Much to celebrate but much to do: the GMC’s regulation of training

Authors: Niall Dickson 

Publication date:  28 Jun 2012

The GMC’s chief executive, Niall Dickson, responds to a recent BMJ Careers article about the regulation of medical training

Benjamin Dean and Matt Jameson Evans in their article “The regulation of medical training: a problem ignored” paint an interesting, but partial, picture of the work of the General Medical Council since it took on the responsibility for regulating postgraduate medical education in 2010 (not 2009 as stated).[1] By focusing on the GMC’s power to withdraw approval of training posts they have missed a host of other key developments in this area of our work.

While we do have the power to withdraw posts, as the national regulator, this is only one of many levers we and others exercise to drive up quality in the system. It is also worth noting that doctors can be and are removed from training sites much more often by deaneries. Deaneries have responsibility for managing the quality of postgraduate education at the local level, and in that role they routinely highlight the need for change to NHS trusts and other local education providers and work with them to improve the quality of individual posts and programmes. In some cases this can require reconfiguration of services or financial investment.

Unacceptable variation

The fact that the GMC and deaneries may not use the power to withdraw posts or trainees in a particular situation does not mean that trusts are unaware that we have this power—the fact that it exists is often enough to precipitate the necessary change.

That said, we fully accept that there are unacceptable variations in the quality of training. Too many trainees report a lack of training, support, and supervision. There are serious concerns about the impact of the Working Time Regulations in specialties with a high emergency workload. Too many trainees also feel forced to cope with problems beyond their clinical competence or experience. These are matters that need to be tackled with some urgency by the GMC and by the system as a whole.

Since taking over from the Postgraduate Medical Education and Training Board we have begun a major programme of reform. This has included significantly increasing the staff involved in overseeing the quality of medical education and taking a number of steps to make sure we have a better understanding of what is happening on the ground. We have also established a new system to respond quickly and effectively where there are concerns.

Rapid response team

We now have a rapid response team of medical advisers who can go and investigate concerns in a very short period, and its members now regularly accompany deanery staff on visits where serious concerns have been raised. Some of these visits are prompted by our own data; others are initiated by the deaneries themselves.

Much of this activity necessarily occurs “below the radar.” But as part of the comprehensive review we have begun to look into how we quality assure medical education. We are also looking at how we report on concerns once they have been substantiated. We will need to strike a balance between encouraging improvement and highlighting failings. But our starting point must be the need for greater transparency. Trainees and others need to see that action has been taken in response to their concerns.

We have also updated the national trainee survey and will continue to develop it with the Conference of Postgraduate Medical Deans of the UK (COPMeD) and the royal colleges and faculties. We want to make sure that it is as accessible as possible. When, for example, trainees raise concerns about patient safety or supervision, deaneries should be able to investigate and report back to us promptly.

We regard our programme of visits as a critical part of this work. Every visit involves direct engagement with trainers and trainees, and every visit results in action plans with clear timetables. At the same time we gather “softer” information about the wider education environment through regular round table discussions with students, trainees, and others.

We have also just launched teams of employer and regional liaison officers throughout the United Kingdom to improve our local contacts and provide support for those delivering care and education.

Encouraging excellence

Other reforms from next year include plans to introduce more support for trainers in secondary care, and we have already approved a new approach to workplace based assessment in the foundation curriculum for 2012. This should move us away from a tick box approach to one in which excellence can be encouraged and nurtured.

Looking further ahead, together with the medical royal colleges, medical schools, and the four UK health departments we have established the independent review of the shape of medical training, chaired by David Greenaway, vice chancellor of Nottingham University. This is a once in a generation opportunity to shape the structure, approach, and content of postgraduate education in the UK and make sure that doctors trained here are among the best in the world.

We operate in a dynamic and changing system. If we in the UK are all to achieve our shared ambition of being a global leader in medical education, we need an open and honest dialogue with all concerned. There is much to celebrate but also much to do.


  1. Dean B, Jameson Evans M. The regulation of medical training: a problem ignored. BMJ Careers  15 May 2012. [Link] .

Niall Dickson chief executive, General Medical Council, London, UK

Cite this as BMJ Careers ; doi: