Appendix 1: Further background
The General Medical Council and its processes
A1.10 The GMC was established by the Medical Act 1858. Its primary role is to protect patients (GMC000504, p7). In 2002, the Medical Act 1983 was amended to insert section 1A, which stated: “The main objective of the General Council in exercising their functions is to protect, promote and maintain the health and safety of the public” (GMC101215, p211). The GMC is the only body that can erase a doctor from practice, or suspend or place conditions upon a doctor’s right to practise in the UK.
A1.11 On 9 December 2004, the fifth report from the Shipman Inquiry, Safeguarding Patients: Lessons from the Past – Proposals for the Future,1 was published. The GMC investigation into the events at Gosport War Memorial Hospital spanned a number of reforms. In large part, these reforms were in response to criticism arising from the Shipman Inquiry.
A1.12 Concerns about the events at the hospital were first brought to the attention of the GMC in 2000. The only doctor whose case was taken to a fitness to practise hearing was Dr Jane Barton. Her case was heard between 2009 and 2010.
Evolution of the GMC’s processes
A1.13 The GMC is an umbrella organisation. It is responsible for regulating doctors. Different bodies within the organisation receive complaints, investigate those complaints and decide if hearings should be held to consider whether interim or full orders should be made in relation to a doctor’s registration. Until the formation of the Medical Practitioners Tribunal Service in June 2012, the GMC also held those hearings and made the decisions.
A1.14 The composition of these different bodies within the overall GMC, and the rules under which they operate, were the subject of fundamental change during the investigation into the events at the hospital.
Fitness to practise rules prior to 1 November 2004
A1.15 Prior to 2004, there were separate rules dealing with the different aspects of doctors’ fitness to practise, depending on whether the concerns about their practice related to conduct, health or performance (GMC101025, pp171–209).
A1.16 The nature of the case would determine which of the GMC committees would consider the case.
A1.17 Conduct: All the investigations arising from events at the hospital were related to the conduct of the doctors, and so were considered as conduct cases.
A1.18 Conduct cases would be considered by the Preliminary Proceedings Committee and then, if there was determined to be sufficient concern, the case would be referred to the Professional Conduct Committee.
A1.19 A case relating to conduct is one where “a question arises whether conduct of a practitioner constitutes serious professional misconduct”.2
A1.20 Performance cases would be considered by the Assessment Referral Committee and then, if applicable, by the Performance Assessment Committee.
A1.21 Health cases would be considered by the Health Committee.
Initial screening prior to 1 November 2004
A1.22 A case against a doctor would begin with the receipt of a complaint or information in writing to the Registrar.
A1.23 The Registrar would submit the matter to a Medical Screener, if it appeared that a question arose as to whether the conduct of a practitioner constituted “serious professional misconduct”.3
A1.24 The second stage was the consideration of the case by the Medical Screener.
A1.25 In 2001 and 2002, when screening decisions were in the process of being taken in this investigation, the Screeners were appointed by the President of the GMC.4
A1.26 At that time, the Medical Screener had to refer the case to the Preliminary Proceedings Committee, unless the Medical Screener decided that the question of whether or not the practitioner’s conduct constituted serious professional misconduct did not arise.
A1.27 If the Medical Screener took this view, the case then had to be considered by a Lay Screener and the case could only be ‘screened out’ if the Lay Screener agreed with the Medical Screener’s decision.5 If the Lay Screener did not agree, the case would be referred to the Preliminary Proceedings Committee.
HM Government, 2002. The Shipman Inquiry. Fifth report, Safeguarding Patients: Lessons from the Past – Proposals for the Future.
http://webarchive.nationalarchives.gov.uk/20090808160144/http://www.the-shipman-inquiry.org.uk/fifthreport.asp (accessed 17 May 2018).
1988 Professional Conduct Rules, Rule 2(1).
1988 Professional Conduct Rules, Rule 6(1).
1988 Professional Conduct Rules, Rule 4; HM Government, 2002. The Shipman Inquiry. Fifth report, Safeguarding Patients: Lessons from the Past – Proposals for the Future.
http://webarchive.nationalarchives.gov.uk/20090808160144/http://www.the-shipman-inquiry.org.uk/fifthreport.asp (accessed 17 May 2018), paragraphs 19.2 and 19.21–19.23.
1988 Professional Conduct Rules, Rule 3(A).