including on patient feedback. The perception of deferral of revalidation as being a judgement on a doctor was also raised.

k That the Scottish Public Services Ombudsman (SPSO) and GMC will be working together to increase the understanding of staff at each organisation of their respective roles.

l Concern that the increase in the number of medical student places in England may have an effect on the recruitment and retention of medical education staff in Scotland.

GMC update

5 The GMC Chief Executive updated the Forum on key areas of the GMC’s work, including the following.

Data and intelligence sharing

a The GMC has ambitions to triangulate its hard data (such as from the National Training Surveys) with soft data to anticipate and tackle problems earlier. The Scottish context allows the GMC to trial this approach and looks forward to working with partners in Scotland on this.

Flexible Training Review

b The review is relevant to all four UK countries and takes forward the principles of the Shape of Training Review. There are currently some constraints on trainees moving to different training programmes and having previous training recognised. These constraints are partly due to EU and UK law. The GMC intends to use its powers to approve postgraduate medical training curricula to drive flexibility. Part of this will involve requiring Generic Professional Capabilities (GPC) to be included in curricula. The GMC will launch its new curricula approval standards and GPC framework soon and will work with the Scottish Academy of Medical Royal


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Colleges. It will also work with the UK government to remove constraints created by EU law following the UK’s departure from the EU.

c The Forum discussed broader issues around the retention of trainees, including new questions on rotas in the NTS, and the extent to which flexibility of training is a factor in decisions by trainees to take time out from training or to work abroad. The Forum noted that some trainees may be using unusual training posts or working abroad to gain the experiences they want. The GMC undertook to share a presentation given by trainees in Northern Ireland on this issue with the Scottish Academy of Medical Royal Colleges.

d The Chair expressed a hope that use of the GMC’s data might help policy makers understand the factors driving trainee behaviour in this regard.

Credentialing

e The GMC outlined its vision for credentials as a means of recognising niche areas of expertise and invited partner organisations to develop credentials. The Forum noted the contribution that credentials might make to more flexible training and to recognise the experience and expertise trainees gain in unusual posts which might also assist in revalidation.

Professionalism

f The GMC highlighted statistics showing that 46% of doctors feel unable to ask for help and that four in five feel that they do not work in supportive environments. Scotland, with Realising Realistic Medicine, is leading the way on professionalism.

Pearson review of Revalidation

g Revalidation is embedding well. Appraisal rates in Scotland are very high at 95%. The Forum discussed patient feedback for revalidation and possible reluctance of some patients to feedback due to perceived potential consequences for their care. Individuals holding the dual roles of Responsible Officer and Medical Director are not generally considered to be a problem in Scotland. The next steps for revalidation include ensuring that all doctors have a connection to a Responsible Officer and considering whether the burden of revalidation can be lightened. This will include helping employers to understand what is and what is not required for revalidation.

h The GMC undertook to follow-up with HIS regarding their approach to a review of how revalidation is quality assured.


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Regulatory Reform

i There is likely to be a consultation on the future of professional healthcare regulation soon to which Members were encouraged to respond. The GMC hopes that the consultation will allow more work and investment to be focused ‘upstream’ in efforts to promote professionalism and prevent fitness to practise (FtP) problems, more local resolution of FtP problems and more discretion over what regulators investigate and how. The Forum noted the probable need for a Section 60 Order to be passed by the Scottish Parliament to enact reforms.

Regulation of Physician Associates

j A consultation on the regulation of Physician Associates (PAs) is anticipated. The GMC position is that PAs should be regulated and would consider regulating them if asked by all four governments.

Britain’s exit from the EU

k The Forum discussed the need for a balance between facilitating the mobility of doctors across Europe and ensuring patient safety. Currently doctors from other EEA countries wishing to work in the UK cannot be subjected to assessment by the GMC before being registered. The GMC proposes that, following the UK’s exit from the EU, EEA doctors wishing to register in the UK would need to pass the proposed Medical Licensing Assessment. Current EU legislation is framed such that medical qualifications are recognised on the basis of time in training. Following the UK’s exit from the EU, training might be made more flexible by becoming more competency-based.

l The Forum noted evidence that a high number of EEA doctors have indicated that they would consider leaving the UK due to its exiting the EU. The GMC has sought to reassure doctors from other EEA countries that it will not change their registration status as a result of the UK leaving the EU.

List of Registered Medical Practitioners

m The majority of responses to the GMC’s consultation on changes to information held on, and available through, the List of Registered Medical Practitioners (LRMP) did not support the proposals and as a result the GMC will not be taking the proposals forward at this time and has undertaken to do more exploratory work.

External agenda item – Complaints Standards Authority: The new NHS Scotland Model Complaints Handling Procedure and relevance to the medical profession and patients

6 The Forum received an update from John Stevenson, Head of the Complaints Standards Authority (CSA), at the office of the Scottish Public Services Ombudsman


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(SPSO). The new procedure uses two stages and allows more time for early resolution (stage one). It encourages the use of apologies and targets primary care more clearly.

7 The Forum welcomed the emphasis in the new procedure on local ownership of complaints handling and early resolution. The Forum noted that responses to complaints at the Early Resolution stage of the procedure (Stage 1) do not need to be in writing but must be recorded.

8 The Forum discussed the need to explore how organisations can work more closely together to identify where there are problems, the challenges around handling complaints involving both NHS and independent providers, culture around complaints, the use of ‘Unacceptable Actions’ policy, and the use of complaints data to identify good practice and issues.

9 The Chair welcomed training currently planned for SPSO investigators on GMC referral thresholds.

Securing the licence to practise: Introducing a Medical Licensing Assessment

10 The GMC’s Director for Education and Standards presented on plans to introduce a Medical Licensing Assessment (MLA); a single, objective demonstration that those who obtain registration with a licence to practise medicine in the UK can meet a common threshold for safe practice. The Chair encouraged members to consider the proposals outlined in the consultation and feedback any comments.

11 The Forum noted that differentiation between schools, including in curricula and style of learning, is a strength of UK medical education that the MLA should preserve.

12 The Forum discussed the proposals to move the point of registration, issues around the design of an Objective Structured Clinical Examination (OSCE) for the MLA, resource implications and the variation in medical school experience that will still exist under the MLA. It also considered alternative and supplementary approaches, co-operation between schools, and the difficulty of predicting interaction of the MLA with constitutional changes to the UK, including Scotland’s relationship with the current UK and the EU.

Any other business

13 The Chair thanked Forum attendees for their contribution to the meeting and noted that members would be welcomed back for the next meeting in October 2017.

UK Advisory Forum (Northern Ireland) - 29 March 2017

Attendees

Charlie Massey, GMC Chief Executive (Chair)

Susan Goldsmith, GMC Chief Operating Officer & Deputy Chief Executive

Lady Christine Eames, GMC Council member

Alan Walker, GMC Head of Northern Ireland Affairs

Paul Buckley, GMC Director of Strategy and Communication

Dr Paddy Woods, Department of Health

Dr Charlie Martyn, South Eastern HSC Trust

Heather Moorhead, NI Confederation of Health and Social Care

Dr Grainne Doran, Royal College of General Practitioners Northern Ireland

Dr Margaret O’Brien, Health and Social Care Board

Dr Paul Darragh, British Medical Association Northern Ireland

Heather Monteverde, Macmillan Cancer Support

Professor Pascal McKeown, Queen’s University Belfast

Olive MacLeod, Regulation and Quality Improvement Authority

Others present

Shane Carmichael, GMC Assistant Director, Strategy and Communications

Emma-Jayne Wright, GMC NI Office Administrator

Dr Sarah Lawson, NI Medical and Dental Training Agency ADEPT Clinical Leadership Fellow

Dr Danielle Leemon, NI Medical and Dental Training Agency ADEPT Clinical Leadership

Fellow

Dr Lyndsay Thompson, NI Medical and Dental Training Agency ADEPT Clinical Leadership

Fellow

Dr Judy Curran, NI Medical and Dental Training Agency ADEPT Clinical Leadership Fellow

3 - Annex C



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Welcome

1 Charlie Massey chaired the meeting and apologised that the GMC Chair, Professor Terence Stephenson, was unable to attend following surgery.

2 The Chair welcomed attendees to the UK Advisory Forum in Northern Ireland, including the ADEPT Clinical Leadership Fellows who observed the meeting. Lady Eames welcomed Charlie Massey to his first UKAF meeting.

3 The Chair took a moment to reflect on the death of Holly Beattie, a member of the GMC Northern Ireland team.

Actions and feedback from October 2016 meeting

4 At the UK Advisory Forum in Northern Ireland in October 2016, the GMC offered support to HSC trusts involved in recruiting a current overseas recruitment campaign of doctors from India. Since October the GMC has offered to provide a named person to assist with the registration issues associated with this recruitment campaign.

5 The GMC has also offered to organise additional Welcome to UK Practice workshops in 2017 to provide additional support for these and other doctors coming to Northern Ireland for the first time. The first is being held on Friday, March 31 in the Southern HSC Trust.

6 The roundtable event to inform our review of flexibility in training took place in February 2017, led by Charlie Massey, GMC Chief Executive and Dr Colin Melville, GMC Director of Education and Standards. The final report is due for publication by the end of March.

Updates on local priorities/areas of interest or concern from Forum members

7 Forum attendees were invited to provide updates on their priorities. During the discussion, the Forum noted:

a The current political uncertainty in Northern Ireland was a cause of concern. Members were concerned about the potential impact on the implementation of the Health and Wellbeing 2026 vision.

b The Civil Service could continue to take forward the direction of travel outlined by the previous Minister. However, the absence of an Assembly means that a budget cannot be set. This means that civil servants have limited access to funds which was causing general concern and particularly within charitable organisations involved in the delivery of health and social care.


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c Some members raised concerns about the long term sustainability and safety of GP services. Enhanced expectations of primary care were being added to with increased management of patients affected by increased patient waiting times for appointments in secondary care. A package to implement the Review of GP led services had been agreed, but could not be implemented because of the absence of an Assembly and agreed budget.

d Forum attendees commented on concerns about the recruitment and retention of doctors in speciality training. An increasing number were choosing not to go into training, leaving recruitment gaps which some were concerned could impact on training posts in the future due to increased service pressures.

e Uncertainty over Brexit continues to cause concerns. Members mentioned the unique circumstances of Northern Ireland having a land border with another EU state. Brexit could have significant impact on planned increases in cross border delivery of services, on those coming from the EU to Northern Ireland for medical training and those already working in Northern Ireland from the EU, especially given the high numbers from the Republic of Ireland.

f Some members noted that they were working more closely with the GMC including in sharing information and data to support wider regulatory work.

GMC Update

8 The Forum received an update on key GMC issues including the GMCs progress on improving the investigation of complaints, the need for legislative and regulatory reform and taking revalidation forward following the review carried out by Sir Keith Pearson.

External Agenda Item: Developments in General Practice in Northern Ireland

9 The Forum received a presentation from Dr Margaret O’Brien, Head of General Medical Services at Health & Social Care Board about developments and challenges in General Practice in Northern Ireland.

10 This included the number of GPs in Northern Ireland and strategic goals set by the GP-led care working group to improve the overall service.

11 To work towards building a sustainable workforce in Northern Ireland there has been an increase in the training places available to GPs from 65 in 2015/16 to 111 in 2018, which HSCB believes can be accommodated within the current system.

12 It was noted that a retainer scheme had been established to support the retention of experienced GPs in Northern Ireland, which had proved successful.


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13 The development of 17 GP Federations across NI had been a significant development and they are viewed as having an increasing future role under the implementation of Health and Wellbeing 2026 strategy.

14 Other initiatives include the increased roll out of Ask my GP online/phone triage system, online repeat prescribing and the roll out of over 100 Pharmacists in GP Practice, to reduce the burden on GPs.

15 Forum members welcomed the presentation and during discussion noted:

a Increasing pressures on services and especially in out of hours GP services. Delivery of the recommendations of the Review of GP led services was necessary.

b Workforce challenges which have impacted primary care recently. This included the number of GP partners approaching retirement and others choosing to retire over part-time working due a variety of reasons: cap on pensionable income, increased workload in General Practice and to a lesser degree the perceived burden of revalidation.

c Increased part-time working, increased feminisation of the workforce and concerns that all GP training places may not be filled in future years were also raised as potential concerns.

d It was noted that there are differing standards and understanding of GP specialities in the UK and the rest of Europe.

e It was suggested that in the future the GMC should consider GP federations as approved training environments, for the advance approval of training posts. This model could be more beneficial for trainees as it could lead to better training environments and promote increased exposure and knowledge of elective pathways.

Securing the license to practise: Introducing a Medical Licencing Assessment

16 The Forum received an update on the development the introduction of a Medical Licencing Assessment (MLA) from Paul Buckley, GMC director of strategy and communication.

17 During discussion, the Forum noted:

a That there would be consequences if you made the MLA your license to practice. Medical schools recognise other exams and are currently open for dialogue.

b Concern was raised about the volume of the assessment and how this would be delivered on a national scale?


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c Medical schools may feel the pressure to change their curriculum to accommodate MLA. There are some concerns that some schools could focus on training students to simply pass a test and lose their drive towards excellence. Would this affect the confidence and competence of graduating students?

d Some forum members said that the GMC needed to be clearer on what specific problem they are trying to fix and how this is addressed by implementing the MLA.

e Members understood that one aim of the MLA was to capture the international/European group and have the same assessment for all. It was noted that significant numbers of Northern Ireland doctors qualified in the Republic of Ireland. Such doctors could find it frustrating if required to take another exam if they studied medicine just across the border.

f Forum members questioned whether the medical school accreditation from the GMC at present was beyond the level of the MLA.

g In response to a query about how long the MLA accreditation would last for, members were advised that the MLA would be the mechanism for entering the register and obtaining a licence, and revalidation allows them to maintain both.

18 Members were advised that all of the points raised in this and our wider engagement taking place would be considered further and the GMC Council would be considering this issue further as the work is taken forward.

Chair’s Closing Remarks

19 The Chair thanked Forum attendees for their contribution to the meeting.


Revalidation Advisory Board

Minutes of the meeting on 7 March 2017* Members present

Sir Keith Pearson, Chair

Sharon Baillie Sharon Lamont Mark Porter Mark Bennett Malcolm Lewis Ian Starke Simon Bennett Ian Mackay Sally White Norman Gibb Leslie Marr Julia Whiteman Mark Hope Sol Mead Paddy Woods Chris Jones Val Millie Guests Bill McMillan, NHS Employers Sean King, NHS Employers Stephen Barasi, Wales Revalidation Delivery Board Others present Terence Stephenson, GMC Chair Charlie Massey, GMC Chief Executive Una Lane, Director, Registration and Revalidation Judith Chrystie, Assistant Director, Policy and Regulatory Development Clare Barton, Assistant Director, Revalidation

Colin Melville, Director, Education and Standards Lindsey Westwood, Head of Revalidation Helen Arrowsmith, Project Manager for Taking Revalidation Forward Rachel Martinez, Project Manager Chris Pratt, Board Secretary Sophie Holland, Executive Assistant to Una Lane

* These minutes should be read in conjunction with the Board papers for this meeting, which are available on our

website at http://www.gmc-uk.org/about/council/21121.asp

3 – Annex D

http://www.gmc-uk.org/about/council/21121.asp

Executive Board meeting, 5 June 2017 Agenda item 11 - External engagement update

Chair’s business

1 The Chair welcomed members and guests.

2 Apologies were noted from Mike Prentice, Ian Findlay, Yvonne Livesey, Andy Lewis and Claire Armstrong, who was represented by Mark Bennett.

Minutes of the meeting on 10 January 2017 3 The Board approved the minutes as an accurate record.

GMC progress report 4 The Board noted the GMC report on progress with revalidation, including the latest

revalidation data provided in the Annexes.

5 The Board commented that:

a The licence withdrawal data (paragraph 11 of Annex A) would be set in better context if it were presented in some way that relates to the overall number of licensed doctors rather than as an ever increasing aggregate number;

b The appeals data (paragraphs 17 and 18 of Annex A) is pleasing and provides evidence of a well governed system; and

c The data in Chart 7 of Annex B shows the highest deferral rate is for doctors aged 28 to 30, who will be doctors at a very early stage in their career. This may be due to doctors moving in and out of training. It may be appropriate to consider this data further and set it in context so that Responsible Officers can take it into account in considering their revalidation recommendations.

6 During the discussion the Board noted in addition that:

a The additional information that the GMC is planning to collect from Responsible Officers about deferral recommendations will provide a better understanding of deferral reasons and allow the data to be set in sharper relief; and

b It was reassuring that the increase in the rate of non-engagement recommendations towards the end of the first revalidation cycle, which had been anticipated by some, had not materialised.

UK progress updates 7 The Board noted the written reports provided by NHS England, Wales and Health

Education England. There were no comments or questions. NHS England commented that it continues to work on the areas described in their update. In Wales,


stakeholder engagement on the Taking Revalidation Forward (TRF) report and recommendations is ongoing.

8 The key points noted in discussion of the verbal updates given by others were:

a In Scotland, the main recent focus had been on considering and engaging with stakeholders on TRF. The additional time now planned for stakeholder engagement to continue is welcome and there will be discussions at the upcoming Revalidation Delivery Board and Responsible Officer network meetings. The 2016/17 audit report on revalidation statistics for Scotland will be available soon.

b In Northern Ireland, recent concentration had also been on TRF. The report and recommendations had been discussed at the Revalidation Delivery Board and would shortly be discussed with medical leaders and Responsible Officers. There will be further consideration of the TRF recommendations in the light of that engagement. RQIA’s recent review of governance arrangements in health and social care organisations that support professional regulation contains elements relevant to TRF.

c The independent healthcare sector’s Revalidation Forum had identified some areas of the TRF report and recommendations where further clarification would be welcome. This would be taken forward outside the Revalidation Advisory Board (RAB).

Collecting additional information about deferral recommendations 9 The Board received a short presentation on the GMC’s plans to collect additional

information from Responsible Officers and Suitable Persons about the reasons for the revalidation deferral recommendations they make.

10 The main objectives are to better understand the factors more likely to lead to deferral recommendations, and whether these differ between different cohorts of doctors. The information would enable the GMC to review the effectiveness and proportionality of its approach to deferral recommendations and consider whether improvements might be made to the process or to GMC guidance.

11 The Board commented that:

a It would aid understanding of the high deferral rate for doctors in training to know, for example, whether the reason for the deferral recommendation is a change of a doctor’s Certificate of Completion of Training (CCT) date, a change in practice or an interruption in practice.

b While there may be multiple reasons for a deferral recommendation, it will always be important to identify the main reason.


c Defining the additional information categories needs to be precise to avoid confusion and expressions such as ‘insufficient evidence’ would be unlikely to contribute to better understanding.

d There is a difference between a change in practice and an interruption to practice and the two should be separated.

e Depending on the degree of granularity, additional information about deferral reasons could show, for instance, whether a doctor’s supporting information collection had been inadequate.

f This work is important in the context of increasing confidence in the revalidation process. The public must be able to understand that purpose and the terminology we use.

12 In discussion, the Board noted:

a The additional information would provide useful comparative data, for example, between designated bodies and between Responsible Officers.

b The UMbRELLA research project is expected to provide some ranking of deferral reasons.

c The GMC is aiming for a stepwise, proportionate and reflective approach to collecting additional information which will provide intelligible insight.

d That systems development and work to develop guidance would be undertaken during 2017 with a view to introducing new deferral reasons information collection in the early part of 2018.

Taking Revalidation Forward – the future 13 The Board received a brief presentation on the future of RAB.

14 The GMC had been considering how best to co-ordinate and oversee the implementation of the TRF recommendations with its external partners. Following both a review of the RAB constitution and terms of reference, and initial engagement with stakeholders and the RAB Chair, the GMC had concluded that a fresh approach would be appropriate.

15 The GMC was now proposing that RAB should cease after this meeting, to be replaced by a new Board, with a limited lifespan of 12 – 18 months. The focus would be on delivery of the TRF recommendations and related revalidation improvements across the 4 countries of the UK.

16 The working title of the new Board is the ‘Revalidation Oversight Board and the proposed terms of reference and membership are:


Purpose: To oversee the delivery of the improvements to revalidation based on the recommendations from Sir Keith Pearson’s Taking Revalidation Forward report by:

committing to collaboration through joint action and an implementation plan

coordinating any agreed activities

monitoring progress against the agreed plan

agreeing revisions to the plan as required

receiving regular reports from the organisations responsible for delivery.

Proposed membership

Chair: Charlie Massey (GMC Chief Executive)

Special Adviser: Sir Keith Pearson

Membership: Individuals representing stakeholder organisations and able to support delivery

Secretariat: GMC

17 The new Board would meet 3-4 times per year, and it was further proposed that sub-groups using existing fora where possible (eg, national RDBs; COPMeD) may be desirable.

18 There were no observations and no substantive discussion of the proposals which were due to be considered at a separate meeting immediately following this RAB meeting.

Closing remarks

19 In bringing RAB’s final proceedings to a close, the Chair noted that it had been a big and brave decision to introduce revalidation. He had been privileged to be involved in a leadership capacity from the outset and had valued the support and professionalism of GMC staff along the way. The Chair indicated his view that it was absolutely right now to proceed to a new phase.

20 Charlie Massey extended the GMC’s warm appreciation for the Chair’s valued and energetic contribution throughout, and looked forward to continuing to work together with Sir Keith in the capacity of special adviser to the new ‘Revalidation Oversight Board’ in taking revalidation forward.


Other business

21 There were no items of other business.

Confirmed:

Sir Keith Pearson, Chair 3 April 2017

Documents

Executive Board meeting, 5 June 2017 - Home - GMC · Goodall - Welsh Government, Andrew Grant - Swansea University and Clare Jenkins ... Suggestions would be considered for future