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Shipman Inquiry criticisms that could sink GMC

The Shipman Inquiry is set to find serious fault with the GMC's past performance and future arrangements ­

we reveal the potential criticisms that could end

self-regulation

The Shipman Inquiry has identified 17 areas where it may wish to 'comment on and express reservations about' the GMC's policies, performance and future plans.

The potential criticisms are contained in a 'salmon' letter ­ a confidential document that gives organisations under scrutiny by an inquiry advance warning of its potential conclusions. The five closely typed A4 sheets to the GMC cover aspects ranging from 'attitudes' and 'administration' to 'screening' and 'revalidation'.

Written by Shipman Inquiry solicitor Henry Palin, the letter makes clear that as well as finding serious fault with the GMC's past policies and performance, inquiry chair Dame Janet Smith may criticise the GMC over current and future arrangements.

The inquiry argues that GMC decision-makers may be said to 'lack objectivity' and that their 'prejudices favoured the doctor rather than the complainant'. It adds that some decisions may have resulted in 'the perception by the public that the GMC is taking no notice of a doctor's misconduct'.

Some of the most serious potential criticisms concern screening and the GMC's role as a recipient of complaints. The inquiry questions whether its role is that of arbiter or complaints-handling organisation. It also draws attention to 'persistent failures' with the screening process.

While acknowledging that the GMC has 'admitted various failures and shortcomings' in its submissions to the inquiry and that it has addressed some of the failings identified, the letter to the GMC's legal team at Field Fisher

Waterhouse details a series of further areas of potential

censure.

Other criticisms the inquiry says it may make of the GMC include:

 · Failing to lay down clear policies governing fitness to practise procedures

 · Failure to take into account the difficulties faced by complainants

 · Failure to investigate complaints

 · Inconsistent screening pro-cesses and lack of transparency

 · A tendency to preserve a doctor's privacy against the legitimate public interest

 · Concern over the determination and capacity to undertake sufficiently thorough investigations

 · Recent administrative errors by staff.

The letter also says the inquiry is 'likely' to adopt criticisms made in reports from the Policy Studies Institute and the report of the evaluation of health procedures by King's College London and the University of Leeds.

The Shipman Inquiry was set up in 2001 and has already produced three reports. The final stage has been looking

into monitoring, disciplinary systems and complaints and public hearings ended in December 2003. The final reports are due in the summer.

17 doubts about the GMC's fitness to practise

 · Policy

 · Attitudes

 · Complaints ­ confusion as

to role

 · Complaints ­ handling procedures

 · Administration

 · Investigation

 · Interim orders

 · Screening

 · Preliminary proceedings committee

 · Professional conduct committee

 · Health procedures

 · Performance procedures

 · Private practice

 · Disclosure of information

 · Excessive privacy or secrecy

 · Delay

 · Revalidation

What the Shipman Inquiry letter says

Policy

'The GMC may be criticised for its failure to lay down clear policies so as to properly reflect its claimed objective of protecting patients.'

'It may said that there has been a persistent failure to provide standards, thresholds and criteria relevant to all stages of the decision-making process.'

Attitudes

'It may be said that those taking decisions for the GMC lacked objectivity and that the prejudices of the decision makers favoured the doctor rather than the complainant.'

'If the outcome for the patient has been serious, the reaction is that that must not be taken into account, as it is the doctor's actions that are to be examined. But, if the outcome following a mistake is good, there is a tendency to minimise the seriousness of the mistake because the patient has, fortunately, not suffered.'

Complaints

'The GMC may face criticism for its failure to clarify its own role as a recipient of complaints and to act accordingly in a consistent way. Is its role that of arbiter? Or is it a complaints-handling organisation?'

'It may be said that the GMC has failed to appreciate

the difficulties faced by complainants and should

have done more to help such persons advance a complaint or concern.'

'Complainants are often confused as to the right destination for their complaints yet the GMC has not clarified and published the criteria by which it will either accept a complaint or advise a complainant

to go elsewhere.'

'The GMC may also be criticised for continuing to encourage members of the public to take their complaints elsewhere before it has been

ascertained whether the complaint is in fact suitable

for the GMC to handle.'

'Further, the GMC may be criticised for its failure to follow up complaints that may have been redirected to another complaints body.'

Administration

'Many criticisms have been heeded but the report may contain examples of continuing shortcomings and of recent administrative errors by staff.'

Investigation

'It may be said that the practice of carrying out minimal investigation before screening has resulted in cases being closed which, if adequately investigated, would have proceeded further.'

Interim orders

'Only recently has the GMC obtained an adequate

range of powers to impose interim orders for the protection of patients.'

Revalidation

'The GMC may be open to criticism in respect of the way in which it proposes to carry out revalidation which may be said to be inadequate to meet the claims presently being made as to its beneficial effects.'

'Further it may be said that the GMC has failed adequately or convincingly to explain its changes of stance in respect [of] its proposals for the implementation of its policy of revalidation.'

'It may be said that apparent changes of stance

have been adopted for reasons of expediency rather than principle.'

Screening

'It may be said that there has been a persistent failure of the GMC to lay down standards and to provide criteria for screening decisions.'

'The inquiry is likely to draw attention to cases in which it appears that the threshold has not been understood by screeners. There will be examples of failures to understand the screening process and to apply the correct test.'

'The GMC may well be criticised for the decision of screeners to override the decision of the council that all cases of serious professional misconduct by definition should be referred to the PCC. Concern may be expressed as to the proposed future arrangements for screening cases which are not going to a fitness to practise panel.'

Health procedures

'There remains no evaluation of a doctor's performance while he or she is going through the health procedures. Concern may be expressed as to the future arrangements, in particular, the availability of

voluntary health procedures for doctors who are also accused of misconduct.'

Private practice

'The GMC may be criticised for its failure to recognise the vulnerability of patients using some private sector services and the difficulties faced by patients wishing to make a complaint. It may be said that rather than recognising such difficulties, the GMC increases them.'

Excessive privacy or secrecy

'It may be said that [the GMC] has leaned towards the preservation of a doctor's privacy and against the legitimate public interest in the conduct and competence of a doctor.'

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