Michael Devlin: Regulatory reform should be a priority for the new secretary of state for health

Plans to reform the way doctors are regulated presents a useful opportunity to ensure public confidence and patient safety is enhanced, writes Michael Devlin

Sajid Javid, the UK’s new Secretary of State for Health certainly has a full inbox, with pressing decisions to be made about when to lift remaining coronavirus restrictions, reform of health and social care, and tackling the immense waiting list backlog. Compared to these challenges, long awaited reforms to the way healthcare professionals are regulated, at first may not seem like a top priority, but at the MDU we would argue they should be, not least because the coronavirus pandemic has underlined just how important dedicated and skilled doctors and other healthcare professionals are to society. 

The public has got used to high standards from doctors and it’s important, as a profession, we continue to live up to those expectations. The regulatory reform proposed by the Department of Health and Social care is an opportunity to do things differently, to the benefit of both doctors and patients. 

An example of this is one of the early lessons learnt in the pandemic: the need to suddenly mobilise large numbers of staff at short notice. This included redeploying those who had recently retired, but were needed either in the front line or to back-fill posts made vacant by others. We support the proposal that regulators are given a permanent emergency registration power. Although no one wants to see another pandemic, one thing we have learnt is that robust plans and agile responsiveness are essential to meet the challenge.

The current legislation underpinning medical regulation dates back to 1983 and reforms to it are difficult, slow, and have not kept pace with modern practice. The reforms being proposed would make cases less adversarial, more efficient, and consequently less stressful for doctors. 

The new system would have three tiers, an initial assessment followed by a decision by case examiners with a formal, panel hearing comprising the final stage. What this means is that case examiners would have greater powers to dispose of cases, including the ability to impose sanctions where these are agreed by the doctor. The devil will be in the detail as to how, precisely, the regulations will work and it is important that sufficient flexibility is retained to allow for constructive dialogue between a doctor’s representative and the case examiners.

Although the MDU broadly welcomes many of the proposed reforms, we do not agree with everything. Where we have raised concerns, it is in relation to proposals which threaten to undermine the principles of fairness and proportionality. For example, plans to remove health as a category of impairment in fitness to practise cases risks undoing the many advances that have been made by the General Medical Council (GMC) in establishing sensitive and separate procedures for dealing with vulnerable doctors whose cases cannot be managed informally. In addition, the stigmatising label of “lack of competence” will be attached to doctors who are already struggling with their physical or mental health. 

We have also objected to proposals to scrap the “five-year rule” which could mean doctors are routinely subjected to fitness to practise proceedings for historic complaints where there is no question of current impairment or risk to patients. The GMC is able, under the rule to investigate allegations which date back more than five years if doing so is in the public interest. This means the fitness to practise process focuses on what really matters: is a professional’s practice currently impaired and are conditions required on their registration to protect the public?

Finally, we are pleased it is proposed that the GMC will no longer have the power to appeal a decision made by a fitness to practise panel. Doctors have for too many years faced the double jeopardy of a successful outcome at a Medical Practitioners Tribunal Service tribunal being subject to appeal by either the GMC or the Professional Standards Authority.  This is unfair and the proposed reform will reassure many doctors.

Doctors work immensely hard to attain and maintain their professional status; they agree to be held to the highest standards by the regulator and swear to do no harm. They deserve a regulatory system which is fair, proportionate, and maintains public confidence in them. 

Reform to the healthcare regulators must be prioritised by the new Secretary of State for Health and for our part, we will be working to ensure the government sticks to its timetable. 

Michael Devlin, head of professional standards and liaison at the Medical Defence Union

Competing interests: none declared.