Policy responses and statements

Name of organisation:

General Medical Council

Name of policy document:

Amendments to Registration Regulations and Procedures

Deadline for response:

10 August 2007

Background: The way in which the GMC carries out its functions is governed by the Medical Act 1983. Recent changes to the Act (brought about by the Medical Act 1983 (Amendment) and Miscellaneous Amendments Order 2006) that will take effect later this year mean that the GMC needs to make a number of changes to the rules, regulations and procedures that support its registration functions. This consultation deals with 2 areas:

(a) The procedures to be followed when dealing with applications for registration and the maintenance of the register; and
(b) The form and content of the re gister.

GMC's proposals:

The GMC's procedures for considering registration applications are described in the document 'Registration Decisions: Arrrangement of Procedures'. The changes to the Medical Act that will take effect later this year include:

(a) Introducing a new requirement for all doctors applying for registration to satisfy the GMC that their fitness to practise is not impaired.

(b) Abolishing the separate system of limited registration that exists for international medical graduates and replacing it with a new, single registration framework for all doctors.

These changes need to be reflected in the GMC's procedures. Most of the changes that need to be made to the 'Arrangement of Procedures' document are relatively minor. They include, for example, the removal of all references to limited registration, and the inclusion of references to the new, direct routes to provisional and full registration for international medical graduates. However, the GMC has also taken the opportunity to clarify a number of additional issues and put its handling of applications for all doctors on an equal footing, regardless of where they have qualified. It is on these issues that the GMC would like views.

Fitness to practise at the point of registration:

Until now, doctors holding recognised UK primary medical qualifications have had a legal entitlement to registration with the GMC. By contrast, the Medical Act made separate provisions for international medical graduates (IMGs). IMGs have been required to satisfy the Registrar of the GMC that, among other things, they are of good character.

The changes to the Medical Act mean that, in future, all applicants for registration will need to satisfy the GMC that their fitness to practise as doctors is not impaired. This creates an opportunity for the GMC to consolidate its registration arrangements so that the process applies equally to all groups of doctors. At the moment, the 'Registration Decisions: Arrangement of Procedures' document applies to applications for registration from IMGs, but not to UK graduates. The GMC believes that it is now appropriate and equitable to extend its scope to cover applications from UK graduates as well as IMGs.

COMMENTS ON
GENERAL MEDICAL COUNCIL
AMENDMENTS TO REGISTRATION REGULATIONS AND PROCEDURES

The Royal College of Physicians of Edinburgh is pleased to respond to the General Medical Council on the consultation paper on Amendments to Registration Regulations and Procedures, as follows:

Q1. Do you agree that the registration processes set out in the Arrangements of Procedures document should apply equally to UK graduates and IMGs?

It has been difficult to access the Arrangements of Procedures document but, from the information contained within the consultation document itself, the College considers that, in principle, the standards of all doctors accepted onto the register should be equivalent irrespective of their medical school of origin. However, the processes for checking credentials may be different for doctors trained in UK medical schools and NHS Foundation Programmes, which are themselves subject to direct scrutiny by the GMC.

Q2. Do you agree that the registration procedures should specify a minimum period for an applicant to comment on any information received? If so, is 14 days an appropriate period?

Given that the applicant has a vested interest in commenting, most will do so at the earliest opportunity but 14 days may be insufficient, particularly if the information is extensive or requires further research to compile a response. This may be crucial to an applicant’s case, and adding time pressures would be unfair.

Q3. Do you agree that the Registrar should be given discretion to decide whether there is dispute regarding any facts that would require an application to be considered at a hearing?

Agreed, provided that applicants retain the right to appeal if they do not agree with the decision of the Registrar. There should also be an audit trail of discretionary decisions to demonstrate adherence with regulations and competence.

Q4. Do you agree that in cases where an entry in the register is alleged to have been obtained by means of fraud, or been incorrectly made, the Registrar should have discretion over whether or not he needs to seek advice from a Registration Panel?

There is a significant difference between a mistake, genuinely made by either the GMC or the applicant, and a fraudulent application. The College accepts that the Registrar should be given discretion over minor errors without the need to refer to a Registrations Panel. However, the erasure or suspension of a doctor is a serious issue, causing significant anxiety and distress to the doctor and which must be balanced against the clear need to protect the public. If this is a rare event, then convening a Registration Panel need not be onerous and may be fairer than giving discretion to an individual officer. If, however, the balance of views is in favour of giving the Registrar the discretion to suspend pending inquiry, then a clear audit trail of decisions must be maintained to retain the confidence of the profession.

Q5. Do you agree that we should be able to request evidence to support an application for a change to a register entry?

Agreed that this should be available for any application for change.

Q5 Do you agree that where there is doubt about the evidence of identity provided in support of an application for a change to a register entry, the Registrar should have discretion over whether or not to seek advice from a Registration Panel?

Agreed but, again, an audit trail of discretionary decisions should be available.

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939

[10 August 2007]