general medical council · 7/8/2020 · council meeting, 8 july 2020 agenda item m2 – minutes of...

General Medical Council

Working with doctors Working for patients

Council Meeting - 8 July 2020

MEETING8 July 2020 09:00

PUBLISHED1 July 2020

Council seminar and meeting, 7-8 July 2020

Council Agenda

Via MS Teams

Wednesday 8 July 2020

09:55 – 12:00

09:55 – 09:58

3 mins

M1 Chair’s business

09:58 – 10:00

2 mins

M2 Minutes of the meeting on 23 April 2020

10:00 – 10:15

15 mins

M3 Chief Executive’s Report

10:15 – 10:30

15 mins

M4 Equality, diversity and inclusion – oral update

10:30 – 10:35

5 mins

BREAK

10:35 – 10:50

15 mins

M5 Report of the MPTS Committee

10:50 – 11:00

10 mins

M6 Complaints report

11:00 – 11:15

15 mins

M7 Report of the Audit and Risk Committee

11:20 – 11:30

10 mins

M8 Trustee’s Annual Report and Accounts 2019

11:30 – 11:35

5 mins

M9 Fitness to Practise Statistics Report 2019

Council seminar and meeting, 7-8 July 2020

2

11:35 – 11:50

15 mins

M10 Annual update on communications and engagement

11:50 – 12:00

10 mins

M11 Any other business

Below the line M12 Freedom To Speak Up Guardian annual report

Contents

Page

M2 - Minutes of the meeting on 23 April 2020 5

M3 - Chief Executive's Report 15

Annex A - Council Portfolio 23Annex B - Corporate Opportunities Risk Register 34

M5 - Report of the MPTS Committee 37

Annex A - Hearing outcomes 44

M7 - Report of the Audit and Risk Committee 47

Annex A - Evaluation of Internal Audit performance 56Annex B - External Quality Assessment 62Annex C - Head of Internal Audit Annual Report 81

M10 - Annual update on communications and engagement 93

Annex A - Communications and engagement data 102

M12 - Freedom to Speak Up Guardian annual report 111

Annex A - Freedom To Speak Up Report 115

4

To approve

Minutes of the meeting held on 23 April 2020, via skype

Members present

Clare Marx, Chair

Steve Burnett

Christine Eames

Philip Hunt

Alison Wright

Rajesh Patel

Deirdre Kelly

Paul Knight

Suzi Leather

Denise Platt

Amerdeep Somal

Others present

Charlie Massey, Chief Executive and Registrar

Paul Buckley, Director of Strategy and Policy

Una Lane, Director of Registration and Revalidation

Colin Melville, Director of Education and Standards

Anthony Omo, Director of Fitness to Practise and General Counsel

Paul Reynolds, Director of Strategic Communications and Engagement

Neil Roberts, Director of Resources and Quality Assurance

Melanie Wilson, Council Secretary

Council meeting – 8 July 2020

Agenda item M2

Minutes of the meeting on 23 April 2020

5

Council meeting, 8 July 2020

Agenda item M2 – Minutes of the meeting on 23 April 2020

Chair’s business (agenda item M1)

1 The Chair welcomed members and the Senior Management Team to the

meeting.

2 Apologies were received from Anthony Harden.

3 Council paused to reflect on the recent passing of Dame Denise Coia who co-

chaired the ‘Caring for doctors, caring for patients’ review with Michael West

which has already had an extremely positive impact.

4 Council also took a moment to reflect on the doctors and other members of the

frontline healthcare system who have lost their lives due to the COVID

pandemic and remembered with gratitude their contribution.

Minutes of the meeting on 26 February 2020 (agenda item M2)

5 Council approved the minutes of 26 February 2020 as a true record, with an

amendment to clarify that Denise Platt and Neil Roberts attended via skype.

Chief Executive’s Report (agenda item M3)

6 Council received the Chief Executive’s report, the Council portfolio and Corporate

Opportunities and Risk Register.

7 Council noted:

a Almost 35,000 doctors have been granted temporarily re-registered under

emergency powers, to assist with the pandemic. In addition, 7,500 final year

medical students have been granted Provisional Registration several months

earlier than usual.

b An ‘ethical hub’ has been launched on the GMC website which has been well

received and utilised by the profession. It provides guidance on key current

topics such as health and wellbeing, working safely, remote consultations,

decision making and consent, and confidentiality and social media.

c Revalidation has been deferred for 12 months for doctors due to revalidate

before the end of September; this will be examined again in December for

further consideration.

d The GMC is running on a home-working basis, and our offices have been

closed but for a small number of essential visits. 120 employees have signed

up to volunteer and will be supported to do this.

6



e The organisation’s financial position has not been significantly impacted due

to COVID-19. The Investment Committee are monitoring the markets

closely.

8 During the discussion Council noted:

a We are not able to register refugee doctors who have not yet sat PLAB, as

their medical competence cannot be judged, though our understanding is

that the numbers involved are far lower than some of the press reports.

b Despite a number of requests, we have struggled to get robust data on the

number of temporarily re-registered doctors who have actually been

employed. At the time of the meeting, our understanding was that

approximately 3000 of the re-registered doctors have been deployed to be

available the frontline.

c The GMC could not support calls for blanket immunity in fitness to practise

cases as a result of COVID-19 as it would remove a patient’s ability to raise

a concern, but we have committed that when concerns are raised the

context will be considered.

d Concerns are increasing in relation to the likelihood of non-COVID illnesses

causing an excess level of mortality as patients are not seeking help

currently.

e ARC recommended CORR should be streamlined to thematic risks. Additional

risks are still captured in the Resources Risk Register.

9 Council:

a Considered the Chief Executive’s report.

b Noted the Council portfolio and Corporate Opportunities and Risk Register.

The Professional Standards Authority’s annual review of our performance

2018/19 (agenda item M4)

10 Council received an update on the Professional Standard Authority’s annual

review of the GMC’s performance in 2018/19 against the standards of Good

Regulation.

7



11 Council noted:

a The GMC met all 24 standards of Good Regulation.

b The PSA has updated its assessment framework to include five new close-

cutting Standards that will apply from the 2019/20 review.

c The current environment has been challenging but the GMC have been

engaging with the PSA on a weekly basis updating them on our response to

the current emergency situation.

d The PSA have announced Dame Glenys Stacey DBE as their new Chair who

took up her post on the 1 April 2020.


a Collaborative work was currently being conducted with other medical

regulators to introduce guidance on remote prescribing.

b Clare Marx and Charlie Massey had a positive meeting with the new Chair of

the PSA, reflecting on the GMC’s response to the pandemic.

13 Council:

a Noted the PSA’s review of our performance against the Standards of Good

Regulation for the 2018/19 period.

2019 Human Resources and Gender Pay Update (agenda item M5)

14 Council received an update on the 2019 Human Resources and gender pay

report.

15 Council noted:

a The data from the 2019 reporting cycle shows that GMC employees continue

to enjoy a good working environment.

b 2019 showed a slight increase in sickness levels to an average of 7.9 days,

which is above the CIPD (Chartered Institute of Personnel and Development)

average but below the public sector average.

c Mental health related issues were the main reason for absence with 31.8%

of all absences being as a result of mental health.

8



d BME recruitment was higher than the previous year; 20.4% of all job offers

were made to BME candidates in 2019. The team has continued to develop

the recruitment process and training support to broaden the intake.

e The three workstreams (wellbeing, workload and change management)

which came about from the staff survey, have been progressing well and

feedback on the work completed has been positive.

f The 2020 staff survey is due to be launched in June, with a report coming to

Council in the autumn.


a An extensive work programme regarding mental health has been created;

with an employee led network, training for staff and managers and regular

events running throughout the year.

b Illness caused by COVID-19 has had a relatively low impact on our absence

rates to date however it is expected that absence figures may increase. The

SMT will fully support managers through this process.

c Protected characteristics data is collected at every opportunity; currently the

HR report highlights gender pay-gap reporting, with other protected

characteristics information included in the annex to the report.

d The gender of staff is approximately a 50/50 split, however females at senior

level makeup only approximately 40%. Further work is doing done on this to

close the gap.

e We don’t currently provide Council with a review of the social mobility of

staff but do collect the information, so will be able to bring a report to

Council in the future.

f The LGBTQ network is working closely with HR to review internal policies

and promote the GMC as an employer

g The profile of our workforce is less diverse than the local employment

market in Manchester and London. We are working on targeted recruitment

and will adapt the initiatives used to promote female colleagues to increase

the BME workforce.

9



17 Council:

a Noted the 2019 Human Resources and gender pay reports.

Welcome to UK practice progress report (agenda item M6)

18 Council received an update on the progress made in the delivery of Welcome to

UK Practice (WtUKP) workshops and discussed the impact that COVID-19 had on

the progress of the delivery.

19 Council noted:

a COVID-19 has resulted in the cancellation of workshops until at least 30

June 2020. Online delivery is currently being considered.

b Legal advice is that WtUKP cannot be made mandatory. The team is working

with the Registration and Revalidation Directorate to align WtUKP with ID

checks which is an expectation prior to registration.

c In 2019 around 1000 doctors cancelled or failed to attend the booked

workshop. Further work will be done to understand the reasons behind this.

d In Northern Ireland the Chief Medical Officer has mandated the workshop as

part of induction to the profession.

e In Wales, the CMO expressed support for making WtUKP a standard part of

the induction process.

f In Scotland, conversations with key stakeholders are still ongoing.

Workshops have been scheduled in Edinburgh as a result of targeted

engagement.

g In England, HEE anticipate recruiting 623 doctors in 2020/21 through

schemes where WtUKP would be a recommended part of induction.

h In light of COVID-19, the team is developing a pandemic-specific e-Learning

module as a refresher to those already working on the front line.


a KPIs measuring participant satisfaction or impact scores will be added to the

measures in relation to WtUKP sessions.

10



b Rebranding for the purposes of highlighting the four countries element will

be revisited.

c 62% of doctors changed an element of their practise as a result of attending

one of the WtUKP sessions.

21 Council:

a Noted the progress for the WtUKP expansion project.

b Agreed the proposed success criteria for delivery and development in 2020.

c Noted the intervention’s place in the next corporate strategy.

The MLA – approach to the statutory determination and its annexes for

publication (agenda item M7)

22 Council received an update on the approach to the statutory determination and

its annexes for publication.

23 Council noted:

a Although there is no formal requirement to consult stakeholders when a

statutory determination is issued, due to the collaborative approach taken

the GMC’s plan is to engage with all relevant stakeholders.

b Engagement with medical schools has already occurred, with elements of

the statutory determination which includes polices and content being

drafted.

c The pandemic has created challenges, which have caused a significant delay

in the delivery of the MLA programme.


a Prior to COVID-19, the plan was to contact medical schools and ask their

views on the process; either to engage now and allow the publication of the

statutory determination as planned or to engage at a later stage when the

details have been finalised.

b Due to the pandemic, medical schools have understandably prioritised the

day to day running of their courses and further engagement on the MLA at

this time may be challenging.

11



c The GMC will use this delay to explore the impact of rescheduling the

original timeline and the potential to achieve a shared outcome.

25 Council:

a Approved the approach to developing the statutory determination.

b Noted the impact of COVID-19 to the MLA’s delivery timetable and potential

need to reschedule full implementation of the MLA.

Section 40a appeals update (agenda item M8)

26 Council received an update on the S40a appeals received before the Executive

Panel.

27 Council noted:

a The Panel met to consider the cases of 19 doctors and decided to appeal

five cases.

b Two appeals from the previous report were accepted by the High Court. As a

result one doctor will be erased from the register and the other case will be

remitted back to a tribunal.


a The PSA not joining the GMC in an appeal does not mean that they do not

support the appeal. The PSA only join an appeal if they feel there is an

additional point to be made.

b Further discussions will be held with the new Chair of the PSA regarding the

appeals process and how it will be considered going forward when the GMC

loses its right to appeal.

29 Council:

a Noted the update in the report.

Four countries update (agenda item M9)

30 Council received an update on the strategic approach to the GMC’s work in the

four countries.

12



a Over the previous six months, the teams have carried out a range of

meetings with parliamentarians and key stakeholders to report on the work

of the GMC.

b Arranging meetings with small and targeted audiences was deliberate to

assess the needs of stakeholders in the four countries and offer a platform

to support where necessary.

c The work programme has been adapted in light of the pandemic and work

will be prioritised to areas that need it most. This has resulted in the March

UKAFs being cancelled.


a The survey results in the south and south east of England were slightly less

positive. Work will be undertaken by the outreach team to engage with

stakeholders in that area to promote stakeholders’ understanding of the

GMC’s work.

b The team will provide comparative data on how the GMC is observed

compared to other regulators.

c Nation-specific reports are planned by the end of 2020 which will report on

the work and activities of the GMC.

d An update from the meetings with each of the four countries setting out the

activities and impact of our work would be beneficial for Council to receive.

32 Council:

a Considered the progress to date on our four-country engagement work and

how we are flexing our approach to the external environment in light of the

pandemic.

Any other business (agenda item M10)

33 Council noted:

a Its next meeting will be in July, however it is still to be decided if this will be

virtual or in person.

13



Confirmed:

Clare Marx, Chair 8 July 2020

14

Action To note

Purpose This report outlines developments in our external environment

and progress on our strategy since Council last met. Key points to

note:

We are planning to restart key services such as our PLAB

examinations and MPTS hearings that cannot be held

virtually, as soon as it is safe to do so;

In light of the disruption caused by the pandemic, we have

worked with the Royal Colleges to agree derogations to

enable the vast majority of trainees to progress through

specialty training. We are also considering proposals for

assessments for Certificates of Completion of Training which

maintain standards;

We continue to work closely with all four Governments of the

UK and our healthcare partners to ensure that the UK has the

healthcare workforce it needs in the months and years

ahead.

Decision trail Council receives this report at each full meeting.

Recommendations a To consider the Chief Executive’s report.

b To note the Council portfolio and the Corporate Opportunities

and Risk Register.

Annexes Annex A: Council Portfolio

Annex B: Corporate Opportunities and Risk Register

Author contacts Tim Swain, Head of the Office of the Chair and Chief Executive,

[email protected], 020 7189 5317

Sponsoring director Charlie Massey, Chief Executive,

[email protected], 020 7189 5037

Council meeting – 8 July 2020

Agenda item M3

Chief Executive’s Report

15

mailto:[email protected]:[email protected]


Agenda item M3 – Chief Executive’s Report

Restarting key services

1 As the lockdown begins to ease, we are planning to resume some of our key

services in a way that is safe to do so. This includes our PLAB examinations

which enable international medical graduates to join the GMC register, our

fitness to practise investigations and those MPTS hearings that cannot take

place virtually.

2 PLAB 1 - the first of the two-part test for overseas doctors - is still going ahead

in four UK locations. We are doing everything we can to get the second part of

the test up and running too by looking again at the format and length of the

test, how we can create more space in our current centre or whether other

venues could offer an environment that allows us to comply with government

guidelines.

3 We believe that there are approximately 240 doctors who are currently in the

UK and are waiting to sit PLAB 2. We are prioritising these doctors and hope to

be able to accommodate them in a series of pilot exams run in August.

4 We have agreed to recommence open and new fitness to practise

investigations, subject to the availability of Responsible Officers (ROs). We have

also agreed to revisit our thresholds to ensure we are concentrating our

investigation efforts on the most important cases.

5 From the beginning of August, the MPTS will hold a small number of socially

distanced hearings in its Manchester hearing centre. It will also continue to hear

cases virtually, ensuring it continues to make independent decisions that protect

the public.

Black Lives Matter

6 The murder of George Floyd in America and the impact of the coronavirus

pandemic have rightly raised many concerns about inequalities in society. Like

many, I have been deeply moved by recent events.

7 Both as a regulator of the medical profession and an employer we have a

responsibility to take note, and to take action, to address continuing injustice

and inequality. While I am proud of much of our work in this area, there is

more we need to do.

8 Our Chair, Dame Clare Marx, has written to the profession setting out our

commitment to work to reduce inequalities. This builds on our Fair to Refer?

report published in June 2019 which looked at why some groups of doctors are

referred to us for fitness to practise concerns more, or less, than others by their

16

https://www.gmc-uk.org/news/news-archive/dame-clare-marxs-message-to-the-professionhttps://www.gmc-uk.org/-/media/documents/fair-to-refer-report_pdf-79011677.pdf



employers and what can be done about it. We are determined to work with

others to take forward the recommendations of this vital work. This must mean

that engaged, positive and inclusive leadership is more consistent across the

NHS and induction, feedback and support improved for doctors new to the UK.

9 We have also engaged extensively with GMC staff, and particularly BME

colleagues, on what we should be doing within the GMC. I recognise that we

have much more to do, particularly in terms of diversity of representation at

senior levels, as well as supporting better progression and retention of BME

staff. We will continue to work in an inclusive way with colleagues on this and

will use the forthcoming staff survey to build a stronger evidence base.

Education and Training

10 We are considering the wider implications of the impact of Covid-19 on the

future of education and training.

11 For current trainees, we have worked with colleges to agree derogations to

enable their progression through specialty training and have agreed to the vast

majority. These will allow continued progression without having completed all of

the normal steps in some cases, on the basis that there is subsequent

summative assessment, so the progression does not represent a risk. Where

there are any concerns around patient safety, we have been clear that there

cannot be progression.

12 We are now considering the proposals being developed for assessments for

Certificates of Completion of Training (CCTs). In these, we have been clear that

whilst we absolutely need to maintain the same standards, with the same

competencies being addressed, we are flexible in how these are assessed as

long as standards and patient safety are maintained. We have developed an

accelerated curricula approval process which will allow quicker decisions on

changes, which nonetheless have the opportunity to be considered by experts.

13 As part of this, we want to consider whether the changes that are made should

be only for the duration of the emergency or for the longer term, in order to

ensure that we do not miss the opportunity to improve judgements around how

trainees meet our outcomes.

14 We have also decided to go ahead with the National Training Surveys and

intend to conduct them in late July and early August. The surveys will this year

have a reduced question set focused on training experiences during the

pandemic and will be open to both trainees and trainers on a voluntary basis.

The surveys are an opportunity to understand not just the challenges

17



experienced during the crisis but also the positives that might have emerged

around team-working and leadership.

Revalidation

15 On 3 June 2020 we wrote to the Chief Medical Officers of the four countries to

update on our plans for revalidation for the rest of 2020 and into 2021.

Following positive feedback about making further change, doctors with

revalidation dates between 1 October 2020 and 16 March 2021 will have their

dates moved back by one year.

16 To give ROs more flexibility when making recommendations, all doctors whose

dates have been moved as part of the response to the pandemic will also be

put under notice. This means ROs can submit recommendations to revalidate

these doctors at any time up to their new submission date.

Workforce challenge

17 As well as the immediate recovery from the COVID-19 pandemic, the healthcare

system needs to prepare for its medium and potential long-term effects. While

much of this is uncertain, it is likely that workforce challenges in the UK will

become more acute in the period ahead.

18 The restrictions on international travel and the relatively high levels of Covid-19

in the UK have suppressed the flow of international doctors into the UK, and

this may yet become a permanent shift.

19 While we have successfully registered almost 30,000 additional doctors using

our emergency powers, we know that actual deployment into the NHS so far

has been low. While this is a positive in the sense that that capacity was not

required during the first peak of the pandemic, this cohort remain important as

the NHS works through the backlog of treatment, as well as prepares for the

winter, at a time when fewer international medical graduates are likely to be

available to work in the UK.

20 The experience of the pandemic also reinforces the importance of the main

themes of our Supporting a Profession Under Pressure work. This includes the

need to focus on compassionate and inclusive leadership and improving the

working environment for doctors and other healthcare professionals. These will

be critical in terms of workforce retention in the months and years ahead.

18



Brexit

21 The UK has confirmed that it will not request an extension to the transition

period. The transition period will therefore end on 31 December 2020, in line

with the provisions of the Withdrawal Agreement.

22 The status of the mutual recognition of professional qualifications (MRPQ) is a

matter for the trade negotiations taking place between the UK and EU. The UK

Government has published its preferred option for the recognition of

professional qualifications in any deal and we have raised some concerns with

its approach. We are working with the Department of Health and Social Care

(DHSC) and the Department for Business, Energy and Industrial Strategy (BEIS)

to support an approach which enables us to continue to register doctors with

qualifications from the European Economic Area (EEA) in a timely and

streamlined way and protects patient safety.

23 In the event that no trade deal is agreed, there are ‘no deal’ regulations on the

statute book which permit the continued automatic recognition of EEA qualified

doctors for two years after the end of the transition period. However, we need

to plan for scenarios where this timeline is brought forward and are in

discussions with officials at the DHSC and BEIS about how we could move EEA

doctors onto the established IMG route to GMC registration.

24 We are also continuing to work with officials and our international medical

regulatory counterparts to ensure that patient safety is recognised and

protected in any future trade agreements signed between the UK and third

countries.

Changes to the combined programme route to specialist and GP

registration

25 In 2019, Council approved a decision of the Executive Board to begin issuing a

Certificate of Completion of Training (CCT), rather than a Certificate of Eligibility

for Specialist Registration (CESR) or Certificate of Eligibility for General Practice

Registration (CEGPR), to some doctors on the combined programme. The

combined programme is a route to specialist and GP registration which allows

doctors to enter an approved training programme above the first year, by

acknowledging training and/or experience gained outside of a UK training

programme. Approximately 120 doctors a year gain specialist or GP registration

through this route.

26 This change, introduced in May 2020, applies to doctors on the combined

programme who have completed the minimum amount of time training in the

19



UK for their specialty (as defined in the Recognition of Professional

Qualifications Directive 2005/36/EC). We are also retrospectively awarding CCTs

on request to eligible doctors who were previously issued with a CESR/CEGPR

through the combined programme. These changes have been welcomed by our

stakeholders and are part of our work to improve the flexibility of postgraduate

medical education and training.

27 In order to begin issuing CCTs as quickly as possible to the cohort of doctors

outlined above, we only considered the specialties listed under the Directive.

However, we have now commenced work on phase two of the project, looking

specifically at doctors who trained in specialties not listed under the Directive,

and for who there is no specified minimum training time. Our aim is to begin

awarding a CCT rather than CESR/CEGPR to these doctors as well (including

retrospectively awarding a CCT on request).

28 While we remain bound by European legislation, we are unable to award a CCT

to a trainee who does not meet the minimum training time requirement for their

specialty, and must continue to award a CESR/ CEGPR. We intend to look again

at the combined programme after the implementation period of our exit from

the European Union has ended, and we have clarity over trade deals and

legislation, in order to try and help this final cohort of doctors on the combined

programme.

Legislative reform

29 We continue to work closely with the UK Government as they introduce

statutory regulation of physician associates (PAs) and anaesthesia associates

(AAs) – or ‘medical associate professions’ (MAPs) – by the GMC. We are making

good progress in developing the policies, processes and systems we will need

when we start regulating, which is likely to be towards the end of 2021.

30 The Government are also exploring options for wider legislative reform to our

functions on fitness to practise, governance, registration and education. We

welcome the commitment to doing so and are keen that the new legislative

framework will provide greater flexibility to amend our rules and guidance in the

years ahead, as well as providing greater discretion over the types of cases we

investigate.

31 A key issue is reform of specialist and GP registration including the CESR /

CEGPR pathway. This will allow us to develop a more flexible, streamlined and

accessible approach to registration and support the availability of doctors for

consultant and GP posts in the NHS. As well as supporting the workforce, this

would also enhance career progression opportunities for our speciality and

20



associate specialist (SAS) doctor community, many of whom are from BME

backgrounds.

32 Another key area of concern is the five-year rule in relation to fitness to practise

investigations. This states that a case cannot usually be investigated if the time

elapsed between the events giving rise to concern and their first being reported

to the GMC is more than five years. I have made clear that we want to be able

to investigate cases on the merits of evidence and not on arbitrary time-limits.

With wider legislative reform, this is the type of rule that we would have the

power to change.

The Independent Medicines and Medical Devices Safety Review

33 The Independent Medicines and Medical Devices Safety Review is due for

publication on 8 July 2020. The review is led by Baroness Julia Cumberlege and

follows patient-led campaigns on the use of hormone pregnancy test Primodos,

the anti-epileptic drug sodium valproate for women and girls of child bearing

age and the use of synthetic mesh in abdominal and vaginal pelvic mesh

procedures.

34 The review covers England only, although we are aware of the strong concerns

about mesh procedures elsewhere, particularly in Scotland. We will study the

report and its recommendations closely and are committed to playing our part

in addressing the issues raised by the review.

Personal Protective Equipment

35 We have been concerned by reports about the availability and adequacy of

personal protective equipment (PPE) for doctors and healthcare workers,

particularly during the peak of the pandemic.

36 Our guidance to doctors about practising during an emergency is based on the

principles of Good Medical Practice and provides a framework for ethical

decision-making. Our guidance is clear that we do not expect doctors to leave

patients without treatment, but we also don’t expect them to provide care

without regard to the risks to themselves or others.

37 In our communications to the profession we have been clear that the current

exceptional circumstances will be taken into account should we receive a

complaint about a doctor. But we have also maintained, I believe rightly, that

we cannot make a definitive statement about what we would or would not

investigate.

21



Executive Board

38 The Executive Board met on 27 April and 1 June 2020 to consider items on:

a COVID-19 response, impact and recovery across the business.

b High level reports on performance, including finance and people, customer

service and learning, and updates on the key risks to achieving our

strategic aims. Data on performance and risk is set out in the annexes to

this report.

c The draft Trustees’ annual report and accounts 2019, along with the

Fitness to Practise annual statistics report, ahead of consideration at this

meeting.

d The biannual review of customer complaints, also ahead of consideration

at this meeting.

22

M3 – Annex A

Council portfolio

Data presented as at 30 April 2020 (unless otherwise stated)

Commentary as at 15 June 2020

Council meeting, DATECouncil meeting, 8 July 2020

M3 – Chief Executive’s Report

23

Operational Key Performance Indicator (KPI) summary Core regulatory object ive Key Performance I ndicator Performance Except ion summary

March April

We decide which doctors are

qualified to work here and we

oversee UK medical education and

training.

Decision on 95% of all registration applications w ithin 3

months 97% 99%Registration and Revalidation missed KPI ’s:• Temporary registration opt-out campaign created a significant

increase in call volumes (23.8% higher for Mar-Apr compared

w ith the prev ious year). Coupled w ith the transition to home

work ing and staff caring responsibilities follow ing school

closures the target was missed in March but recovered in

April. Call volumes expected to remain high.• Changes to revalidation dates made in March impacted the

usual profile and volume of expected recommendations

processed in April. As a result of the deferral of dates we

processed a much lower volume of decisions than usual and

the exceptions w ithin this had an exaggerated impact on the

overall target.

Fitness to Practise missed KPI s:• Target was missed due to a range of concurrent factors

including case type and complexity and staff availability .

Forecasts• Forecast summaries have been removed for this report given

the significant uncertainty and disruption to processes. As an

outcome of our Recovery Planning Task force we w ill consider

work back logs and longer-term impacts on our KPI

performance.

Answer 80% of calls w ithin 20 seconds69% 83%

We set the standards that doctors

need to follow, and mak e sure

that they continue to meet these

standards throughout their

careers.

Decision on 95% of all revalidation recommendations

w ithin 5 work ing days 98% 42%

Respond to 90% of ethical/ standards enquir ies w ithin 15 work ing days 96.5% 97.7%

We tak e action to prevent a

doctor from putting the safety of

patients, or the public's

confidence in doctors, at r isk .

Conclude 90% of fitness to practise cases w ithin 12

months 92% 89%

Conclude or refer 90% of cases at investigation stage

w ithin 6 months 91% 93%

Conclude or refer 95% of cases at the investigation

stage w ithin 12 months 95% 95%

Commence 100% of I nvestigation Committee hearings w ithin 2 months of referral No cases 100%

Commence 100% of I nter im Order Tribunal hearings

w ithin 3 weeks of referral 100% 100%

Business support area Key Performance I ndicator Performance Except ion summary

March April

Finance 2019/ 20 I ncome and expenditure [ % variance]2.71% 3.51%

Finance • Cancelling PLAB 2 test days resulted in a loss of income in

March, however there has been a reduction in expenditure

related to staging the test days. The cancellation of hearings

and halting of most travel and expenses in March resulted in

a greater drop in expenditure compared to income.

HR • Low volumes of external moves which is expected to continue

over the course of the pandemic.

HRRolling twelve month staff turnover w ithin 8-15% 7.27% 6.88%

I nformation systems I S system availability (% ) – target 98.8%

99.98% 99.97%

Media monitor ing Monthly media score823 274

A224

Strategic delivery – overall view

Delay / issue in

delivery –

overall

objective or

deadline at

r isk

Delay / issue in

delivery but

overall

deadline or

objective on

track

On track

Doctors are supported to

deliver high quality care

Doctors have a fulfilling/

sustained career

Enhanced trust in our role

Enhanced customer

service

UK workforce needs

better met

Improved identification of

risk

Right response by the

right organisation, at the

right time

Smarter Regulation’

1 . Supporting doctors in

deliver ing good medical

practice

2 . Strengthening

collaboration with regulatory

partners.

3 . Strengthening our

relationship with the public

and the profession

4 . Meeting the change needs

of the health services across

the four countr ies of the UK

Maintenance of a

coherent model of

regulation across the UK

We are well prepared for

and can influence

legislative change

Contribute to public

confidence in doctors

Increased confidence in

the quality of training

environments

Public confidence in GMC

Enhanced perception of

regulation

Corporate Strategy 2018-2020

As part of our recovery planning we’re reviewing our plans for this year to ensure our approach remains the right one. While

we do this, we’ve paused a range of projects to limit the impact that these may have had on stakeholders’ time and

resources. We are continuing as much as possible to continue to bring Medical Associate Professionals into regulation,

introducing a Medical Licensing Assessment, and preparing for Brexit. The diagram below shows the key benefits of the 2018-

2020 Corporate Strategy. The RAG ratings indicate our progress with delivery of these continuing projects but does not include

paused project updates. More detail on exceptions is on Slide 4.

A3

These RAGs are based on delivery of

strategic benefits env isioned in the GMC

Corporate Strategy . While they may be

affected by external issues and challenges

they w ill not, as a necessity , reflect in all

cases external opinion at that point in time

as they are future focussed on benefit

delivery and the GMC contr ibution to that

delivery .

25

Strategic delivery (by exception - reported for May)

Strategic aim 1: Supporting doctors in delivering good medical practice

Key benefit Act ivit ies to deliver (by except ion)

Lead indicators Lag indicators

Doctors are supported to deliver high quality care

1. Perceptions Q - % public are confident in UK

doctors

2. MORI poll

Ongoing discussions about the MLA’s governance, and—more recently—the need to respond to COVID-19, have affected progress. Work in several areas

remain on track. But we need to review and possibly reschedule other tasks. There are particular issues for work strands that assume the involvement of

medical education colleagues: for example, recruiting associates to operational panels and engaging with medical schools’ parent universities. As this

review has the potential to impact on the overall programme plan, we recommend that the programme remains at amber.

A4

Medical Licensing

Assessment

Consensus on proposals for the Applied Knowledge Test

Our plans to prepare the business for EU exit were completed in advance of 31 January 2020. Policy, guidance and operations were updated, together with

a communications plan as part of efforts to ensure that EU exit does not have an adverse impact on our operations. The rating therefore reflects the

uncertainty that remains despite the fact that the UK has left the EU. Trade talks between the UK and EU have commenced but there remains a high

degree of uncertainty whether they will be completed and ratified by the end of the transition period on 31 December. We are speaking to Government

officials about their preferred option for the recognition of qualifications in the trade agreement following the publication of the UK's draft text as we have

some concerns about the system they are proposing. If a new framework for the recognition of professional qualifications is not agreed by the end of the

year, we risk a 'no deal' exit. In this situation, we will revive our 'no deal' planning and the new routes to registration for EEA qualified doctors that were

adopted by Parliament in March 2019 will be enacted.

Preparing for Brexit

More certainty on likelihood of scenarios

Perceptions question - % stakeholders felt that

they knew at least a fair amount about ‘why

the GMC is calling for legislative reform and the

effects that such reform could have on the

medical workforce on how well prepared for an

can influence legislative change’

We are well prepared for and can influence legislat ive change

Strategic aim 4: Meeting the change needs of the health services across the four countries of the UK

26

Financial summary

A5

Financial summary as at April 2020Budget

AprilActual April Variance

Budget 2020

Forecast 2020

Variance

£000 £000 £000 % £000 £000 £000 %

Operational expenditure 36,397 33,541 2,856 8% 112,169 105,987 6,182 6%

New initiatives fund 60 60 0 0% 3,500 3,500 0 0%

Capital expenditure 1,783 1,898 (115) (6)% 6,250 6,248 2 0%

Pension top up payment 1,300 1,300 0 0% 1,300 1,300 0 0%

Total expenditure 39,540 36,799 2,741 7% 123,219 117,035 6,184 5%

Operational income 37,656 36,023 (1,633) (4)% 117,006 113,530 (3,476) (3)%

Operational surplus/ (deficit) (1,884) (776) 1,108 (6,213) (3,505) 2,708

Investment income 735 (1,667) (2,402) (327)% 2,234 (1,400) (3,634) (163)%

Total surplus/ (deficit ) (1,149) (2,443) (1,294) (3,979) (4,905) (926)

Income forecast movement Value £000 Commentary

Income reduction - permanent

(543)

Waiving the provisional registration fee for the remainder of 2020 reduces income by £399k and

the recent reduction in the BOE base rate has a knock on effect to interest income return of

£36k. The reduction in ad hoc income is included here (£108k).

Income reduction - temporary

(3,528)

The forecast includes the effects of the June PLAB 1 test sitting cancellation. Income is forecast

to reduce by £2.6m due to cancelling PLAB 2 days in March, April, May and June. We are

currently forecasting PLAB days to restart in late June. There will be a reduction in IMG new

applications through the PLAB route equivalent to the period of time PLAB is shut down, which

reduces income by £400k. The forecast also incorporates a reduction in PLAB cancellation fees of

£340k and a small reduction in specialist applications.

2020 income catch up 595

Compared to the February forecast and in response to the closure of the PLAB centre 10

additional PLAB 2 days have been added to the diary in 2020.

Total (3,476)

27

Financial summary

A6

Expenditure forecast movement Value £000 Commentary

Headcount changes/natural variations in forecast

(224)

The forecast, without the impact of changes to operations, is driven by the additional

variable costs of the uplift in PLAB 1 candidates and 7 additional PLAB 2 days already

being scheduled for later in 2020. This overspend would have been offset by holding a

higher level of vacancies than budgeted and leaving Centurion House earlier than

planned.

Permanent reduction in expenditure

1,502

The main driver of permanent savings is the reduction in staff expenses. Further ongoing

savings are by reducing the forecast for research, £200k, staff recruitment & training,

£180k, education visits, £60k and further ad hoc reductions such as stationery and

postage. All additional capital costs related to home working will have equivalent capital

costs reduced from the existing profile of projects, these have not been fully identified

yet however the reduction is in line with the anticipated £100k additional cost of

purchasing home working equipment.

New activities/ costs generated by Coronavirus

(903)

The key increase in cost we expect is additional annual leave being sold by employees.

The current forecast is based on all permanent staff selling half a weeks leave more than

historic trends, which equates to £600k. Other additional costs identified include £100k

estimate additional cost of purchasing home working equipment. This additional cost will

offset by reducing other capital projects.

Temporary reduction in expenditure (generates

backlog of work)

6,152

Closing the hearing centre until July, combined with the existing plan for a phased re-

introduction of hearings will result in a backlog of 898 hearing days at year end, this

equates to a £1.9m reduction in spend in MPTS and an £1.6 cost reduction in FTP direct

hearing costs, such as legal fees. Further deferred FTP costs include £430k for a drop in

performance assessments and £300k due to a reduced volume of testing and expert

reports. Registration and Revalidation will see a reduction of £2.05m in costs related to

the postponement of PLAB 2 days and TOC's.

Current plans to clear backlog

(345)

The current plan in MPTS & FTP, a phased re-introduction of hearings from July, would

result in none of the backlog being reduced in 2020. The additional costs relate solely to

additional PLAB days scheduled later in 2020.

Total 6,182

The forecast current ly assumes the ef f iciency target will be met of which £1.5m is yet to be ident if ied, and the full £3.5m new init iat ive fund will be spent . This forecast

assumes some operat ions will return f rom July on a phased basis and does not yet link to the plans created by the recovery taskforce led by Rob Scanlon. 28

Financial - detail

A7

Expenditure as at April 2020Budget


Budget 2020

Forecast 2020

Variance

£000 £000 £000 % £000 £000 £000 %

Staff costs 22,367 22,044 323 1% 68,909 69,220 (311) (0)%

Staff support costs 1,343 909 434 32% 4,356 3,456 900 21%

Office supplies 598 433 165 28% 1,910 1,696 214 11%

IT & telecoms costs 1,400 1,337 63 5% 4,333 4,289 44 1%

Accommodation costs 2,540 2,493 47 2% 7,639 7,585 54 1%

Legal costs 1,299 932 367 28% 4,016 2,384 1,632 41%

Professional fees 693 743 (50) (7)% 3,072 2,955 117 4%

Council & members costs 136 120 16 12% 532 509 23 4%

Panel & assessment costs 5,893 4,261 1,632 28% 18,080 14,567 3,513 19%

PSA Levy 269 269 0 0% 825 829 (4) (0)%

Under-achievement of efficiency savings (141) 0 (141) 0% (1,503) (1,503) 0 0%

Operat ional expenditure 36,397 33,541 2,856 8% 112,169 105,987 6,182 6%

New initiatives fund 60 60 0 0% 3,500 3,500 0 0%

Capital expenditure 1,783 1,898 (115) (6)% 6,250 6,248 2 0%

Pension top up payment 1,300 1,300 0 0% 1,300 1,300 0 0%

Total expenditure 39,540 36,799 2,741 7% 123,219 117,035 6,184 5%

Income as at April 2020Budget


Budget 2020

Forecast 2020

Variance

£000 £000 £000 % £000 £000 £000 %

Annual retention fees 30,550 30,456 (94) (0)% 93,465 93,371 (94) (0)%

Registration fees 1,323 1,658 335 25% 5,558 4,758 (800) (14)%

PLAB fees 4,388 2,674 (1,714) (39)% 12,962 10,563 (2,399) (19)%

Specialist application CCT fees 645 641 (4) (1)% 2,730 2,776 46 2%

Specialist application CESR/CEGPR fees 453 392 (61) (13)% 1,400 1,308 (92) (7)%

Interest income 85 99 14 16% 256 227 (29) (11)%

Other income 212 103 (109) (51)% 635 527 (108) (17)%

Total Operat ional Income 37,656 36,023 (1,633) (4)% 117,006 113,530 (3,476) (3)%

29

GMCSI summary and investments summary

A8

GMCSI summary as at March 2020Budget YTD Actual YTD Variance

Budget 2020

Forecast 2020

Variance

£000 £000 £000 % £000 £000 £000 %

GMCSI income 144 70 (74) (51)% 626 367 (259) (41)%

GMCSI expenditure 161 98 63 39% 581 321 260 45%

Profit / ( loss) (17) (28) (11) 45 46 1

Investment summary 2020Value as at Dec 2019

Value at 30 April 2020 returns*

£000£000 £000

CCLA managed funds £54,765 £53,042 £(1,723)

Investments summary 2020 ( figures are updated quarterly)

Asset Allocat ionGMC

thresholdsCurrent

allocat ion

Equities 0% - 45% 26.0%

Bonds and cash 20% - 80% 55.0%

Alternatives 0% - 45% 19.0%

Investment returns1 year rolling

Target (CPI + 2%) 3.50%

CCLA performance 0.61%

* Return af ter fees 30

9

Legal summary (as at 27 May 2020)

A9

The table below provides a summary of appeals and judicial reviews as at 27 May 2020:

Open cases carried forward since

last report

New cases Concluded cases Outstanding cases

s.40 (Pract it ioner) Appeals 14 1 4 11

s.40A (GMC) Appeals 6 1 2 5

PSA Appeals 1 0 0 1

Judicial Reviews 1 6 1 6

IOT Challenges 1 0 0 1

Explanat ion of concluded cases

s.40 (Pract it ioner) Appeals

2 dismissed

2 withdrawn

s.40A (GMC) Appeals 2 successful

Judicial Reviews 1 permission refused

New referrals by PSA to the High Court under Sect ion 29

since the last report with explanat ion, and any

applicat ions outstanding

PSA Appeals N/A

Any new applicat ions in the High Court challenging the

imposit ion of interim orders since the last report with

explanat ion; and total number of applicat ions outstanding

IOT challenges

There has been no new applicat ions in the High Court challenging

the imposit ion of interim orders since the last report ; and

therefore a total of 1 applicat ion outstanding.

Any other lit igat ion of part icular noteWe cont inue to deal with a range of other lit igat ion, including cases before the Employment Tribunal, the

Employment Appeals Tribunal and the Court of Appeal.

31

10

Trends in registration applications

A1032

11

Trends in registration applications

A1133

M3 – Annex B

Corporate Opportunities and

Risk Register

Council meeting, DATECouncil meeting, 8 July 2020

M3 – Chief Executive’s Report

34

Id Classification Title Category Detail Owner

Like

lihoo

d -

Inhe

rent

Impa

ct -

Inhe

rent

Ratin

g -

Inhe

rent

Mitigation/Enhancement

Like

lihoo

d -

Resi

dual

Impa

ct -

Resi

dual

Ratin

g -

Resi

dual

Council and/or Board Assurance Assurance Further Action Detail Ri

sk

Appe

tite

## Operational Threat

Delivery of statutory functions

Operational If we fail to deliver our core statutory functions, there is a potential impact on patient safety, public confidence, and the GMC’s reputation as a leading regulator

Charlie Massey

QUIT

E LI

KELY

MAJ

OR

CRIT

ICAL

• Monitoring and reporting against statutory delivery to Executive Board and Council. • Forecasting of operational demand is built into budget planning.• Active engagement with doctors about potential situations which may put patients at risk.• New Outreach structure in place (ensures statutory process for responsible officers to continue effectively) to help identify and manage concerns (pre-investigation).• Available staff with relevant training and skills.• Information exchange with competent authorities informs our processes.• Documented operational process and procedures, that are subject to regular review and continuous improvement by specialist staff.• Triaging all new concerns and progressing those where there’s a patient safety risk that requires immediate action• Progressing ongoing investigations where possible to minimise delays

QUIT

E LI

KELY

MOD

ERAT

E

SIGN

IFIC

ANT

Council• Review of performance metrics through the quarterly CEO report

Executive Board• Review of performance metrics through the bi-monthly Performance and Risk Report

Internal Audit• Interim Order Tribunals (January 2020, green-amber)• Interim Order Review on Papers (May 2019, green-amber)• MPTS Governance arrangements (October 2018, green-amber)• FtP and MPTS separation green/amber (November 2018, green-amber)• Review of UK Registration Applications (February 2018, green-amber)• Voluntary and admin erasure (May 2019, green-amber)

Other assurance• Annual PSA Performance review

• Continue to engage with the Professional Standards Authority and other regulatory partners, coordinating the Covid-19 response and reviewing our approach as the situation evolves. •We’ll consider and triage all new concerns, but pause those requiring investigation, unless we consider there’s a patient safety risk that requires immediate action.•We won’t request information from healthcare providers or healthcare professionals to support investigations, unless there’s a patient safety risk that requires immediate action. This means that some ongoing investigations will be paused. •We’ll progress ongoing investigations where possible and with the agreement of relevant parties, to minimise delays.

LOW


Availability of resources

Resource If we do not have a high calibre flexible workforce, appropriate technological capability and a financially sustainable business model we may not continue to provide the current level of service to all our customers and stakeholders.

Neil Roberts

HIGH

LY L

IKEL

Y

MAJ

OR

CRIT

ICAL

• Work is underpinned by a clear Financial approach and safeguards including around investment (GMCSI), fraud policies and pensions.• New Initative Fund requests considered by SMT collectively.• Capture and monitoring of the volume and complexity of our work, with effective prioritisation criteria and approach. • Our HR practices and leadership strategy is aimed towards attracting and retaining a high calibre workforce. • Our Health and safety policies and procedures are robust in regards to our workforce.

QUIT

E LI

KELY

MOD

ERAT

E

SIGN

IFIC

ANT

Council• Review of annual budget and Annual Accounts

Internal Audit• Transformation Programme (July 2019, amber)• Managing change (August 2019, amber)• Risk Management (June 2019, green-amber)• Recruitment (September 2019, green-amber)

• Cross-GMC working group formed to effectively sequence and prioritise the resumption of activity paused in response to Covid-19 including opportunities to embrace new ways of working (April - June 2020). •Transition to a new business planning model to support the 2021-25 Corporate Strategy (from Sep 2020).

MED

IUM


Ability to work with others

Strategic / Policy

If we are unable to work collaboratively with others, we may not be able to achieve the ambitions of the corporate strategy, reducing our potential impact on patient safety and doctors’ practice

Paul Reynolds

QUIT

E LI

KELY

MAJ

OR

CRIT

ICAL

• Being transparent and managing stakeholders at SMT level.• Engagement with other regulators through the Chief Executive Officer Regulatory Body (CEORB) group and the PSA and four UK health departments through the Chief Executives Steering Group (CESG) to identify opportunities for collaboration and regulatory alignment. • Proactive engagement on all major policy and issues.• Collaboration with devolved nations though national offices, and development and management of stakeholder relationships of strategic importance in each country of the UK, Europe and internationally.• Relationships with key partners evaluated annually through perceptions survey.• Active engagement with the four UK Governments over the future of our legislation.

QUIT

E LI

KELY

MOD

ERAT

E

SIGN

IFIC

ANT

Council• Seminar: Four countries update (September 2019)• Paper: People planning across the United Kingdom (November 2019)• Paper: Regulatory reform (November 2019)• Paper: Review of UK Advisory Forum meetings (December 2019)• Paper: Four countries update (April 2020)• Paper: Annual update on communications and engagement (July 2020)

Executive Board• Public affairs strategy (December 2019)

• Corporate strategy and stakeholder perceptions baseline survey (published March 2019)

• Contribute to joint work through the CEORB• Implementation of public affairs strategy (throughout 2020).• Contribute to UK plans to manage the coronavirus (Covid-19) impact and engage with other regulatory partners to coordinate our response, including through joint statements and guidance for doctors and medical professionals. • Following joint statements in March 2020 with our partners to provide sufficient guidance to doctors in response to the pandemic, we will continue to work closely with representative organisations such as the BMA, medical colleges, employers and MDOs to provide support to the profession and the system, and co-ordinate messaging where possible.• In light of the Paterson inquiry report we are working closely with key partners including CQC/NMC/PSA to strengthen regulatory collaboration.• Development of annual relationship plans for organisations with greatest strategic value to our work.

MED

IUM


Responding to a changing environment

Strategic / Policy

Inability to respond effectively to changes in the external environment, including legislation and wider social impact changes, could lessen our influence and reduce public, profession and political confidence in our role.

Paul Reynolds

QUIT

E LI

KELY

MAJ

OR

CRIT

ICAL

• Proactive senior level engagement.• Outreach teams structures in place, aligned to UK countries and England regions to liaise directly with the workforce.• Contribution to NHS People Plan (England) and Government initiatives across the UK. • Continous monitoring of our external environment, including longer term horizon scanning.• Contributing to meetings and networks across the UK and Europe.• Internal governance to process, consider and make decisions on the intelligence we receive about the quality and safety of local practice and training environments.

QUIT

E LI

KELY

MOD

ERAT

E

SIGN

IFIC

ANT

Council• Seminar: Four countries update (September 2019) Executive Board:• New public affairs strategy (December 2019)

• Intelligence from our external environment is being shared on a weekly basis with senior management to aid the organisation’s response to the COVID-19 pandemic.• Adoption of new 'Engage' system by engagement and policy teams to capture intelligence from our engagement with stakeholders is ongoing (expected to complete by the end of 2020).• Implement new public affairs strategy (throughout 2020).

LOW

Corporate Opportunities & Risk Register - July Council

Operational Threats

35


Unplanned event Reputational The impact of an event in the external or internal environment causes our systems to be compromised or our activities to be publicly challenged, potentially leaving us vulnerable to delivery of key functions central to patient safety and reputational damage.

Neil Roberts

QUIT

E LI

KELY

MAJ

OR

CRIT

ICAL

• Crisis management policies & procedures; pandemic response plan.• Business continuity champions and emergency response plans in place with regular testing. • Mandatory e-learning for GMC staff and support from business continuity consultants.• Responding to public inquiries and reviews, and proactive horizon scanning.• Analysis of range of qualitative and quantitative information about the external environment through the Patient Safety Intelligence Forum.• Regular engagement with the Professional Standards Authority to assure them on the exercise of our statutory powers – including emergency powers under section 18A of the Medical Act 1983 (Covid-19).

QUIT

E LI

KELY

MOD

ERAT

E

SIGN

IFIC

ANT

• Paper: People planning across the United Kingdom (November 2019)

Internal audit• Cyber security (July 2019)• Business continuity arrangements (May 2018, green-amber)• Anti-fraud and corruption (May 2018, green)

Audit and Risk Committee• Learning reviews of our actions in the Dr Bawa-Garba/Jack Adcock case presented to ARC in late 2018 • Significant Event Review: Fraudulent doctor Zholia Alemi (November 2019)

• Response to a range of public Inquiries and Reviews underway including Paterson (now reported), Infected Blood Inquiry, Hyponatraemia, and Historical Public Abuse.• Continue to engage with the Professional Standards Authority regularly, to assure them of how we use our emergency powers in response to the Covid-19 pandemic arising from section 18A of the Medical Act 1983. M

EDIU

M

26 Operational Opportunity

New government Strategic / Policy

The strength of the new government provides an opportunity to drive forward our ambitions for change.

Paul Reynolds

QUIT

E LI

KELY

MAJ

OR

GOLD

• Regular Chair and CEO engagement with Governments across the UK to identify shared goals.• Regular contact with governments and relevant departments to influence legislative proposals.• Active engagement with stakeholders across the UK to build support for legislative reform and to help manage our transition towards post Brexit trade agreements with the EU and beyond where they impact on the recognition of medical professional qualifications. Q

UITE

LIK

ELY

MAJ

OR

GOLD

• Paper: Regulatory reform (November 2019)

• Annual perceptions survey showing awareness of legislative reform proposals in our key audiences and stakeholders

• Continue to engage with the Department of Health and Social Care on potential Section 60 orders that will reform aspects of our education powers, governance, fitness to practise investigations, and the requirements of international registration.• Continue to engage with the Department of Health and Social Care, BIS and DIT on new post-Brexit trade agreements with the EU and beyond.

HIGH


Deriving more insight from our data capability

Strategic / Policy

Developing, sharing and working with others using our insight capability provides an opportunity to shape public debate, influence the external environment and deliver more proactive regulation.

Paul Buckley

QUIT

E LI

KELY

MAJ

OR

GOLD

• We use our research and insights to highlight key issues facing the medical profession, suggesting courses of action which healthcare systems can take to improve workforce and workplace issues.• We leverage our communications channels (such as media and social media) and engagement opportunities to raise awareness of our research and insights and secure external support for the issues and recommendations we are highlighting.• We use our influence to bring regulatory partners and key stakeholders together to drive positive changes in practice and training environments.

QUIT

E LI

KELY

MAJ

OR

GOLD

• Paper: Review of UK Advisory Forum meetings (December 2019)

• Corporate strategy and stakeholder perceptions baseline survey (published March 2019)

• Embed outputs from horizon scanning scrum process in PLG and other GMC-wide forums.• Continue to use data to contribute to mailouts, briefings and external engagement.• Provide data support to the rest of the GMC in managing our response to the Covid-19 pandemic.

HIGH


Working with patients and public

Operational Developing more proactive engagement with patients and the public provides an opportunity to understand and demonstrate that all our activities are aligned with patient safety so that we gain their trust and confidence as an effective and transparent regulator.

Una Lane

QUIT

E LI

KELY

MOD

ERAT

E

SILV

ER• Champion for patients established at SMT level to ensure senior-level overview of our engagement.• Charter for patients, relatives and carers published on our website (Nov 2019).• Clear engagement objectives in our annual patient and public engagement plan (2020 plan was agreed by Directors in May 2020).• Regular assessment of patients and public's perceptions through annual research.• Roundtable with patient leaders from all four UK countries, meeting twice a year to explore policy issues and initiatives at an early stage of their development. This is supplemented by twice-yearly UKAF meetings in Scotland, Wales and Northern Ireland plus ongoing engagement with patient organisations throughout the year.

QUIT

E LI

KELY

MOD

ERAT

E

SILV

ER

Council• Our strategic approach to communications and engagement – an update (June 2019)• Discussions at Council Away days (July 2018 and 2019) about patient and public engagement in our work and preparation for the next Corporate Strategy• Council considered current Corporate Strategy success measures baseline report results at its meeting in November 2018• Paper: annual update on communications and engagement (July 2020)

• Annual perceptions survey showing the public's confidence in how doctors are regulated and feedback on working relationships with patient and public bodies

• Full results of 2020 perceptions survey due to be received late summer 2020. Initial findings included in SC&E's annual update to Council (July 2020). • Following SMT discussion of 2020 engagement plan, we have agreed that a corporate-wide approach to patient and public engagement should be developed by the end of 2020.• We have commissioned The Patients Association to host a focus group with patients to help us test key elements of our next corporate strategy.• We are in the process of evaluating our performance against the six promises contained in the charter for patients, relatives and carers. We expect to complete this work by the end of 2020.

MED

IUM

Operational Opportunities

36


www.mpts-uk.org 1

Agenda item: M5

Report title: Report of the Medical Practitioners Tribunal

Service Committee

Report by: Dame Caroline Swift, Chair of the MPTS, [email protected], 0161 240 7115

Considered by: MPTS Committee, GMC/MPTS Liaison Group

Action: To consider

Executive summary

This report gives an update on the work of the Medical Practitioners Tribunal

Service (MPTS) since the last report to Council in December 2019.

Key points to note:

The MPTS closed its hearing centre in March 2020, in response to the COVID-

19 pandemic.

Virtual hearings began immediately, so urgent decisions could continue to be

taken in order to protect the public.

Referrals to medical practitioners tribunal hearings continued to increase in

2019.

Prior to closing the hearing centre, we made good progress in evening out the

hearings workload.

Recommendations

Consider the report of the MPTS Committee.

Consider the MPTS Report to Parliament 2019 (Annex B).

37

mailto:[email protected]


Agenda Item M5 – Report of the MPTS Committee

www.mpts-uk.org 2

Governance

1 The Medical Practitioners Tribunal Service (MPTS) reports twice a year to Council on how we are fulfilling the statutory duties for which we are

accountable to the UK Parliament.

2 This paper is the MPTS Committee’s first report of 2020.

3 The MPTS Committee met on 20 February 2020 and considered adjournments, quality assurance, tribunal member training and business planning.

4 The Committee also met virtually for the first time on 12 May 2020 and considered adjournments, complaints and the Committee’s effectiveness.

5 The MPTS will lay its annual report for 2019 before Parliament later this year. A copy of the text is attached for Council’s information.

Operational update

Responding to the COVID-19 pandemic

6 Since 2016 the MPTS has worked with the GMC’s Business Continuity Team to review and maintain our business continuity plans in the event of a pandemic.

7 On 28 January 2020 we started to see an escalation of COVID-19 in China and so a GMC-wide Incident Management Team (IMT) was convened. The Executive

Manager of the MPTS is a member of the IMT alongside representatives of the

other GMC directorates.

8 IMT moved the GMC to the response phase of our plans on the afternoon of 16 March, soon after the government moved from the ‘contain’ to the ‘delay’ stage of their plan.

9 That evening the UK Government issued stricter new guidance, including that everyone who was able to should work from home. At 8.30pm, IMT met to

discuss this guidance and, that night, we sent a text and an email to all

colleagues, explaining who should and shouldn’t travel to the office the next day.

10 On 17 March we took the unprecedented decision to close the hearing centre at St James’s Buildings. That afternoon, we postponed around 130 hearings that were due to sit between March and the beginning of July, contacting every

doctor and/or their representatives individually.

11 Most ongoing hearings ceased the following day. This was necessary in order to free up medical tribunal members to treat coronavirus patients, and to protect

the health of all those involved in our hearings.

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12 By the end of the week, our 100 or so members of staff had all switched to working at home and were therefore not having to travel unnecessarily.

13 Public protection is our first priority, so we were keen to find ways to deal with the most urgent cases requiring decisions. Our Tribunal Development and

Operations sections worked rapidly with GMC Information Systems (IS) to

devise a plan for running virtual hearings (VHs) for new interim order tribunal

(IOT) cases and for IOT and MPT review cases.

14 On 19 March (within 48 hours of our decision to close the hearing centre), tribunal members held the MPTS’s first VH, communicating with each other, with the parties and with MPTS staff by using Skype for Business.

15 Throughout the pandemic we have continued to review existing sanctions and consider interim restrictions where necessary. The MPTS ran 406 hearings

between the 19 March and 16 June, 265 were virtual hearings and 141 were

considered ‘on the papers’ by Legally Qualified Chairs.

16 On 5 May 2020 and with the approval of GMC SMT we postponed the majority of MPT hearings currently scheduled, other than MPT reviews and part-heard

hearings due to reconvene.

17 These postponements have allowed us to focus on listing hearings on a prioritised basis, applying criteria which include whether a doctor has an

interim restriction, whether a hearing is part heard, how long it has been since

a case was referred or postponed and how prepared parties are to proceed.

18 We have initially been prioritising shorter hearings and those with fewer witnesses (including preliminary hearings and hearings due to reconvene at the

impairment or sanction stages), as these are more likely to be able to run as

virtual hearings if necessary.

19 Doctors, their representatives and the Fitness to Practise directorate have the opportunity to make relevant submissions to the MPTS as part of this process

(including information about case readiness), to help us decide which hearings

we can hold.

20 The MPTS hearing centre was originally scheduled to reopen on 6 July 2020. On 1 June 2020, the GMC Executive Board approved the holding of all hearings

scheduled for July virtually.

21 On 22 June 2020, the GMC SMT approved the holding of a limited number of physical hearings at our hearing centre from the beginning of August 2020. At

all times, we will continue to act in accordance with the advice from the UK

government and Public Health England.

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Other operational matters

22 Prior to our decision to close the hearing centre, we had made good progress on evening out our hearings workload across the year, in order to provide a

more effective and efficient service.

23 As previously reported, in 2019 we made improvements to our pre-hearing case management processes, to better meet the needs of those attending our

hearings.

24 Parties are now clear on our expectations of the level of information we require from them once a case has been referred to us. Pre-hearing meetings are also

now held earlier, allowing us to use our powers to issue legally binding

directions at the earliest opportunity. This helps ensure parties are ready to

present their respective cases from the first day of a hearing.

25 As a result of these changes, we are now better able to manage the peaks in hearing volumes at certain times of the year that we previously identified as an

issue of concern (please see paragraphs 40-43 below for further detail).

26 Our Doctor Contact Service continues to offer support to doctors on the day of a hearing, particularly those attending alone or without legal representation.

The Service aims to help lessen the isolation and stress doctors might

encounter when attending a hearing. A member of our staff unconnected to

the doctor’s case can be available to support them at any time.

27 In 2019 the Service helped 129 doctors on 249 occasions. We have continued to receive positive feedback on the impact of the Service, users have

highlighted the benefits of having processes explained to them and being

signposted to the most relevant information.

Guidance

28 In November 2019 we issued updated guidance to MPTs on Adjourning to direct an assessment or for further information or reports, to improve consistency in

our decision-making.

29 In the same month, we issued new guidance on the use of Skype for Business in hearings for receiving oral evidence.

30 In February 2020 we issued additional guidance on restoration for MPTs considering applications for restoration following voluntary or administrative

erasure.

31 In April 2020, new guidance was urgently issued for GMC and MPTS decision-makers on Requests to relax or revoke sanctions or IOT orders in response to

COVID-19.

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32 We previously reported that we would be carrying out a review of the Sanctions guidance, working with colleagues in the GMC’s Fitness to Practise directorate, with a view to a public consultation later this year. In February 2020 the

working group responsible for the review took the decision to postpone this

work until early 2021, in anticipation of imminent legislative reform.

Tribunal members

33 As of 31 December 2019, we had 338 tribunal members, of whom 47% were medical members and 53% lay members (including legally qualified chairs). In

total, 45% of tribunal members were female and 20% identified as coming from

black, Asian and minority ethnic (BAME) backgrounds.

34 This compares favourably with the most recently published figures for courts in England and Wales (32% female and 7% BAME) and tribunals in England and

Wales (50% female and 15% BAME). (Source: https://www.judiciary.uk/about-

the-judiciary/who-are-the-judiciary/diversity/judicial-diversity-statistics-2019)

35 It also compares well with the UK population (51% female and 13% BAME). (Source: www.ons.gov.uk/census/2011census)

Quality assurance

36 The MPTS Quality Assurance Group (QAG) meets monthly to review a proportion of written tribunal determinations. The purpose of these reviews is

to make sure the determinations are clear, well-reasoned and compliant with

the relevant case law and guidance.

37 QAG also identifies issues which can usefully be incorporated into future tribunal training sessions, or included in tribunal circulars.

38 All learning points issued to tribunal members can be viewed at https://www.mpts-uk.org/learning_points

Referrals

39 Referrals to a new MPT hearing rose in 2019 to 363, compared to 292 in 2018 and 239 in 2017.

40 Our Case Management team has been working jointly with colleagues in MPTS Operations to even out the monthly hearings workload. This work aims to

reduce workload pressures and support staff wellbeing whilst improving our

effectiveness and efficiency.

41 The chart below demonstrates the progress made, prior to our decision to close the hearing centre.

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42 In 2018 the maximum deviation from the average monthly workload was 23%. In 2019 this was been reduced to just 11%.

Hearing outcomes

43 Hearing outcomes for the previous three years and the first quarter of 2020 are provided at Annex A.

44 In 2019, 359 doctors appeared at new IOT hearings, a slight reduction on the previous year. 14% of those doctors were suspended from the medical register

on an interim basis, 63% given interim conditions and no order made in 23% of

hearings.

45 In 2019, 257 doctors appeared at new MPT hearings, a small increase on the previous year. 21% of those doctors had their name erased from the medical

register, 47% were suspended and 5% given conditions. 17% were found not

impaired and a further 7% found not impaired but issued with a warning. In 2%

of hearings, the tribunal decided no action was necessary after a finding of

impairment. In three hearings (1%), the tribunal accepted an application for

voluntary erasure from the register.

46 If the GMC believes a doctor is consistently or explicitly refusing to comply with a direction to undergo a health, performance, or English language assessment,

it may refer them to the MPTS for a non-compliance hearing.

47 Five new non-compliance hearings were held in 2019, with a suspension imposed in all cases.

48 13 restoration hearings were held in 2019, with the doctor’s application being accepted in two cases and refused in 11.

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Looking ahead

49 In our next report we will provide a more detailed update our response to the COVID-19 pandemic and our use of virtual hearings.

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Council meeting, 8 July 2020 Agenda item M5, Annex A – Report of the MPTS Committee

www.mpts-uk.org

Agenda item: M5

Report title: Report of the Medical Practitioners Tribunal

Service Committee

Annex A

Hearing outcomes for 2017-2019 and quarter 1 2020

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Agenda item M5, Annex A – Report of the MPTS Committee

www.mpts-uk.org 1

Hearing outcomes 2017 – Q1 2020

Medical Practitioners Tribunals

New MPT hearing

outcomes

2017 2018 2019 Q1 2020

Cases % Cases % Cases % Cases %

Impaired: Erasure 62 31% 65 26% 55 21% 13 20%

Impaired: Suspension 76 39% 101 41% 120 47% 24 37%

Impaired: Conditions 13 7% 25 10% 14 5% 9 14%

Impaired: No action 4 2% 2 1% 4 2% 0 0%

Not impaired: Warning 13 7% 10 4% 17 7% 9 14%

Not impaired 27 14% 41 17% 44 17% 8 12%

Voluntary erasure 0 0% 3 1% 3 1% 2 3%

Total 195 100% 247 100% 257 100% 65 100%

Non-compliance hearing

outcomes

2017 2018 2019 Q1 2020

Cases Cases Cases Cases

Suspension 8 7 5 1

Conditions 0 0 0 0

Non-compliance not

found 1 3 0 0

Total 9 10 5 1

Outcomes in restoration

hearings

2017 2018 2019 Q1 2020

Cases Cases Cases Cases

Application granted 8 5 2 2

Application refused 13 10 11 1

Total 21 15 13 3

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Agenda item M5, Annex A – Report of the MPT

general medical council · 7/8/2020 · council meeting, 8 july 2020 agenda item m2 – minutes of...

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