General and Specialist Medical Practice (Education, Training and Qualifications) Order 2010

My Lords, the order being debated today is the first in a series of legislative instruments implementing the recommendations made in the report of the Tooke inquiry, Aspiring to Excellence—Findings and Final Recommendations of the Independent Inquiry into Modernising Medical Careers. This is quite a complex order and my remarks will be quite lengthy. I apologise in advance for that. However, I hope they will be helpful in facilitating the discussion. The draft order is made under powers in Section 60 of the Health Act 1999. It abolishes the Postgraduate Medical Education and Training Board and transfers its functions to the General Medical Council. The Postgraduate Medical Education and Training Board was created in 2003 and took over the functions of its two predecessor bodies—the Specialist Training Authority, the STA, and the Joint Committee on Postgraduate Training in General Practice, known colloquially as the JCPTGP—in September 2005. It currently approves standards for assessments, trainers and programmes for the delivery of postgraduate medical education and training, and monitors training, quality standards and outcomes through inspection visits and other arrangements in the UK. It also awards certificates of completion of training, CCTs, and determines the eligibility of doctors for inclusion on the specialist and GP registers. The effect of the draft order is to transfer to the GMC statutory responsibility for delivering these functions, which are central to ensuring the delivery of effective patient care. The GMC already has responsibility for setting and assuring standards in undergraduate medical education and for ensuring that all doctors participate effectively in continuing professional development to ensure that they keep their skills up to date after completing training. While taking on responsibility for postgraduate medical education and training is a significant extension of the GMC’s remit, it is in a functional area in which the GMC already has a strong track record. When the Postgraduate Medical Education and Training Board was created in 2003, it brought together, for the first time, responsibility for setting and maintaining standards in both postgraduate general practice education and training and specialist medical education and training. The rationale for merging the functions of the Postgraduate Medical Education and Training Board with the GMC originates from the report of the Tooke Inquiry, Aspiring to Excellence—Findings and Final Recommendations of the Independent Inquiry into Modernising Medical Careers. This is not a new idea. It was first recommended in 1975 in the Merrison report. The Tooke inquiry demonstrated dissatisfaction among the profession with the current fragmented system and found evidence that the medical profession sought an education and training standards-setting authority that was independent of both the Government and the NHS, had strong lay representation and which could work in close partnership with the profession. Such a body would also need to draw on relevant specialist expertise to facilitate flexible training and set standards across the continuum of medical education, from undergraduate studies through to postgraduate qualification and continuing professional development. The inquiry suggested that a merger of the two bodies responsible for medical education and training would provide the potential for shared expertise, the development of a shared philosophy and facilitate economies of scale. The merger will also create a single competent authority for medical education and training and a single point of contact for doctors, employers and other partner organisations. Historically, the financial burden of standard setting in postgraduate medical education and training has fallen primarily on the trainee. The Tooke report also revealed that there is strong support for the view that it would be more appropriate for the costs to be borne by the profession as a whole. Transferring responsibility for setting and assuring standards of postgraduate medical education and training into the GMC’s remit will enable changes to the current funding structure to be made so that, in future, the system of assuring postgraduate medical education and training could be funded through GMC fees with the burden of costs shared across all licensed doctors. Both the GMC and the Postgraduate Medical Education and Training Board support the merger, recognising that it creates an opportunity to realise more far-reaching improvements in the way that medical education and training are regulated. During the public consultation on the proposed legislation, there was also very strong support for the proposal, with a large majority of respondents supporting a merger of the two bodies. Turning to the proposed transfer of functions, I have already said that the draft order makes provision similar to that currently in the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003. I apologise for going into some detail. As the order integrates the provisions of the 2003 order into the Medical Act 2003, it is, I am afraid, rather complicated legislation. Article 3 of the order formally abolishes the Postgraduate Medical Education and Training Board. Article 4 then introduces a number of amendments into the Medical Act 1983, made in Schedule 1 to the order. Although the PMETB is currently responsible for setting standards for entry to the GP register and the specialist register, the GMC as the body responsible for regulating medical practitioners currently holds and administers the registers. The GMC will continue to hold and administer the registers once the PMETB is abolished. However, a number of consequential amendments to the Medical Act 1983 are required in order to ensure that the GMC is able to perform all the statutory functions necessary, both in connection with the keeping of the registers and postgraduate medical education and training generally. With this in mind, paragraph 10 of Schedule 1 inserts a new Part 4A into the Medical Act 1983 dealing with postgraduate medical education and training. I shall not take up the House’s time by going through all the provisions of new Part 4A in detail as there is a comprehensive explanation of them in the consultation paper on the draft order prepared by the Department of Health. I should perhaps mention, however, the provisions where there is a departure from the current legislative position. These relate to the categories of registered medical practitioners, other than those who have been awarded a CCT, who are eligible for entry in the GP register and the specialist register. Whereas the 2003 order set out the eligibility criteria for doctors wishing to be included in the GP register and the specialist register, new Part 4A provides new delegated powers enabling the Privy Council to prescribe such criteria in an order. These new powers, at new Section 34C(2)(c) and Section 34D(2)(c), enable the Privy Council by order to specify other categories of registered medical practitioners who may be entitled to be included on the GP register or the specialist register respectively. There is also a power at new Section 34D(3) for the Privy Council by order to designate specialties as recognised specialties for the purpose of inclusion in the specialist register. Creating a new regulation-making power will enable any necessary changes to the criteria for inclusion on the registers to be made more quickly and easily in order to reflect changes in the wider external environment. However, I believe that the necessary checks and balances would be provided, as many of the eligibility criteria are derived from European Community legislation. Changes would be consulted on and be subject to approval by Parliament. The Postgraduate Medical Education and Training Order of Council 2010, which sets out detailed provisions relating to the categories of registered medical practitioners other than those who have been awarded a CCT who will be eligible for entry in the GP register and the specialist register, was consulted on at the same time as the draft order before us today and will be laid before Parliament as soon as this order is made. The draft order does not make any substantial changes to standards of postgraduate medical education and training, the process for certifying that doctors have completed postgraduate medical education and training, or the way that any of the quality assurance functions in postgraduate medical education and training are undertaken. It was felt that changing procedures at the same time as significant personnel changes were taking place would increase the risk of disruption and that there was a need to maintain the operational stability of both organisations during the transfer. However, the need for a comprehensive review of the system of medical education and training is recognised. The noble Lord, Lord Patel, chairman of the National Patient Safety Agency and former chair of the Specialist Training Authority, was invited by the GMC and the Postgraduate Medical Education and Training Board to lead the ongoing review of the current arrangements, which is due to make recommendations on an appropriate, contemporary approach to medical education and training in March 2010. Noble Lords may be aware that the GMC and PMETB published for consultation recommendations arising from the review of the noble Lord, Lord Patel, on 11 January. I understand that the outcome of the consultation will then inform the final report and recommendations to the GMC. A merger in advance of the noble Lord’s final report makes sense because it allows the GMC to take an overview of the whole continuous system. The GMC will then be better placed to identify and implement any changes required as a result. Finally, I should also point out that the order makes a technical amendment to the Medical Act to enable GPs to be included on the GP register without the need to make a request to the GMC when they have been registered temporarily under Section 18A of the Medical Act in the event that the GMC has been advised that a civil emergency has occurred, is occurring, or is about to occur. As part of the Government’s planning in response to the recent swine flu epidemic, it became clear that, although the powers introduced in the Health Care and Associated Professions (Miscellaneous Amendments) Order 2008 enabled temporary registration of doctors generally, they did not give the GMC the explicit power to be able automatically to add former GPs to the GP register. To practise primary medical services, GPs need to be included on the GP register before they can be included on their employer’s local performers list. New section 34F(4) of the Medical Act enables the GMC automatically to include doctors’ names on the GP register as soon as re-registration occurs. I commend the order to the House.