The Donaldson Report Good Doctors, Safer Patients

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The Donaldson ReportGood Doctors, Safer Patients

• By Lianne Kylänpää

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What is it?

• CMO for England Liam Donaldson
• Suggestions for overhaul of regulation of medical
  profession
• July 2006
• Will affect doctors in whole of UK
• 44 recommendations

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Why relevant?

• Career
• Oral

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Why the report?

• Shipman
• Last review of medical regulation in 1972
• Other enquiries
• Clifford Ayling (Obs/Gyn 2004)
• Richard Neale (Obs/Gyn 2000)
• William Kerr / Michael Haslam (Psychs1960s-1980s)

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• Enquiries showed
• GMC slow to deal with concerns
• NHS not valuing complaints
• Poor communication between organisations
• No checks of clinical competence
• Members of local healthcare community remained
  silent

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Some quotes..

• Professionals only have duties they do not
  have privileges. They have duties over and above
  the duties of being a citizen
• Professor Sir Ian Kennedy, Chairman of the
  Healthcare Commission 2005

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• Harold Shipman would, of course, have passed any
  appraisal of fitness to practice with flying
  colours
• Drs Jonathan and Bridget Osborne 2005

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• However bad a doctor is, another doctor, acting
  as an expert in disciplinary proceedings, will
  usually be willing to say that the doctors
  actions were within the limits of acceptable
  practice
• Janice Barbour, Managing Partner, Hempsons
  Solicitors, 2005

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• The GMCs proposals, prior to Dame Janet, much
  as we might wish them to have been adequate, were
  more appropriate to a golf clubs membership
  committee
• Roger Neighbour, President RCGP 2005

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Main points

• Changes to GMC structure and function
• Changes to fitness to practice hearings
• Increased local regulation
• Definition of Good Doctor
• Revalidation
• Regulation of students
• Management of undergraduate education to PMETB
• Increased public access to info on doctors
• Easier for patients to make complaints

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GMC changes

• Only responsible for register
• Members appointed by Public Appointments
  Commission, more lay members than doctors
• No power of adjudication / removal
• Can still investigate and assess doctors before
  fitness to practice hearing
• Accountable to Parliament

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Fitness to practice hearings

• Independent tribunals (not GMC)
• Now civil standard of proof not criminal

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Increased local regulation

• GMC affiliates for each healthcare organisation
• Affiliates can deal with less severe end of
  spectrum fitness to practice cases locally
• Healthcare organisations should bring to
  attention of affiliates those complaints dealing
  with performance / conduct

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Definition of good doctor in contract

• A clear unambiguous set of standards created for
  generic medical practice, set jointly by the GMC
  and PMETB
• Also separate standards for each area of
  specialist medical practice

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Revalidation

• Re-licensure (to remain registered with GMC)
• Based on existing NHS appraisal system
• 360 degree feedback
• Re-certification (to remain on specialist
  register / GP register)
• Every 5 years
• Standards set by Royal College
• If you fail, will need period of supervised
  practice

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Regulation of students

• Medical school curriculum and approval of medical
  schools to be transferred from GMC to PMETB
• Students will require registration with GMC

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BMAs response Nov 2006

• Missed opportunity by CMO to harness medical
  professions enthusiasm for change
• Good
• Revalidation (if practical)
• Tailored plan of remediation and rehab for
  doctors failing to meet standard of revalidation
• Taking patient complaints more seriously and
  dealing with them at local level

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• Bad
• Standard of proof change
• Fitness to practice not under GMC 2 part
• Moving undergrad education to PMETB yet
  untested and currently overloaded
• The proposal to define standards of
  professionalism and insert them within an
  employment contract shows a grave
  misunderstanding of the concept
• GMC members not voted for by doctors, majority to
  be lay members

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And now..

• The White Paper Feb 2007 Trust, Assurance and
  Safety the regulation of health professionals in
  the 21st century
• DoH response to Donaldson Report
• Health secretary has launched period of
  consultation
• Primary legislation expected 2007/8 Parliamentary
  session

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Some thoughts

• Loss of professionally led regulation?
• GMC powers effectively given to DoH?
• Will doctors want to pay GMC membership?
• Anglocentric