Q&A
Aspiring to “right-touch” P
GMC Chair of Council Professor Terence Stephenson discusses some of the issues facing the regulator in this crucial era for UK healthcare
ROFESSOR Terence Stephenson took up the role as Chair of the GMC’s Council in January 2015. He has spent
most of his career specialising in paediatrics, having studied medicine at Oxford Medical School. He is currently Nuffield Professor of Child Health at University College London and an honorary consultant paediatrician at University College Hospital London and Great Ormond Street Hospital. He only recently stood down as chair of
the Academy of Medical Royal Colleges and is a former president of the Royal College of Paediatrics and Child Health. Professor Stephenson is not involved in
the day-to-day running of the GMC. Te role of the Council – with its six lay and six medical members – is one of strategic oversight: making sure the regulator is properly managed by its executive team and fulfils its statutory duty to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.
What do you see as the main challenge facing UK healthcare and the GMC as a regulator in coming years? I think the biggest challenge facing any regulator is the fairly relentless increase in complaints over the last decade. And it’s not particular to doctors – if you look outside healthcare it also applies to lawyers and other professionals. Allied with this is the fact that healthcare in the UK is in a very stressed state – most doctors, nurses and other professionals would say there is a lot of pressure on. We’ve had a recession, finances are tight and there are concerns over recruitment into particular specialties. But I think for regulators the big
challenge is the rise in complaints. One of the reforms ideally we would like to see is that only relevant complaints make it to the GMC. We get about 10,000 complaints a year and probably about half of those get very quickly referred back to the employer:
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contractual or other issues we don’t really want coming to a national body like the GMC. We think they should be kept locally. Tey may have some substance, some issue needing investigation, but are not appropriate for the GMC.
Why are complaints against doctors rising? I think it’s a societal thing and, like I said, that’s true in all professions. We have a more well-informed population and a less deferential relationship between the public and professionals like lawyers, accountants, dentists and doctors. We also have a more litigious society in general, with people more willing to make complaints across the board. Medicine has also become more
complex. It was Sir Cyril Chantler who said medicine used to be ‘simple, ineffective and relatively safe’. Now it’s complex and oſten carries risk, but saves lives. It’s certainly more complex than when I was a student, with more complex therapies, more complex treatments.
Do you think there is a danger of doctors becoming over-regulated? I think that is a very fair question and it behoves all regulators to make sure that the burden of regulation is proportionate and risk-based. We are overseen by another body called the Professional Standards Authority and they produce a regular report on the nine healthcare regulators. Tey have complimented us on what they called our ‘right-touch’ regulation – and that implies proportionality; that you are light touch where you can be but have heavy boots on the ground where it’s required. And I think that is what we aspire to.
I’m a practising doctor and have twice
been reported to the GMC. Nobody likes it and you feel the sword of Damocles as you go through the procedure. But I would say we are working hard to make the process more proportionate. Perhaps we haven’t been as good at getting the message across
to all our 267,000 doctors that the GMC has an obligation by Act of Parliament to investigate every single complaint that is brought to us. So we can be ‘right touch’ for the downstream of what we do but there is no discretion to say “actually that doesn’t sound very serious so we won’t look at that”. We definitely have to look at all of those 10,000 complaints.
Has revalidation had any demonstrable effect on quality of care? Tis is a common question and, in truth, there is no way you can show causality between revalidation and quality of care because there are a huge number of other things going on over a five-year period [of revalidation] that might affect quality of care. I would turn the question around. I
think most people would be astonished with the idea that doctors didn’t somehow have to demonstrate that they were still fit to practise. I last took a professional exam in 1986 and until I revalidated in 2013, there had never really been a formal process by which I could be called to account and asked to demonstrate I was still a fit doctor to be seeing patients. So I think that is the role of revalidation. Trying to show that it has had an impact
on quality of care would be quite difficult but we do know that we have already declined licences for a significant number of doctors; so it does again have teeth. It’s not a tick box; it’s not a shoe-in that everybody automatically revalidates.
Is the organisation any closer to understanding the cultural disparity among doctors subject to GMC investigations? I think we are getting closer but are not yet at the bottom of it. We are continuing to work with organisations like the BMA and BAPIO to try and understand it better. I think if I went tomorrow to work in another country where English wasn’t the main language, with a different culture and context, I would probably be more likely to
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