GMC fires warning shot to protect doctors’ training

Authors: Abi Rimmer 

Publication date:  01 Feb 2017


The GMC’s new chief executive, Charlie Massey, tells Abi Rimmer about his organisation’s role in standing up for junior doctors and his ambitions in his new post

Within a month of starting his new post Charlie Massey was reminding NHS trusts of their obligations to support junior doctors with their training and development.

In November 2016, when Massey took on the role of chief executive at the General Medical Council, the organisation published the findings of its annual national training survey. The results showed that increasingly heavy workloads were eroding the time that doctors had available for training.[1] In response to the findings Massey wrote to employers to remind them of their obligations to ensure that doctors’ training was protected.

It was a move he describes as “basically firing a shot across employers’ bows to protect training time, to protect trainees.” During a period of increasing pressure on the health service, Massey is clear that, though one of the GMC’s key responsibilities is to protect patients, it must at the same time support doctors. And he adds, “We also need to support employers. As well as firing a shot across their bows, we need to support them where things aren’t working.”

Forgotten tribe

Massey says that, in times of strain, it is important that the GMC uses its data, knowledge, and understanding and works with other regulators, such as the Care Quality Commission, NHS Improvement, and Health Education England, to improve matters for trainees. The GMC should “anticipate where problems might be arising and to get a bit more ahead of the curve,” he says. “If there is any organisation that is going to stand up and support trainee doctors and make sure that they have got the training experience that they should have, it’s going to be the GMC.”

Until the dispute over changes to the contract for junior doctors in England “trainees were a bit of a forgotten tribe,” he says. “They were relied upon hugely, perhaps too hugely, to provide services, and we know through the National Training Survey that those facing the heaviest workloads were sometimes having their training jeopardised as a result. It is incumbent on all of us in the system, but especially the GMC, to recognise that the training of doctors is absolutely critical to provide the quality of medical professionalism that we need in the NHS for the next 20 to 30 years.”

Appointment not welcomed by all

Despite his enthusiasm for safeguarding doctors of the future, his appointment to GMC chief executive was not universally welcomed by the profession.[2] “I would say that my role was misunderstood by many in terms of that aspect of being a civil servant,” he says. “The thing I would add, for the avoidance of doubt, is that I have resigned from the civil service. It is really important that the GMC is independent and is perceived to be independent, so I am not bound, in any shape or form, to government. What I would ask of doctors is that they judge me by my track record in this role, rather than what they may perceive me to have done in my previous roles.”

As well as his experience at the Department of Health (box), which included leading the response to Robert Francis’s inquiry into failings at Mid Staffordshire NHS Foundation Trust, Massey says that his previous regulatory experience will also help him in his new role. “I think it has been incredibly helpful coming here,” he says.

While the GMC is frustrated by the lack of movement towards the legislative change needed for the organisation to be able to make big differences to the way it works, some changes are expected this year. It has recently launched a consultation on a national medical licensing assessment for all doctors who wish to practise in the UK.

“The medical licensing assessment is really important for us because we don’t, at the moment, have any clear way we can assess the consistency of standards that people achieve graduating from UK medical schools,” Massey says.

Brexit opportunities

Since the medical licensing assessment was first proposed in 2005, the GMC has been keen for it to apply to all doctors who come to work in the UK, including those from the European Union. However, current rules on freedom of movement across the European Economic Area make this difficult.[3]

“We think there is an opportunity afforded by Brexit to apply the medical licensing assessment to European doctors who want to practise in the UK too,” Massey says. “We’re not singling out European doctors as being particularly problematic, but what we want is to have an MLA [medical licensing assessment] that would apply to all doctors, whether they come from the European Union, outside the EU, or UK medical schools.”

With the introduction of the assessment the question of whether the point of full registration with the GMC should be moved from the end of the first year of foundation training to the point of graduation may again rear its head.

Massey says that the GMC has always been agnostic on this question but that once the assessment is introduced it would be easier for the point of registration to be moved. However, he also says that such a move would be unlikely with the government’s focus now shifted firmly on Brexit.

“From a wider perspective,” Massey adds, “the fact that you have got the point of registration half way through the foundation programme creates some oddities in terms of how you select people to the foundation programme when they only have a provisional registration. So there is something about a cleaner break if it were aligned with graduation from medical schools.”

Charlie Massey’s CV

1983 to 1988 Cranleigh School, Surrey

1989 to 1992 St Catharine’s College, Cambridge: MA, BA (Hons), history

1992 to 1993 St Catharine’s College: MPhil, social anthropology and development

1993 to 2001 Department of Social Security and HM Treasury: various roles including private secretary to minister for social security and policy lead for Post Office

2001 to 2005 Department of Work and Pensions: deputy director, Prime Minister’s Strategy Unit

2005 to 2008 Pensions Regulator: executive director

2008 to 2012 Department for Work and Pensions: ageing society and state pensions director

2012 to 2016 Department of Health for England: director general, strategy and external relations

2016- General Medical Council: chief executive

References

  1. Rimmer A. Workloads threaten to undermine doctors’ training, GMC finds. BMJ Careers 1 Dec 2016. [Link]
  2. Rimmer A. GMC independence is a great British compromise. BMJ  2016;355:i5905. [Link]   [Link] .
  3. Gulland A. GMC proposes single test for all doctors wishing to work in UK. [Link]

Abi Rimmer BMJ Careers

 arimmer@bmj.com

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