Case study on accreditation: the GMC’s perspective The General Medical Council is the statutory regulator of doctors in the UK. We regulate all doctors, not just those who practice in the NHS, so you will have a relationship with us throughout your medical career – regardless of the path that might take. The purpose of this presentation is to provide you with more information about what the GMC does. Martin Hart Assistant Director Education

Agenda What GMC does How doctors are educated and trained How we accredit and quality assure Strengths of our process Issues and challenges

Our purpose ‘to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine’ The GMC was founded in 1858, and its core purpose has remained the same over the last 150 years. Our purpose is set out in legislation. It is to ‘protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine’.

Our aim To secure a regulatory system which: Enhances patient safety Fosters professionalism Commands the confidence of all stakeholders Is independent, fair, efficient and effective In fulfilling our purpose, our aim is to secure a regulatory system which: Enhances patient safety Fosters professionalism Commands the confidence of all stakeholders – patients and the public, employers, medical schools and royal colleges, and the medical profession itself – which includes all of you here today. It is also important that we are an independent regulator. This means that we are independent of Government – the dominant provider of healthcare and training in the UK – and of any other single group.

General Medical Council A new council took office at the beginning of 2009: All appointed by the Appointments Commission The Council, of which I am a member, is the governing body of the GMC. It oversees and is responsible for, all of its activities. In 2009 Council was reconstituted, with new members. It now has 12 medical members 12 lay members The members of Council are drawn from a variety of backgrounds, which ensures there is a good mix of knowledge and experience. Members include Doctors from a variety of medical specialties. Members from across the four countries of the UK Members with a background in the delivery of medical education Those with experience of healthcare management and delivery [Something about yourself] And those representing patients and the public. We were all appointed following a rigorous process, overseen by the Appointments Commission. 5

Our functions Registration Education Fitness to Standards Practise and Ethics The Medical Act (1983) gives us four functions, which although distinct are interlinked. They are: Keeping up to date registers of qualified medical practitioners Fostering good medical practice by giving advice to the profession on standards and ethics Promoting high standards of medical education And dealing firmly and fairly with doctors whose fitness to practise is in doubt. We will return to each of these functions in a moment.

Specialist/GP register Structure of UK education and training Provisional registration Full registration Certificate of completion of training (CCT) Medical School (4-6 years) Medical School (4-6 years) F1 year (1 year) F1 year (1 year) F2 year (1 year) Specialty/ GP training (3-8 years) Specialist/GP register Career stage Employment/ regulatory status Student, not licensed Employed, licensed Employed, in training, licensed by GMC Education standards F1 and F2 in new Foundation Programme with UK-wide curriculum PMETB – Postgraduate Medical Education and Training Board TD – Tomorrow’s Doctors Currently students acquire first provisional and, after F1, full registration. From 16 November, they will also acquire a licence to practise.

The GMC’s role in medical education Responsible for promoting high standards of medical education In April 2010 PMETB will merge with the GMC For the first time, one organisation will be responsible for regulating all stages of medical education and training The GMC is responsible for promoting high standards of medical education in the UK. This involves a variety of activity, such as developing guidance for medical schools, deaneries and students and making sure that those standards are met. At the moment our remit extends to undergraduate education, and the first year of the Foundation Programme In April 2010 the Postgraduate Medical Education and Training Board will merge with the GMC. We will then be responsible for the regulation of all stages of medical education and training. In addition to our current responsibilities, from this point we will be responsible for the whole of the Foundation Programme, approving curricula for speciality training programmes, and granting Certificates of Completion of Training – which demonstrate that a doctor has successfully completed a speciality training programme. For you, it means that you will have an ongoing relationship with us throughout your medical careers, beginning with the time that you are now spending at medical school.

Medical School Medical School (4-6 years) 32 medical schools in the UK 35,000 medical students (60% female) Have own approaches to curricula, teaching, assessment etc But must all meet standards and outcomes in Tomorrow’s Doctors Subject to fitness to practise, graduates receive provisional registration with GMC GMC quality assures (QABME) 4-6 years – usually 5, 6 with an intercalated degree, 4 with graduate entry Tomorrow’s Doctors specifies the outcomes we expect all medical students to have achieved by the time they graduate. It also sets the standards we expect of medical schools delivering undergraduate courses. A new edition of Tomorrow’s Doctors was published in September 2009. We ensure that these standards are met through a process called Quality Assurance of Basic Medical Education, or QABME. Interestingly, we have swung in reverse to the EC. In the 2003 edition we set very high level standards but: Feedback from employers about the variation in graduates’ preparedness Employer feedback and research indicating graduates could be better prepared for the practical task of prescribing (as opposed to the science of pharmacology) has resulted in a set of detailed outcomes for students covering knowledge, professional behaviour and skills More detailed standards for schools to: demonstrate appropriate management of risks to patient safety precipitated by a push for students to have more practical clinical experience inevitably heightens risk evidence employer and patient engagement in the design, delivery and evaluation of the course: schools must demonstrate patient centredness and that their programmes will prepare graduate for practice. demonstrate analysis of equality and diversity trends in medical education

Foundation Programme F1 year and F2 year (2 years) Foundation programme is a two year programme of general training with placements within various specialties and healthcare settings (hospital bias) Foundation Programme has national application scheme (UKFPO) and is overseen by postgraduate deaneries Curriculum developed by Academy of Medical Royal Colleges, approved by GMC and PMETB F1 has outcomes set by the GMC which must be achieved to receive full registration GMC and PMETB jointly quality assure Foundation Programme (QAFP) 14,000 junior doctors in Foundation Programme (2009) Hospital bias – although most a GP placement in F2 year UKFPO – UK Foundation Programme Officer Academy of MRC – body brings together all the medical royal colleges QAFP – Quality Assurance of Foundation Programme

Specialty/GP training Specialty training Specialty/GP training (3-8 years) Medical royal colleges draw up criteria for specialist and GP training and assessments, which are approved by PMETB National competition for selection, training overseen by postgraduate deans PMETB* certifies completion of training, leads to entry on GMC GP or specialist register and eligibility to work as a consultant PMETB* quality assures specialist training Length of training varies – 3 years for GP, 8 years for other specialties *GMC from 2010

Maintaining Standards: Quality Assurance Two quality assurance processes: Foundation Programme (QAFP) Medical Schools (QABME) Focussed on the institution, not students and trainees Key elements are analysis of documentation, interviews with academic staff, students and clinicians Quality assurance of specialty training currently undertaken by PMETB

Quality Assurance of Medical Education Make sure institutions comply with standards Identify examples of innovation and good practice Identify concerns and help to resolve them. Identify changes institutions need to make to comply with and a timetable for their implementation Promote equality and diversity in medical education

QA Visit Processes QAFP QABME Joint process with PMETB Postgraduate Deaneries quality management 6 visitors 4-day visit over 4 sites in one week QABME Medical Schools Quality Management Curriculum content Examination framework 8 – 10 visitors Minimum 4 days visit over 6 months FP has a national curriculum and assessment programme the focus is therefore limited to postgraduate deaneries’ implementation and quality management of the curriculum and assessments TD sets outcomes but no curriculum. QABME must therefore assess the extent to which schools’ curricular and assessments enable students to demonstrate the outcomes. QA Reports and institutions’ replies publish on website

QA Visit Teams Undergraduate/ postgraduate deans & school/deanery staff Medical education specialists Clinicians Students/ junior doctors Lay Visitors All are ‘full and equal members’ of visit teams

QA visit teams Consistent approach to recruitment Same contracts (responsibilities, payment and time) Mandatory annual training Same performance management framework Annual appraisal Share competencies

QA Monitoring Process Targeted action plans & updates Annual Returns of information PMETB Survey of Trainees (for QAFP) Data from all three sources published on GMC website

Strengths of QABME at the end of 5 years In depth evaluation of School Wide range of team expertise Interactive with School Triangulation from multiple sources Seen as important and generally supportive by Schools Transparent process and status of schools’ progress on requirements is available to students and the public

Strengths of QAFP midway through Has galvanised postgraduate deaneries to evaluate and demonstrate improvements in quality management Has given trainees a greater voice in the quality management and assurance of their training Has identified areas where improvements are needed particularly in the supervision of trainees Postgraduate deaneries have reported the process as challenging and helpful – perhaps particularly the self assessment

Issues in GMC accreditation QABME & QAFP: Resource intensive – GMC and institutions Maintaining team focus/knowledge over cycle Potential variability of teams Potentially insufficient involvement of employers and patients in the QA process Disseminating good practice/innovation

Challenges for accreditation generally Is the QA focus on institutions sufficient for maintaining a register of professionals? Sanctions – ‘nuclear option’: removal of accreditation Reliance on others: can the GMC’s QA processes effectively identify areas of poor practice? Deaneries and Schools measure the quality of individual students and junior doctors Health systems regulator measures quality of care (and by extension doctors)

Issues for the future: Student Registration? Medical students are not registered with the GMC BUT guidance for schools and a significant programme of student engagement Has the challenge of keeping in touch with students and instilling professional values been met? Could student registration strengthen the link between the GMC and students? The CHRE asked health professions regulators to consider whether they should register students a couple of years ago to reinforce the sense of professionalism. This health professions programmes tend to put students in contact with patients early on requiring early development of professional values. There was also a sense that students were not aware of the impact their conduct may have on their registration and later professional life. The Council took the position that this would be a step beyond its duty to maintain a register of practitioners. It did however agree to increase efforts to engage students using and this now represents a significant programme of work involving road shows given by council members, email newsletters and ad hoc student forums. However it is still too early to determine whether this programme of work has been successful in engaging students and debate about student registration continues in health professions regulation: Should GMC have a role in decisions on students’ health and conduct before graduation? If not, could registration only (i.e. with no fitness to practise remit) provide a closer link between students and the GMC and reinforce the sense of belonging to a profession?

www.gmc-uk.org/education This is the address for our website. We look forward to working with you throughout your careers. Thank you.