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GMC puts its case for the defence

The under-fire GMC has reacted vigorously to the Shipman Inquiry letter with a point-by-point repudiation of the criticisms ­ Ian Cameron reports

The GMC has vigorously defended its reform programme and predicted the Shipman Inquiry's final report will not mark the end of self-regulation for doctors.

In a defiant response to the letter from the inquiry revealed by Pulse last week, the council said its criticisms were 'unjustified' and 'inaccurate'.

But GMC members admitted the council was braced for some criticism in Dame Janet Smith's final report, due in the summer.

GMC chief executive Finlay Scott said he did not believe the letter reflected the inquiry's likely conclusions. 'By its very nature a Salmon letter is negative,' he said.

'I don't think it is intended to reflect conclusions they may or may not have reached. But even taking [the salmon letter] as what it is some of the points do not accurately reflect [the changes we have made].'

Mr Finlay said the GMC had accepted some deficiencies in its evidence to the inquiry. But he added its reform programme was supported by the Government and GMC witnesses to the inquiry had demonstrated it was 'robust'.

The Salmon letter was sent by the Shipman Inquiry's solicitors in December after a dozen GMC witnesses had given evidence to its fourth session. Its aim was to warn the GMC of potential conclusions that could be made in the inquiry's final report and give the council time to respond.

GP members of the GMC gave mixed reactions to the criticisms in the letter.

Dr Krishna Korlipara, a GP in Bolton, said many of the points were 'totally unjustified'. He added: 'It's extremely dispiriting to see the number of areas of potential criticism which were successfully addressed by our evidence.

'The concern is that the inquiry may not have taken much notice of the evidence submitted, but I hope the final report will not be so damning of the GMC.'

He said he was concerned the inquiry had exceeded its original terms of reference.

GMC member Dr Malcolm Lewis, a GP in Swansea, said he believed the comments in the letter would not necessarily make it into the final report.

'It's only right the inquiry brings to the attention of the GMC areas where they may have concerns,' he said. 'But it's no more than that.'

The GMC's response to the 17 possible criticisms of the Shipman Inquiry

1 Policy Failure to lay down clear policies on fitness to practise procedures GMC is reforming fitness to practise procedures to make them streamlined and more transparent. Review of existing performance procedures is near completion. Review of existing health procedures is beginning.

2 Attitudes GMC lacks objectivity and favours doctors over patients GMC gave the inquiry a number of case files in response to requests. It should not generalise from this sample. Examination of entire GMC caseload would point clearly to objectivity. Claiming decision makers favour doctors is unfair.

3/4 Complaints GMC is confused over its role in dealing with complaints and fails to help patients lodge them GMC has long called for a 'complaints gateway' for patients so they can access advice more easily.

5 Administration Despite progress there continue to be shortcomings and errors GMC admits there have been instances of unacceptable delay in dealing with complaints. The backlog has now cleared. Such delays should not occur in the future.

6 Investigation Minimal investigation and closure of some cases which should have proceeded

GMC is reforming procedures and introducing a single investigation stage. In future it will speak to doctors and employers at an early stage to see if a complaint is part of a wider pattern of concerns. GMC is developing an

in-house legal team.

7 Interim orders GMC should have requested powers to impose interim orders earlier GMC

has no reluctance to seek extra statutory powers. It

cannot be responsible for Government decisions not to devote parliamentary time to allow this.

8 Screening Inconsistent and not transparent GMC is abolishing the role of screener and replacing it with medical and lay case examiners. Systematic

auditing system being piloted. Investigation committee will be responsible for quality assurance and reports will be made public.

9/10 Preliminary proceedings and professional conduct committees Failure to provide standards and criteria for decisions PPC to be abolished and superseded by investigation stage in new fitness to practise procedures. PCC will be replaced by fitness to practise panels. GMC members will not sit on the panels. They will be staffed by 'associates' with both medical and lay backgrounds.

11 Health procedures Lack of criteria over decisions governing entry to health procedures Privy Council has issued guidance on how cases that raise issues of health and conduct are handled. GMC will review health procedures shortly.

12 Performance procedures Beset by delays

and a failure to make arrangements for the remediation of doctors Performance

procedures will be abolished with the introduction

of new fitness to practise procedures. The GMC

does not accept that it is its role to provide remediation

for doctors.

13 Private practice Failure to recognise the vulnerability of private patients GMC regulates doctors working in the private sector but does not

regulate the private sector itself. Where there is evidence of serious professional misconduct it will pursue the matter vigorously.

14 Disclosure of Information Consistent protection of the confidentiality of doctors and against disclosure of material to the public GMC has decided employers will be told about complaints at an earlier stage. It is undertaking consultation on disclosure, looking at disclosure of fitness to practise history.

15 Excessive privacy or secrecy Doctors' privacy is preserved against the legitimate public interest The PCC has always sat in public. In future all fitness to practise panels will sit in public except where issues are exclusively about a doctor's health.

16 Delay Delays in process have been inexcusable GMC readily admits to instances of unacceptable delay in dealing with complaints and concerns. Such delays should not occur in the future.

17 Revalidation A change of stance adopted for expediency rather than principle GMC proposed

and developed revalidation. It felt the system should interlock with appraisal and clinical governance, with no duplication or overlap. GMC absolutely rejects claims of expediency. It accepts proposals need to be filled out

with more detail.

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