F E AT URE Q & A
Dame Clare Marx – the first woman chair of the GMC in its 160-year history – discusses some of the many challenges facing the regulator and UK healthcare
A NEW ‘NORMAL’ D
AME Clare Marx was appointed chair of the General Medical Council in January of this year – the first woman to hold that position since the GMC was established 160 years ago. She is the immediate past president of the
Royal College of Surgeons of England and was also the first woman in the history of the College to hold that role. She worked as an orthopaedic
surgeon at Ipswich Hospital NHS Trust for over 20 years before becoming associate medical director for appraisal and revalidation in 2013. Dame Clare also chaired the Trauma and Orthopaedic Specialist Advisory Committee for the Royal College of Surgeons when the new trauma and orthopaedic surgery curriculum was written, and is a past president of the British Orthopaedic Association.
What are your first impressions as GMC chair five months in – both the strengths and challenges and how the public and profession regard the organisation? I’ve been really struck by the organisation’s commitment to change and delivering more proactive, preventative support as part of its regulatory function. I strongly believe that the best way to protect patients is to have well-trained doctors in supportive work environments. Historically, the GMC comes right at the end of the
story; a patient has come to harm and a doctor risks losing their career. We’d much prefer this cycle never started. Our mission now is to help prevent harm, by identifying concerns early, acting to remove risks and pushing for improvements where needed. The GMC has teams working hard to improve the support they provide the profession in all four UK countries. A lot of our ‘on-the-ground’ work is not widely known, but I’ve found it eye-opening to see just how positive this sort of local contact can be. I would really encourage doctors to attend our locally-delivered sessions and let us know what else we could be doing.
Do you think the GMC has a duty of care to the doctors it investigates? We know and see how distressing investigations can be and the stress they can cause. The current legislation that governs our processes means that we are obliged to investigate every complaint that comes to us. We are doing our utmost to work as flexibly as we can within these constraints to resolve complaints as quickly and with as little stress as possible for all concerned. Mental health and wellbeing has been central to our
recent programme of reforms, with the express intention to bring sensitivity and proportionality to our processes. Acknowledging the need for better support, we launched the Doctor Support Service, to provide confidential, emotional help to doctors during investigations, and we have seen the positive support that this service has been able to offer. In cases where learning is evident and there is a low risk
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of repeated harm we are working to reduce the number of unnecessary investigations. Overall, we have significantly reduced the number of full enquiries, by working to better understand issues at an early stage. Since 2014, as a result of our provisional enquiries programme, more than 950 unnecessary full investigations have been averted. A successful two-year pilot to consider ‘single clinical incident’ cases has further reduced investigations, enabling 202 of 309 cases to be closed. Understanding the big picture of why referrals
are made in the first place is essential. We’re looking forward to seeing the results of independent research, which aims to uncover why certain groups of doctors are overrepresented. We hope this might result in more consistent processes across the board.
What key risks does Brexit pose for healthcare regulation in the UK? European doctors have always made a significant contribution to our health services and we recently received some much-needed assurance about how they can continue to do so in the years to come. Our teams have worked closely with the Department of Health and Social Care to identify potential blocks and to suggest solutions which would ensure we could register European doctors in a fast and efficient way. Last month, legal changes were secured to ensure
relevant European qualifications would be recognised in the event of a ‘no-deal’ outcome – a welcome development amid the uncertainty. Whatever terms are agreed, it is essential that doctors from the EEA are not deterred from practising here.
How is the GMC balancing patient safety against a growing workforce crisis demanding increased recruitment of overseas healthcare professionals? Safety will always be our top priority, and whatever measures we take to close the gaps cannot jeopardise the high standard of care patients expect and deserve in the UK. We welcome good, hardworking doctors from all over the world and we’re confident in the checks we have in place to make sure they have the skills and knowledge required to work here. We’re currently in the process of opening a new assessment centre – doubling our capacity – to test up to 11,000 doctors a year. But there must be a renewed focus on retaining the excellent doctors already working in the NHS, who must be the bedrock for building and growing a sustainable workforce. There must also be greater flexibility for doctors in training.
Do you think the NHS has a serious problem with bullying and sexual harassment among medical staff? Recent reports are deeply troubling, and our frontline teams are hearing this particularly from doctors who work in high-risk, complex environments. The last thing they should have to suffer is the fear and worry these behaviours incite. Undermining can affect workers’
“Women have brought fresh perspective, skill and talent to evoke positive cultural change”
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