The human brain is an amazing thing. It starts working at the moment of birth and only stops when you have to speak in public

Medico-legal Update:

What’s new and what’s on the horizon.

Julian Woolfson LLM FRCOG

April 2007

• The Regulation of Health Professionals in the 21st Century: the White Paper on Professional Regulation.

• Acting as an Expert Witness: GMC draft for consultation.

• RCOG Guidelines on VBAC and the management of perineal tears.

and, finally,

• A message from the taxman.

The Regulation of Health Professionals in the 21st Century: the White Paper on Professional

Regulation

• Largely accepts the recommendations made in Good doctors, safer patients and in the response to the Shipman report, though with changes and clarifications in key areas.

• A move from the criminal standard of proof to the lower civil standard in fitness-to-practise cases. Sliding scale, with stronger evidence needed in the most serious cases, so the standard would be virtually indistinguishable from the criminal standard were a doctor’s livelihood to be threatened;

• The make-up and role of the GMC.

• Revalidation/fitness to practise assessment by means of Relicensure and, for specialists including GPs, Recertification;

• A regional network of GMC Affiliates

• A three-board model covering undergraduate education, postgraduate education and continuing professional development. PMETB to continue as a separate legal entity;

• Changes to the nature and amount of information held by the GMC on individual doctors.

• Commissioning and piloting 360-degree feedback;

• the introduction of an appraisal process with a summative component (looking back at performance against specific standards);

• Standards for each area of specialist recertification, (for which the costs would be recovered either through a direct payment to the relevant Royal College or through fees to the GMC, depending on the circumstances);

• A rehabilitative and supporting emphasis to professional regulation;

• Continuous professional development and life-long learning.

Will anything change?

• Little or no relevance to the vast majority of doctors, who already practice to a very high standard:

For every time that Harold Shipman and Beverley Allitt are

mentioned, we must recall the hundreds of thousands of

extraordinary individuals who dedicate themselves

impeccably to their patients every day. Most health

professionals meet high standards routinely and have a

lifelong appetite to be even better. That professionalism is

an unquantifiable asset to our society, which rules,

regulations and systems must support, not inhibit.

Patricia HewittForeword to the White Paper

But what about the tiny minority who don’t ….

Will they now change their ways and do what they are asked to do ?

Patricia Hewitt (if only)

The medical profession (not likely)

Or will they stick their necks out and remain on the outside?

Will anything change?

• With the exception of 360-degree appraisal, little evidence to support many of the proposed changes to regulation.

• There is likely to be increased scrutiny, through availability of more detailed information held on doctors. May be a help or a hindrance in Clinical Governance

• Someone has to pay for the increased governance activity, but who?

• The White Paper recognises that the Royal Medical Colleges do, after all, have an important role in providing education, setting standards and assessing competence.

Which is where we started, millions of £££ ago…

PMETB, NPEU, CHi, GMC and others demonstrating effective communication

Acting as an Expert Witness: GMC draft for consultation

Raising Concerns

“If you become aware that patients or others are being placed at risk of death

or serious harm, you should report your concerns, to the appropriate person or

organisation without delay. If the information giving rise to your concerns is

covered by legal professional privilege (legal advice or litigation privilege)

you can still report that you have concerns and about whom, though you must

explain that you came by your concerns in privileged circumstances and so

cannot lawfully disclose the documents or their substance”.

“Documents exchanged between parties in litigation (thereby waiving legal privilege) remain confidential, and disclosure of these documents or their substance may be in contempt of court. As with documents that are legally privileged, you can report that you have concerns, and about whom, without disclosing the documents or their substance. It will then be for the person or organisation to investigate as they see fit.”

“You should exercise caution if asked to enter into contracts that require you to remain silent about details of cases settled out of court, which are not legal privileged but are confidential. Signing a contract which may require silence will, in those exceptional cases where patients may be at risk, put you in the difficult position of having to break that contract in order to satisfy your professional, ethical obligations”

A group of Medical Experts maintaining silence.

RCOG Guidelines on VBAC and the management of perineal tears:

Helpful in defining the standard of care

And finally, a message from the taxman:

• Charges made by Health Professionals are VATable if the primary purpose of the service is not the protection, maintenance or restoration of the health of the person concerned or are outside of the profession in which you are registered or are otherwise specifically exempted or outside the scope of VAT.

• VATable charges specifically include the following:

Medico-Legal medicals and reports

Expert witness testimony and allowances (unless in respect of giving only professional evidence to the High Court under Supreme Court Act 1981)

HEALTH PROFESSIONALS— VATABLE SERVICES FROM 1ST MAY 2007Please refer to the full text of VAT Notice 701/57 Health Professionals January 2007,

available from Latest Updates on the VAT section at www.hmrc.gov.uk.

The End

(Of Medical and Legal Practice as we know them?)