Summary note of the meeting on 1 October 2015

UK Advisory Forums - Scotland Summary note of the meeting on 1 October 2015 Attendees Terence Stephenson, Chair Peter Bennie, British Medical Association Jason Birch, Scottish Government Paul Buckley, GMC Director of Strategy and Communication Catherine Calderwood, Chief Medical Officer David Carter, The Board for Academic Medicine for Scotland Niall Dickson, GMC Chief Executive Rachel Dunk, Scottish Government Tracey Gillies, Scottish Association of Medical Directors Stewart Irvine, NHS Education Scotland Mike Lavelle-Jones, Academy of Medical Royal Colleges and Faculties in Scotland Chris Kenny, Medical and Dental Defence Union of Scotland Gordon McDavid, Medical Protection Society Jim McKillop, GMC Council Robbie Pearson, Healthcare Improvement Scotland Ian Ritchie, Academy of Medical Royal Colleges and Faculties in Scotland Steven Wilson, Healthcare Improvement Scotland Victoria Carson, GMC Head of Scottish Affairs Willie Paxton, GMC Employer Liaison Adviser Others present Shane Carmichael, GMC Assistant Director, Strategy and Communication Catherine Evans, GMC Executive Policy Officer Ian Somerville, GMC Scottish Affairs Officer

Welcome 1 The Chair welcomed attendees to the meeting of the Advisory Forum in Scotland, and in particular Catherine Calderwood (Chief Medical Officer) Robbie Pearson (Healthcare Improvement Scotland) and Tracey Gillies (Scottish Association of Medical Directors), who all attended for the first time. Chair s introduction 2 The Chair thanked members for their ongoing support and emphasised the key element and purpose of the meeting was for the GMC to hear from those with a key interest in our work in Scotland and that the GMC valued the opportunity. 3 The Forum noted the feedback from the last meeting which was broadly positive, and that the GMC had acted on the feedback given, including the provision of more advance notice of meetings dates and the opportunity to influence the agenda. 4 The Chair reiterated his commitment as incoming Chair to focus on all four key areas of the GMC s work: registration, education, guidance and fitness to practise. The Forum noted that the GMC was pressing ahead with reforms to all four areas, including work on a single licensing assessment, making our guidance more accessible, and reforming our fitness to practise procedures. Updates on local priorities/ areas of interest or concern from Forum members 5 Forum attendees were invited to provide updates on their priorities. 6 During discussion, the Forum noted: a That this meeting would be Ian Ritchie s last as Chair of the Academy of Medical Royal Colleges and Faculties in Scotland (The Scottish Academy). He was accompanied to the meeting by Mike Lavelle-Jones, his successor as President of the Royal College of Surgeons of Edinburgh (RCSEd). b NHS Education Scotland s (NES) plans to appoint a new Chief Executive by the end of October. NES had also appointed two new Post Graduate Deans Professor Claire MacKenzie, NES East Region and Professor Ronald MacVicar, NES North Region. c That NES had implemented the first stage of its integrated IT systems, with systems like eportfolio and Soar now on one integrated management system. It was also acknowledged that the UK consensus around medical education was under strain and that there were challenges to retaining consensus. d A concern that a new NHS e-mail system being rolled out might have information security issues in terms of sharing confidential patient information. 2

e The ongoing work and value of the Scottish Clinical Leadership Fellows, and that each of the Ancient Colleges in Scotland sponsors one either full time or part time post. f The publication of the Scottish Academy s report on Serious Failings of care in Scotland, which was directed at the medical profession and how it might learn from lessons to improve care. g That the medical defence organisations continued to see an increase in the number and cost of claims, but that GMC fitness to practise reforms should see complaints processed more quickly. Differing disciplinary processes (with regard to employers) in Scotland compared to the rest of the UK were highlighted, and it was acknowledged that a review of the Scottish system could be beneficial. It was acknowledged that the GMC s disciplinary procedures were applied consistently across the UK, operate entirely separately to employers processes, and that employers should not wait for a GMC investigation to conclude before initiating their own procedures. h Support for the regulation of Physicians Associates. The GMC agreed that this group should be regulated and if asked to do so by the four governments of the UK would look seriously into the implications of regulating this group. i j That Healthcare Improvement Scotland s (HIS) annual review of revalidation in Scotland would be published at the next Revalidation Delivery Board Scotland on 20 October 2015. It was acknowledged that the first cycle of revalidation would end in 2016 and that the GMC was seeking views on making the process better and would consult on any future changes. That HIS and the GMC had signed a Memorandum of Understanding in March 2015. The GMC office in Scotland and HIS had jointly chaired a meeting to discuss the information that we hold with the aim of working towards the signing of an Information Sharing Agreement in late 2015/early 2016. 7 The Forum also discussed: a Confidentiality in the context of patient details being shared within non-healthcare organisations such as the Scottish Government. It was noted that the Chief Medical Officer s Clinical Leadership Fellow had been tasked with scoping out better internal guidance for Scottish Government staff. The GMC guidance for doctors Raising and Acting on Concerns about Patient Safety was cited as a useful basis which seemed to be used by other organisations. b Workforce issues in Scotland. Discussion points included: the challenges to various specialties; the strain on medical training; data on admissions of home fee undergraduates and the need to increase numbers from 800 to 1,000 per-annum; the Accelerated Graduate Entry; the impact on primary care and psychiatry and 3

the need to explore other solutions; the completion of processes around recognition of trainers; the impact in Scotland of junior doctor contract discussions in England; future changes to seven-day working; recruitment and retention within the NHS in Scotland. The Scottish Government suggested that it might be useful to invite someone from Workforce to future meetings. The Chair noted a misconception that the GMC had control of the number of doctors in specialties, while the GMC shared the concerns of others with regard to leavers, the solution was not within the GMC s control. c The Professionalism and Excellence in Medicine Group meeting hosted by the Scottish Government and Chaired by the Academy of Medical Royal Colleges. GMC update 8 The Forum received updates on key area of our work, including the Professional Accountability Bill (formerly Law Commissions Bill), the UK Medical Licensing Assessment (UKMLA) and the possibility of legislation from the UK government to abolish provisional registration and move the point of registration. Professional Accountability Bill (formerly Law Commissions Bill) 9 The Forum noted that the GMC shared the frustration of others in the UK that the Bill had not yet been introduced to the UK Parliament. While the UK Government had confirmed its commitment to reform, it was unclear whether it would be introduced in the second term of the UK Parliament. One criticism of the original Bill was that it was too lengthy. The GMC favoured a slimmed down Bill if it enabled a settlement to last a generation and allowed regulators to adapt. It was important that a future Bill allowed the GMC to speed up its fitness to practise procedures and reform the medical register. 10 It was noted that the defence organisations would like to see flexibility and predictability within any new system to allow them to improve their processes for doctors. The GMC noted the inflexibility of the current system, and ongoing work to speed up our investigations processes. 11 There was consensus amongst the Forum attendees on the need for the Bill and legislative reform, and it was noted that there was support from the devolved governments/ administrations in Scotland, Wales and Northern Ireland. Future work might be needed if the Bill was introduced to ensure that the devolved parliaments/assemblies in Scotland, Wales and Northern Ireland find consensus. 12 The Forum noted that if the Bill was introduced in the next session of the UK Parliament, the GMC would work in parallel to ensure that it could act when royal consent is granted but that implementing any reforms would approximately take an additional year bearing in mind the need for associated secondary legislation. 4

UK Medical Licensing Assessment 13 The Forum noted that the GMC Council had approved a plan to work with partners to develop a unified assessment for every doctor seeking to practise in the UK. Work on developing a model was ongoing and it was envisaged that the assessment would consist of a three part assessment; parts one and two to be taken during undergraduate training and part three to be taken after registration but within the first 18 months or so of practice. 14 It was envisaged that doctors entering the UK from European Economic Area countries would undertake part three of the assessment, and international graduates would take parts one and two in place of the current PLAB exam. 15 The Forum noted that: a There was general support amongst medical schools and educators in Scotland for the introduction of a UK Medical Licensing Assessment (UKMLA). b Subject to Council approval in June 2016, the GMC would consult on the plans in due course. Point of Registration 16 Linked to UKMLA, the Forum received an update on the possibility that the UK Government would propose abolishing provisional registration and moving the point of registration to the end of medical school. The Forum noted that the GMC s position remains that we do not object in principle to moving the point of registration but we do have significant concerns that would need to be addressed and could not favour any change that might impact adversely on patient safety. It was also recognised that the concerns could be mitigated by the introduction of a UKMLA. 17 The Forum noted that a change to the point of registration would make graduate entry programme degrees non-compliant with EU and therefore UK law. Professional Events 18 The Forum noted an update on a series of GMC promoting professionalism events being held across the UK. There were tentative plans to hold a quality improvement event in Scotland in 2016, and the GMC was keen to talk to Forum members about the title and content. 19 The Scottish Academy confirmed that it would be willing to collaborate. 5

Summary of Healthcare Improvement Scotland s consultation on Quality of Care Reviews 20 The Forum received an update on the HIS consultation on Quality of Care Reviews and noted: a That HIS is seeking to establish a more rounded and proportionate review of scrutiny. b That HIS is an improvement organisation and not a regulator. Its ongoing work aims to build a more coherent narrative for scrutiny, reconcile specific reviews with broader and more comprehensive assessments, and share intelligence and the thresholds that trigger intervention in a systematic way. c The goal of HIS is to ensure people are confident that every part of the health and care system delivers high quality care, and people are assured that appropriate processes, systems and culture are in place to support continuous improvement and to deliver sustainable quality services. d The proposals set out included: a new framework to assess and improve the quality of care; the establishment of more comprehensive assessments of the quality of care; independent and objective external assessments of the sustainability of care, and; an increased emphasis on local systems of scrutiny and assurance. 21 During discussion, the Forum noted: a That despite the fact that HIS has scrutiny and report producing functions; it is not a regulator has and has no improvement or enforcement powers. The Scottish Government has accountability. b Comparisons with the Care Quality Commission (CQC) model, in which improvement is increasingly being talked about. The CQC is also exploring how it might assess quality in a particular healthcare economy, looking at how the totality of the system works for the patient. HIS confirmed joint work with the Care Inspectorate could add value with the integration of health and social care in Scotland where joint work possibilities exist, for example joint inspection teams or joint commissioning. c HIS confirmed a need to get away from a system in which improvement followed scrutiny to a system of continuous improvement there was a need to work with healthcare organisations at an earlier stage. d That while there is no tool to measure organisational culture, there were a range of indicators and HIS is generally aware when culture deviates. The Chair noted that within organisations cultures can deviate from ward to ward, and that there is a danger of thinking about a monolithic institutional culture. 6

e That HIS is getting more confident in relation to the indicators on doctors in training provided by the GMC and the quality of care associated with that. They are getting more confident and open in terms of sharing intelligence, including soft intelligence. f That the CMO recognised there was a role for the principles of professionalism and excellence. Forum attendees were called on to propose solutions to quality of care problems, rather than drowning in a sea of data. g A suggestion from the Scottish Academy around whether a solution would be for the development of a resource whereby someone went into an organisation and asked them what the problems were and what help they needed, noting that it was simplistic but everything else had failed. HIS confirmed that the problem at the front-line was one to think about. Using the data we have on doctors to minimise risk to patients 22 The Forum received a presentation on how the GMC is using its data to improve its regulatory functions and how it assures standards of medical education and practice. 23 The Forum noted the GMC s ambition to make the best use of the data that we hold, and our activity in this area, including: a The focus on environment and education, and career paths. b Looking at patterns of Fitness to Practise complaints, for example where there are doctors with a number of low-level complaints, using data to target early intervention could be beneficial before something more serious develops. c Developing plans to ensure the Register is more up-to-date, usable and reliable. By the end of 2015/early 2016 the following will be noted on the List of Registered Medical Practitioners: doctors who are trainees, their specialty, and their Deanery/ Local Education and Training Board (LETB); doctors who are GP trainers; the Responsible Officer and Designated Body for each doctor. d Considering how we use the National Training Survey for early warnings, using data to help flag up issues. e Plans to publish a discussion document setting out these proposals. The GMC also wants to make its data more accessible externally, recognising we should be the guardian rather than the custodian of the data we collect. 24 During discussion, the Forum noted: a Its support of the proposed developments, noting the need for a more mature approach to the use of data. The GMC is keen to work with the Royal Colleges and 7

with others, including on developing a taxonomy for scope of practice information to ensure it gets things right. b That individual doctors data would remain confidential, however changes would be made to understand what early warning systems are, allowing it to feed back to individual doctors or on a system-wide basis. c That there is a need to ensure greater working between partners and welcomed the Sharing Intelligence for Health and Social Care Group in Scotland as an example of good practice. The GMC confirmed it remains committed to working with bodies where problems have been identified to promote professionalism and GMC supporting guidance for the medical profession. Any other business 25 The Chair confirmed is the GMC s commitment to four-country regulation. 26 The Chair thanked attendees for their attendance, and noted the date of the next meeting on 14 March 2016. 8