Summary: The state of medical education and practice in the UK: 2012

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Summary: The state of medical educatio ad practice i the UK: 2012 The state of medical educatio ad practice i the UK: 2012 uses data from the Geeral Medical Coucil (GMC) ad from others to provide a

1 Summary: The state of medical educatio ad practice i the UK: 2012 The state of medical educatio ad practice i the UK: 2012 uses data from the Geeral Medical Coucil (GMC) ad from others to provide a picture of the medical professio i the UK ad to idetify some of the barriers ad eablers to good medical practice. Aims of the report There is much to celebrate about the state of the medical professio i the UK: it is diverse, doctors cotiue to be the most trusted professio i the UK, * ad the umber of doctors draw to the GMC s attetio who are fallig seriously short of the stadards expected of them remais very small. But we kow there is variatio i how doctors practise. This secod editio of The state of medical educatio ad practice i the UK starts to idetify the causes of this variatio. It cosiders what barriers doctors might face i deliverig high quality care for patiets ad i meetig the stadards set out i the GMC s core guidace Good Medical Practice. Some barriers to good medical practice may be idividual to the doctor, whereas others ca relate to the cotext i which doctors work. By startig to idetify the causes of variatio, we should be able to fid ways of overcomig barriers to good medical practice. We hope this report will ecourage debate, reflectio ad practical steps to improve patiet care. About the report The full report covers four mai areas. Chages i the medical professio sice last year (chapter 1) updates o key idicators about the professio from last year s report, ad reflects o sigificat chages. Medical practice at differet stages of doctors careers (chapter 2) looks at how types of complaits vary over doctors professioal lives, ad the importace of tailorig support for them. Doctors i the workplace (chapter 3) assesses the variability of practice across differet eviromets, ad cosiders how these factors ca costrai ad support good medical practice. The fial chapter, Overcomig barriers to good medical practice (chapter 4), cosiders the chages that may be required to esure the professio ca meet existig ad future challeges ad healthcare eeds. This summary provides a overview of the report s mai fidigs ad coclusios. * Ipsos Mori (2011) Trust i professios 2011 Lodo, Ipsos Mori Geeral Medical Coucil 1

2 Chages i the medical professio sice last year (chapter 1) The compositio of the UK s medical professio cotiues to chage, as do the demads placed upo it. The figure below shows the breakdow of the medical register i 2011, ad how it has chaged sice Total umber of doctors o the medical register: 245, Geder Male: 141, Register Specialist: 71,307 GP: 61, PMQ regio UK: 155, Ethicity White: 118, Age (years) : 68, : 71,983 2 Uder 25: 4, or = approximately 5,000 doctors Doctor characteristics chage from 2010 figures PMQ=primary medical qualificatio. IMG=iteratioal medical graduate. EEA=Europea Ecoomic Area.

3 2.8 medical register: 245, Female: 104, Doctors ot o either register: 113,440* GP: 61, Doctors ot o either register: 113,440* 46 * This icludes specialty doctors (formerly referred to as staff ad associate specialist SAS doctors), foudatio doctors, specialty *Register. This icludes specialty doctors (formerly referred to as staff ad associate specialist SAS doctors), f (icludig GP) postgraduate doctors i traiig, ad doctors who have ot bee etered oto the Specialist (icludig GP) postgraduate doctors i traiig, ad doctors who have ot bee etered oto the Spe IMG: 66,608 EEA: 24, Asia: 46, Other: 9, Black: 6, : 51, Proportio of the total register : 71, chage from 2010 figures Not stated: 60, Doctor characteristics Mixed: 3, doctors Female: 104, IMG: 66, Asia: 46, Other: 9, Black: 6,812 Mixed: 3,643 Not stated: 60, : 28, : Ukow: 12,360 8, : 51, Proportio of the total register : 28,483 21

4 Doctors o the medical register i 2011 The umber of doctors o the register cotiued to grow ad, for the first time, the umber of female doctors passed the 100,000 mark. Complaits about doctors The umber of complaits received by the GMC has cotiued to rise. We received 8,781 complaits i 2011, up 23 from 7,153 i Chagig lifestyles ad expectatios of doctors mea that the eed for flexible workig ad traiig is becomig icreasigly importat. A third of the UK s doctors qualified outside of the UK. There are chages i the coutries from which doctors come to the UK to practise, with the professio shaped by exteral factors. Medical educatio ad traiig Medical studets cotiue to come from higher socioecoomic backgrouds. Of the udergraduate medical schools itake, 57 came from the top three socioecoomic groups, ad 7 from the bottom three. * The rise i the umber of complaits i recet years meas that the likelihood that we will ivestigate a complait about a doctor has icreased from oe i 68 to oe i 64 a year. We saw a particular icrease i complaits from patiets. The issues that they, as opposed to doctors, ted to complai about were the greatest areas of icrease sice last year. These icluded how doctors relate to patiets ad doctors opeess with patiets. I 2011, we received proportioally more complaits about me, older doctors ad GPs. This is cosistet with the patter of complaits i There is a cotiuig debate about the distributio of doctors across specialties, particularly whether we have a appropriate balace betwee specialists ad geeralists, ad if we have eough doctors i the right specialties to care for a ageig populatio. A small umber of doctors fell seriously short of the stadards expected of them. We erased 65 doctors i 2011, permaetly removig their right to practise medicie i the UK. Number of complaits received by the GMC ( ) , , ,195 5,168 5,773 * The Cabiet Office (2012) Fair Access to Professioal Careers: A progress report Lodo, The Cabiet Office, p4 Geeral Medical Coucil 4

5 Medical practice at differet stages of doctors careers (chapter 2) Doctors face differet challeges, which might affect their fitess to practise at differet stages of their careers. We ad others eed to uderstad these patters better to idetify areas where doctors may eed more tailored support. Patters i allegatios at differet stages of doctors careers There were three marked treds i the ature of allegatios that the GMC ivestigated i 2011 (see the figure o page 6). As time sice a doctor s qualificatio icreased, we eeded to ivestigate: a lower proportio of allegatios about probity a higher proportio of allegatios about cliical care, with a overall icrease that appears to coicide with the ed of traiig a higher proportio of allegatios about relatioships with patiets (maily issues relatig to doctors commuicatio skills ad how they iteract with their patiets). These treds are set i the cotext that the GMC received proportioally more complaits about older doctors overall. Stages i the medical career Before qualificatio medical studets ad doctors i traiig Male medical studets were more likely to face complaits about their coduct, ad female medical studets about their health. Place of qualificatio Where i the world doctors qualified did ot affect the overall likelihood of them beig complaied about, but it did affect the type of complait. Older iteratioal medical graduate doctors were more likely to be complaied about tha doctors i the same age group who qualified i the UK or the Europea Ecoomic Area. Doctors o the GP or Specialist Register How doctors gaied specialist or GP registratio did ot ifluece the likelihood of them beig complaied about. But the specialty they worked i affected both the volume ad type of complaits they faced. For example, psychiatrists, obstetricias ad gyaecologists, surgeos ad GPs were overrepreseted i the allegatios we ivestigated about relatioships with patiets. Doctors i service posts We eed to kow more about the support eeds of locum doctors ad specialty doctors, * who play a importat role i the UK s health systems. The itroductio of revalidatio, the process by which licesed doctors will regularly demostrate to the GMC that they are up to date ad fit to practise, should help. As part of revalidatio, plaed for the ed of 2012, all doctors will eed to submit a rage of evidece of professioal competece as part of their appraisal process. Revalidatio should also esure that these doctors have access to appraisals. I , just 54 of specialty doctors had a appraisal, compared with 74 of cosultats ad 90 of GPs. This was a improvemet, however, from , whe appraisal rates for specialty doctors were just 36. Health cocers Oly a very small umber of complaits were about doctors health. However, the majority of these related to substace misuse ad metal health. The type of health issues varied at differet stages of doctors careers. * Formerly kow as staff ad associate specialist SAS doctors. Subject to the Secretary of State for Health s approval. NHS Revalidatio Support Team (2012) Orgaisatioal Readiess Self Assessmet (ORSA) progress report Lodo, NHS Revalidatio Support Team, p30 Geeral Medical Coucil 5

6 Distributio of allegatios ivestigated about doctors by time sice primary medical qualificatio ( ) * 70 Profile of allegatios by stage of career Time sice PMQ (years) Cliical care Compliace with GMC ivestigatios Health Maitaiig good medical practice Probity Relatioships with patiets Teachig/supervisio Workig with colleagues * This aalysis is based o sapshot data, showig which allegatios were more likely to be made agaist certai groups of doctors at a fixed poit i time. It does ot track a particular cohort of doctors over the course of their career. Neither does it seek to coclude that we ca predict the fitess to practise issues that doctors are likely to face i the future. It is importat to emphasise that the aalysis compares proportios of allegatios withi each cohort of doctors, rather tha absolute umbers of allegatios ivestigated.

7 Doctors i the workplace (chapter 3) Medical practice is ot oly determied by the characteristics of idividual doctors, but ca be shaped ad iflueced by the cotexts i which they work ad trai. We ad others eed to uderstad better how orgaisatioal issues ad factors might ehace or costrai good medical practice. Where doctors work There was little differece i complaits across the four UK coutries ad health systems. There were some differeces betwee regios of Eglad i the type of allegatios the GMC ivestigated betwee 2007 ad 2011 South Cetral (Berkshire, Buckighamshire, Hampshire ad Oxfordshire) had the highest proportio of cliical care allegatios, ad Lodo had the highest proportio of relatioships with patiets allegatios. The orgaisatios i which doctors work ad trai Aalysis of GMC complaits data shows that, o average, smaller hospital trusts (those with fewer doctors) teded to have slightly higher umbers of complaits per doctor tha larger trusts. Although the differece i the umber of complaits per doctor betwee smaller ad larger trusts was relatively small, there was large variatio i the umber of complaits per doctor across trusts i the small ad medium groups. Workforce issues are cotiuig to impact o medical traiig ad practice. There is a growig body of evidece that patiet outcomes are worse o eveigs ad weekeds times whe there is less seior doctor cover. Ad, i some specialties, recruitmet difficulties are affectig both service provisio ad traiig, particularly esurig that doctors i traiig have access to adequate supervisio ad protected time for educatio. We foud a relatioship betwee reported satisfactio with cliical supervisio withi particular orgaisatios ad the volume of complaits to the GMC from those same orgaisatios. Orgaisatios where doctors i traiig reported below average satisfactio with cliical supervisio i the 2011 atioal traiig survey also had a higher proportio of complaits to the GMC (see the figure below). More ca be doe to support doctors to raise cocers if they feel patiet safety is beig put at risk. Employers must esure doctors are appropriately supported to speak out whe they see evidece of poor care. The patiets who doctors treat There cotiues to be evidece of poor care i the treatmet of the most vulerable groups such as childre, older people ad people with learig disabilities. We eed to uderstad more what drives these variatios i patiet experiece ad outcomes. This icludes lookig more closely for patters ad treds i complaits, so that we ad others ca get a clearer view o what improvemets ad support may be eeded. Number of complaits per 1,000 doctors i a orgaisatio compared with traiees satisfactio with cliical supervisio (2011 atioal traiig survey) Below average satisfactio 22.2 Above average satisfactio 17.6 Geeral Medical Coucil 7

8 Overcomig barriers to good medical practice (chapter 4) Overall, the state of medical educatio ad practice i the UK should be a cause for celebratio, while ever forgettig that there are further opportuities for improvemet. The GMC is committed to supportig doctors to provide the best possible care ad to reduce the umber who struggle to meet our stadards so that patiets are protected. The mai report explores some of the evidece aroud variatio i medical educatio ad practice. We have also idetified some potetial barriers to good medical practice that may be overcome with the right evidece, kowledge ad support. Below we set out four areas where we believe there is a eed for further debate ad actio to address these barriers. 1. The size ad shape of the medical workforce As the professio chages, so must its egagemet with wider society. There eeds to be: ogoig discussio to esure a shared uderstadig of what is expected of our doctors ad what support is required for them more flexibility withi medical careers to meet the chagig eeds of doctors i traiig, patiets ad healthcare providers more data to help doctors i traiig make decisios about their future role ad place of work, based ot just o their ambitios, but o the eeds of society ad gaps i service provisio. 2. The risig tide of complaits We eed to uderstad: what might lead to a complait what support doctors might eed which groups of patiets complai to the GMC, what they complai about, ad the eviromets from which complaits arise. 3. Tailorig support for doctors across their career We ad others eed to: esure that doctors have tailored support to help them overcome the challeges they face at differet stages of their career uderstad how the stadards we set ca be applied i a meaigful way to doctors day-today work ad provide more guidace ad advice. 4. Orgaisatioal factors affectig performace There eeds to be a better uderstadig of the eviromets i which doctors work ad trai, ad their impact o esurig high stadards of practice. As we cotiue to aalyse fitess to practise treds at a regioal ad a trust or board level, ad share these data with others, we hope to gai a better uderstadig of how orgaisatioal factors ca affect medical practice. Read the full report ad tell us what you thik about our fidigs at Read last year s report The state of medical educatio ad practice i the UK: 2011 at Published September Geeral Medical Coucil The GMC is a charity registered i Eglad ad Wales ( ) ad Scotlad (SC037750) Code: GMC/SOMEP2012-sum/0912 Geeral Medical Coucil 8

Complaints about doctors

Complaints about doctors Complaits about doctors This chapter sets out the types of complait received by the GMC ad how these complaits are resolved. Over the five years from 2010 14, complaits about doctors to the GMC icreased