PSA response August 2020

Dear Mr Pond

The General Medical Council (the GMC)

Thank you for your letter to Dame Glenys Stacey, former Chair of the Professional Standards Authority (the Authority). You may be aware that Dame Glenys Stacey has now left the Authority and so I am responding as I am the person who usually deals with issues of concern raised with us.

I am sorry as it appears that we have overlooked your correspondence until your recent chasing email was discovered in a ‘junk’ mail folder. I sincerely apologise for this delay.

You wrote concerning the Montgomery Judgement of 2015 asking for the Authority’s views on the GMC’s delay in producing new guidance. This judgement requires doctors to provide patients with all the information they may reasonably need or understand when seeking consent for treatment.

We do welcome feedback about any aspect of the regulator’s performance. What individuals tell us can often influence the areas we choose to look at in the greatest depth and so I thank you for contacting us. I hope it is helpful to begin by telling you a little about our role.

Our role

The Authority promotes the health, safety and wellbeing of patients, service users and the public by raising standards of regulation and voluntary registration of people working in health and care. We are an independent organisation, accountable to the UK Parliament. We oversee the work of ten statutory organisations, that regulate health professionals in the UK and social workers in England.

We review the regulators’ performance and audit and scrutinise their decisions about whether people on their registers are fit to practise. We can refer final fitness to practise panel decisions to court where we believe the decision was insufficient to protect the public; maintain public confidence in the profession; and/or maintain proper professional standards.

Your concerns

You drew attention to the Authority’s 2018/19 Performance Review of the GMC where, in the section on standards and guidance, we note that the GMC has consulted on revisions to its guidance on consent. We understood that the GMC intended to publish updated guidance in the first quarter of 2020. You note that the publication of this guidance has been delayed and asked the following questions. I have replied to each in turn.

  1. Does the PSA take a view on the length of time between the Montgomery judgement in 2015 and the issuance of the required update to doctors by the GMC which is yet to be published?

The Authority has reported previously on the GMC’s approach to revising its guidance and we have been satisfied that its approach was reasonable. We note also that the GMC’s existing guidance from 2008 includes the requirement to involve patients in decisions about their treatment; For example it states, ‘The amount of information about risk that you should share with patients will depend on the individual patient and what they want or need to know. Your discussions with patients should focus on their individual situation and the risk to them’.

  1. What is the PSA’s position on the breech by the GMC of its undertaking to publish updated guidance as provided to the Annual Review of Performance 2018/2019?

The draft guidance was approved by Council in November 2019 with the intention to publish early this year. However, it was reported to Council in February (page 14) that the GMC has taken the decision to defer this publication in light of recommendations for the GMC made by the Paterson Inquiry:

‘We recommend that there should be a short period introduced into the process of patients giving consent for surgical procedures, to allow them time to reflect on their diagnosis and treatment options. We recommend that the GMC monitors this as part of ‘Good Medical Practice’

This decision by the GMC does not appear unreasonable to us and we therefore accept its reasons. It is a matter that we can return to in our next performance review if there is unacceptable delay, but we do not consider the GMC’s decision to delay for this reason a ‘breech’.

  1. How does the PSA risk assess the impact of the Montgomery judgements on possible legal action against incorrectly advised doctors, and how does this relate to the GMC’s failure to issue guidance?

We do not consider that the impact of potential court cases is our field to comment upon. Our focus is on reviewing the regulators’ performance in respect of their public protection functions, rather than on what might happen in hypothetical court cases. Clearly, where the law changes or where best practice evolves, we expect regulators to consider whether their guidance needs to be reviewed. It appears to us that this is what the GMC is doing, but we will continue to consider how well it fulfils this aspect of its role.

I hope this response is helpful, but please do not hesitate to let me know if you have any questions about it, any further concerns about the GMC or general questions about our role.

Yours sincerely

David Martin
Concerns and Appointments Officer

Professional Standards Authority
157-197 Buckingham Palace Road
London SW1W 9SP

Switchboard: 020 7389 8030
Fax: 020 7389 8040

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