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Gold, incentives and meh

Researchers record 'baffling' falls in common infections

GPs see the Government's super-regulator as subjecting them to double jeopardy, but its boss could prove to be GPs' ally ­ Ian Cameron reports

In recent times GPs could be forgiven for feeling under attack. The scathing conclusions of the Shipman Inquiry, the Government's review of the GMC's plans for revalidation and the related review into medical regulation are only the most recent examples.

Pre-empting that, the creation of the Council for Healthcare Regulatory Excellence, a body that can challenge regulators' fitness to practise decisions for undue leniency, added to the expectation that the broad regulatory framework is about to get much tougher.

But the tides may be turning, with support for the status quo coming from what might have been considered unlikely allies.

Last week Dame Janet Smith herself, chair of the Shipman Inquiry, said she had never meant to portray GPs as murderers. In a sympathetic speech to the RCGP she claimed it had never been her intention to create an 'iron cage' of regulation.

Now the head of the CHRE has joined in, saying the criticism of the GMC in the inquiry's final report

was 'unfair', and that the regulatory environment is in no need of radical restructuring.

Sandy Forrest, director of CHRE, believes there was a 'certain level of unfairness' in relation to the GMC in Dame Janet's report. 'The GMC of today is different to the one regulating Shipman in the 1970s and 1980s,' he said. 'Perhaps it hasn't been given due credit for advances made in recent years.'

He added: 'We need more evolution, not a revolution. The Chief Medical Officer group is building on a secure foundation ­ whatever he re- commends [I hope] does not knock the house down and start again.' He also wants to challenge what he believes are mistaken assumptions about the CHRE. The notion that it is 'disproportionately focused' on GPs, for one, or that it is on a 'moral crusade' against sexual misconduct.

'We don't get to choose our workload,' he said. 'We are relying on the regulatory bodies getting it right. We don't get to choose what the 500 fitness to practise cases are or what we see as aberrant decisions.'

Doctors clearly do not see it as such. Last week they called for its abolition at the BMA's annual conference. They see the organisation and its ability to challenge decisions for undue leniency as the harbinger of double jeopardy.

As such, the feeling among some is that it undermines the whole point of professionally-led regulation.

Sandy Forrest thinks doctors should, in fact, see the existence of the CHRE as a strength and says its role is changing to reflect the fact that regulators' practices have already learned from its work.

That will see it challenging fewer of the regulators' decisions. In fact, he foresees an environment where the very efficacy of the organisation is judged by the increasing infrequency in which it involves itself in the decisions of, say, the GMC.

'There has always been a sharing of good practice between the nine regulators informally,' he said. 'CHRE has put that into focus ­ we've provided the forums for collaboration to happen.'

Rather than the CHRE interfering in all manner of cases, he emphasises it sends only between eight and 10 cases to court for being unduly lenient out of around 500 fitness to practise cases heard every year and he anticipates this level will fall. 'We haven't found our natural level as yet but the number of cases we take an interest in is reducing as regulators learn the issues,' he said.

'Our work in GMC and Nursing and Midwifery Council cases of undue leniency has thrown up some risk areas but other regulators don't need to fall off a cliff to know it hurts.

'If we ended up with no cases to report that would be fantastic.'

He added: 'It's now clear to the regulatory bodies that explaining why they made a decision is as important as the decision itself. Now regulatory bodies have a clear idea what the margin of error is.'

What this all boils down to is the CHRE becoming a substantially different organisation in five years' time, the focus shifting away from its challenging fitness to practise decisions to one of encouraging continuous development.

'Our success should be judged on the extent to which the health care regulators are protecting the public. That seems trite but if we ended up with no cases to report that would be fantastic.

'The ultimate aim for the CHRE is to work itself out of a job.'

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