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sydney Racist wrangling for foreign doctors in Australia
DISPATCHES
LONDON
Time for the General Medical Council to protect UK patients
eorge Bernard Shaw, who believed all professions were conspiracies against the public, would be rubbing his eyes. The revalidation steering group, set up by the General Medical Council (GMC) last November, was unequivocal in its first report published this week. Specialists and general practitioners (GPs) should be required to “demonstrate on a regular basis” that they are up-to-date in their knowledge and skills and remain fit to practise. The steering group concluded that an effective revalidation system could be delivered and that it was necessary to link such a system with registration. It also asked the GMC to consider whether revalidation should be extended beyond specialists and GPs to all doctors. One aim of reform, says George Alberti, president of the Royal College of Physicians, is to pick up problems before they become scandals. One of the main driving forces of reform has been two embarrassing cases of inadequate regulation in Bristol and Kent. In the first, two doctors were belatedly struck off, and a third suspended, for continuing with operations on babies with heart defects long after the unit’s death rates were known to be unacceptable; and in the second, a consultant gynaecologist about whom a series of doctors had expressed concern over 6 years, was belatedly found guilty of serious professional misconduct. In November, the GMC unanimously agreed in principle to the revalidation of doctors’ fitness to practise. But the Council deferred its
G
SYDNEY
decision on the precise mechanism for revalidation and whether it should be linked to registration. Into this vacuum stepped the former health minister, Alan Milburn, who late last year announced that the government’s new health inspectorate, the Commission for Health Improvement (CHI), would be ready to name doctors whose standards of care put patients at risk if doctors were not ready to identify dangerous colleagues. Milburn told a conference at the Royal College of Physicians that the CHI would have “access to data about individual doctors as well as powers to assure quality through
“One of the main driving forces of reform has been two embarrassing cases of inadequate regulation” visits, spot checks, and, where necessary, immediate interventions in hospitals”. He told the college that there would “no longer be any hiding place for doctors or managers who failed to acknowledge the seriousness of problems inside their own organisation”. The GMC could, at its meeting next week, endorse the steering group’s proposals and remove the threat of CHI inspectors to name and shame doctors. Some GMC members are reported to be ready to accept revalidation but reluctant to link it with registration. The steering group was unequivocal: “We are convinced . . . that any system has to be linked with registration.” Striking a
doctor off the register would be the ultimate sanction. The report sets out six stages for revalidation. The first three would apply to all doctors: local profiling of performance; periodic external peer reviews of the profiling process; and the provision of evidence for revalidation. Where there was concern about a doctor’s performance, three further actions could follow: “local remediation”, under which a doctor would receive advice and retraining; where on “exceptional occasions”, serious deficiencies appear intractable, the doctor would be referred to the GMC Performance Procedures, under which detailed scrutiny of a doctor’s knowledge, skills, attitudes, and performance would be made; and finally, failing revalidation would incur removal from the register. The report rules out an examination system. The aim would be to reflect performance at work. Doctors would be given a performance profile —a blueprint of what they should be doing and the targets they should meet. External assessors would check periodically how doctors were faring. The new system is designed to restore public trust by providing an open process, indicating which doctors have the confidence of the profession and management. “Equally, revalidation would give patients better protection from dysfunctional doctors by making sure that concerns are recognised at the earliest possible stage and by requiring prompt action”, the report says. Malcolm Dean
Racist wrangling for foreign doctors in Australia
A
ustralia’s medical organisations have been forced to defend their accreditation systems for overseas-trained doctors following allegations of restrictive practices, discrimination, and burdensome entry requirements. The controversy erupted after Inderjit Singh Virdi, a cardiac surgeon and a member of the Royal College of Surgeons, UK, was refused the right to practise without further training by the Royal Australasian College of Surgeons (RACS). The allegations, reported by the media, were detailed in The Race to Qualify, a document intended for the New South Wales (NSW) government.
THE LANCET • Vol 353 • February 6, 1999
The leaked report, which has not been published in full, is the work of a committee comprising members of the NSW Ethnic Affairs Commission, the Antidiscrimination Board of NSW, and the Equal Opportunity in Public Employment organisation. The report has sparked claim and counterclaim about the stringency of entry requirements for overseas doctors. The Australian Doctors Trained Overseas Association (ADTOA) argues the system needs reform. President Ding Chen said “temporary resident doctors can practise without an exam, but as soon as people become permanent residents or citizens they have to sit
an exam. We are in favour of exams, but the system is unreasonable”. Bruce Barraclough, president of RACS, has denied the allegations and stated that it was unethical to discuss Virdi’s case. He emphasised that the College was an equal opportunity organisation and supported overseas-trained doctors. “In Melbourne alone, seven of the nine cardiac surgery trainees are from non-Anglo-Celtic backgrounds; Greek, Chinese, Italian, Polish, Spanish and Indian.” This month a group of overseas doctors will begin a hunger strike, the second to take place in 3 years. Amanda Tattam
475
LONDON
Time for the General Medical Council to protect UK patients
eorge Bernard Shaw, who believed all professions were conspiracies against the public, would be rubbing his eyes. The revalidation steering group, set up by the General Medical Council (GMC) last November, was unequivocal in its first report published this week. Specialists and general practitioners (GPs) should be required to “demonstrate on a regular basis” that they are up-to-date in their knowledge and skills and remain fit to practise. The steering group concluded that an effective revalidation system could be delivered and that it was necessary to link such a system with registration. It also asked the GMC to consider whether revalidation should be extended beyond specialists and GPs to all doctors. One aim of reform, says George Alberti, president of the Royal College of Physicians, is to pick up problems before they become scandals. One of the main driving forces of reform has been two embarrassing cases of inadequate regulation in Bristol and Kent. In the first, two doctors were belatedly struck off, and a third suspended, for continuing with operations on babies with heart defects long after the unit’s death rates were known to be unacceptable; and in the second, a consultant gynaecologist about whom a series of doctors had expressed concern over 6 years, was belatedly found guilty of serious professional misconduct. In November, the GMC unanimously agreed in principle to the revalidation of doctors’ fitness to practise. But the Council deferred its
G
SYDNEY
decision on the precise mechanism for revalidation and whether it should be linked to registration. Into this vacuum stepped the former health minister, Alan Milburn, who late last year announced that the government’s new health inspectorate, the Commission for Health Improvement (CHI), would be ready to name doctors whose standards of care put patients at risk if doctors were not ready to identify dangerous colleagues. Milburn told a conference at the Royal College of Physicians that the CHI would have “access to data about individual doctors as well as powers to assure quality through
“One of the main driving forces of reform has been two embarrassing cases of inadequate regulation” visits, spot checks, and, where necessary, immediate interventions in hospitals”. He told the college that there would “no longer be any hiding place for doctors or managers who failed to acknowledge the seriousness of problems inside their own organisation”. The GMC could, at its meeting next week, endorse the steering group’s proposals and remove the threat of CHI inspectors to name and shame doctors. Some GMC members are reported to be ready to accept revalidation but reluctant to link it with registration. The steering group was unequivocal: “We are convinced . . . that any system has to be linked with registration.” Striking a
doctor off the register would be the ultimate sanction. The report sets out six stages for revalidation. The first three would apply to all doctors: local profiling of performance; periodic external peer reviews of the profiling process; and the provision of evidence for revalidation. Where there was concern about a doctor’s performance, three further actions could follow: “local remediation”, under which a doctor would receive advice and retraining; where on “exceptional occasions”, serious deficiencies appear intractable, the doctor would be referred to the GMC Performance Procedures, under which detailed scrutiny of a doctor’s knowledge, skills, attitudes, and performance would be made; and finally, failing revalidation would incur removal from the register. The report rules out an examination system. The aim would be to reflect performance at work. Doctors would be given a performance profile —a blueprint of what they should be doing and the targets they should meet. External assessors would check periodically how doctors were faring. The new system is designed to restore public trust by providing an open process, indicating which doctors have the confidence of the profession and management. “Equally, revalidation would give patients better protection from dysfunctional doctors by making sure that concerns are recognised at the earliest possible stage and by requiring prompt action”, the report says. Malcolm Dean
Racist wrangling for foreign doctors in Australia
A
ustralia’s medical organisations have been forced to defend their accreditation systems for overseas-trained doctors following allegations of restrictive practices, discrimination, and burdensome entry requirements. The controversy erupted after Inderjit Singh Virdi, a cardiac surgeon and a member of the Royal College of Surgeons, UK, was refused the right to practise without further training by the Royal Australasian College of Surgeons (RACS). The allegations, reported by the media, were detailed in The Race to Qualify, a document intended for the New South Wales (NSW) government.
THE LANCET • Vol 353 • February 6, 1999
The leaked report, which has not been published in full, is the work of a committee comprising members of the NSW Ethnic Affairs Commission, the Antidiscrimination Board of NSW, and the Equal Opportunity in Public Employment organisation. The report has sparked claim and counterclaim about the stringency of entry requirements for overseas doctors. The Australian Doctors Trained Overseas Association (ADTOA) argues the system needs reform. President Ding Chen said “temporary resident doctors can practise without an exam, but as soon as people become permanent residents or citizens they have to sit
an exam. We are in favour of exams, but the system is unreasonable”. Bruce Barraclough, president of RACS, has denied the allegations and stated that it was unethical to discuss Virdi’s case. He emphasised that the College was an equal opportunity organisation and supported overseas-trained doctors. “In Melbourne alone, seven of the nine cardiac surgery trainees are from non-Anglo-Celtic backgrounds; Greek, Chinese, Italian, Polish, Spanish and Indian.” This month a group of overseas doctors will begin a hunger strike, the second to take place in 3 years. Amanda Tattam
475