GMC chief: ‘Revalidation can’t just be a chore for GPs’
The new chief executive of the GMC is friendly and cheerful, in stark contrast to the harsh, buttoned-up image his organisation conjures up for many GPs
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Charlie Massey wants to portray the GMC as an organisation trying to support doctors rather than punish them, but he starts his new job in the wake of a rocky period for the regulator.
The GMC is trying to reform its fitness-to-practise (FtP) process after the deaths by suicide of several doctors who were under investigation, while the suggestion in 2015 by the regulator’s chair that doctors require ‘resilience training’ like soldiers in Afghanistan was very badly received by the medical profession.
Having been director general of strategy and external relations at the Department of Health before taking on the GMC top job last year, Mr Massey is a consummate Whitehall insider, but he insists that he wants to be an independent voice for the medical profession. He talks to Pulse a few months into the role about the GMC’s hopes and plans for the future of regulation and medical education.
What have you done in response to the report showing 28 doctors took their own lives during the FtP process?
We did a lot of work last year with Professor Louis Appleby, the author of the report on suicides of doctors in the FtP process, to help think through what we could be doing differently. We introduced an independent BMA-led doctor support service, and we’re now using that support service to help train our investigators. We’re also setting up a dedicated team to support doctors who have a health concern, and we’re creating an opportunity to pause processes if a doctor is unwell and needs support.
There is also an issue about how far we can reduce the number of cases that we pursue. Broadly speaking we have around 10,000 cases each year that are complaints made to us, and normally about 3,000 of those result in some sort of investigative process. Yet, we strike off fewer than 100 doctors at the end of that process.
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So for the 2,900 who are investigated and don’t get struck off is there a better, easier way?
Are there things we can do to create a better filter before we decide to investigate a doctor?
But have you done enough to stop doctors going through this traumatic process in the first place?
We started piloting provisional enquiries. What that means is that before we start a formal investigation, we make some informal enquiries that a doctor won’t know about in order to decide whether a case passes our threshold to investigate.
This has helped to reduce the number of cases we push through to investigation – indeed in 2016, we had about 800 fewer investigations than we’d had the previous year.
Professor Appleby also advised us that we needed to improve the training of our investigators so they become more understanding of doctors who may have health concerns. That’s why we are using the BMA doctor support service to train our investigators.
I don’t think there are any of Professor Appleby’s recommendations that we haven’t really thought quite hard about and taken appropriate action with. Having said that, we can always do more.
Is it right that doctors should pay GMC fees when the GMC is really there to protect patients?
Well, if doctors didn’t pay the registrant fees, the public would be funding the GMC through the Government. I would argue that it’s really important that the GMC is independent of the Government – we are much freer and more able to call it where there are problems in the system. Indeed, I think we’ve been doing that recently; we’ve described a state of unease in terms of what junior doctors told us in the beginning of November.
There’s a massive GP recruitment crisis at the moment. Is that something you see GMC involvement in?
We don’t have formal role in workforce planning. We do have a lot of data, and I’m very keen that we should be using our data to help people with the responsibility for workforce planning. We also have a role in terms of helping relate the status of different specialties. So, we said in January we were happy to treat general practice as a specialty in its own right, but that requires legislative change. We reported to the four governments at the end of March on a review of flexibility for trainees – one of the ambitions from that work is that it becomes easier for someone to switch from one specialty to another – which may be advantageous in terms of people wanting to come into general practice.
Are you worried about the implications of Brexit on workforce and any other aspects of the GMC’s work?
There are lots of issues that arise from Brexit and a couple of opportunities. Certainly, we see some worrying noises from EEA-trained doctors in the NHS about their intentions to stay in the NHS. Around 2,000 or so non-UK graduates replied to our own survey, with just over half saying that they were considering leaving the UK and 90% of those said it was because of Brexit and uncertainties about their residency status. Anything the Government can do to allay those concerns will be welcome.
There’s been a lot of talk about the disparity between the MRCGP pass rates of white and non-white graduates. Is this something you’re concerned about?
It is something I’m concerned about. I think it is really important that the GMC plays its role with others in making sure every doctor, wherever they come from, has the opportunity and support to fulfil their potential. In the data you see this does not appear to be the case.
We’ve been doing qualitative work, literature reviews and analysing our own data. There’s quite a lot of research on the value of mixed peer groups, training trainers, dealing with unconscious bias and how we build the skills of trainees to deal with perceived bias. Some of this goes to what the GMC can lead on; some of it is working with others – so we’re working with Health Education England on better diagnostic tools as well.
How do you justify putting GPs through the process of revalidation when it takes a lot of time and effort away from frontline care?
Revalidation is the only mechanism that enables us to know that a doctor is up to date and fit to practise. For revalidation to be successful it needs to be something that isn’t just a chore for doctors to go through. If you forget the words around revalidation, then the process of doctors reflecting on their practice and feedback from patients, peers and colleagues is really important. And if revalidation can drive appraisal rates up in the NHS, as it has done, I think that can only be a good thing.
A lot of GPs would say that for them, appraisal is often just a box-ticking exercise – so instead of being useful it ends up taking time away from patient care. How can you make sure it’s useful for GPs?
Well, if it is a box-ticking exercise it’s not as effective a process as the one I’ve described as my aspiration. And it is clear in what Sir Keith Pearson [chair of the GMC’s revalidation advisory board and author of the GMC’s review of revalidation last year] found that the quality of appraisal does vary quite significantly from place to place and from country to country. What I don’t think we should do is say we’re going to somehow relax our standards of appraisal, revalidation and reflective practice.
If we can be clearer about what is and is not a requirement of revalidation, I think it will become easier for doctors to understand what they need to do – and hopefully a lot of the benefits I’ve described will continue to grow.
Recently there was a proposal about merging healthcare professional regulators. What would this mean for doctors?
The Government hasn’t yet published its consultation on regulatory reform. There was a lot of speculation in the press around creating a single super-regulator. I don’t believe that is what the Government is going to propose. For us, the real prize of regulatory reform is about having more discretion in deciding what to investigate and what not to investigate.
My fear is that Brexit will occupy an awful lot of parliamentary time for the foreseeable future and it is less clear whether the Government will be in a position to secure the time needed for a bill to achieve whatever it wants to do in terms of regulatory reform.
Policy adviser, security manager, private secretary to social security minister; leader of inter-departmental review; policy lead for Post Office, Department of Social Security; HM Treasury
Deputy director, Prime Minister’s Strategy Unit, Department for Work and Pensions
Executive director, the Pensions Regulator
Ageing society and state pensions director, Department for Work and Pensions
2012 – 16
Director general, strategy and external relations, Department of Health
Chief executive, GMC