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Shipman Inquiry

Exactly—that is indeed what the Minister is proposing. However, we are dealing, in that sense, with two different things. They are not alternatives. In order to combat the risk of any eventuality arising in which a medical practitioner’s responsibility for malfeasance, wrongdoing, malice or incompetence was such that we needed to act on the basis of risk, we must have a very robust system for acting on concerns. We must be very clear that we are trying to ensure that practitioners are fit to practise; that part of the system has to be robust but proportionate. It is for us to work out how much effort and time and how many resources need to be put into revalidation to make it work in a way that commands the confidence of the medical profession and the public. Enormous amounts of resources are going to be involved. I do not want to anticipate the Second Reading debate of a future health professions Bill. However, as the Government published their White Paper in February, it would be useful to air some issues; if, in the next parliamentary Session, we can secure legislation that commands consensus across the House and creates a stable system for the long term, it will be the better for that. I am content for us to move towards a structure of governance for the GMC that is balanced in respect of its representation of the professions and of lay people. We just need to talk a bit more about how confident we are of what ““independent appointment”” means in practice. I know that the Government are clear that they have to set out the specifications and criteria for appointments and that things will be conducted through the Appointments Commission, which is independent, but we are placing a large amount of confidence in the ability of the commission to secure the right candidates for posts. I am not yet clear about how confident we can be about that; we should go further. I turn to revalidation. As I said, I have questions about the risk that, by putting in place a rigid structure, we will not only incur large costs and a diversion of effort, but may end up with something that becomes routine rather than proactive. If we looked, as we must, at where the real deficiencies lie, we would find that clinical governance in the hospitals—the secondary sector—has developed enormously in recent years. From my vicarious experience, it is far stronger now than it was many years ago. I do not want to underestimate the efforts that those working in primary care put into continuing professional development. However, I do not think that the sector’s process of clinical governance as a whole—particularly the effort put into audit of outcomes, adverse events and risks—is anything like as strong or systematic as that of the hospital sector. That is why the medical examiner should not only be concerned with assuring people about the certification of deaths, but should be integral to securing that quality of audit trail through primary care. We need to be confident that we are creating structures in primary care, for GPs in particular, that are at least as strong as those in the secondary sector. There are many single-handed general practitioners, and I do not disparage them in any sense. However, we must be aware that large numbers of doctors practise in the community in a highly professional independent way. When we debate the pay and remuneration of GPs, we often forget how independent and responsible they are. With that responsibility must go an equal level of audit and clinical governance. I turn to some questions for the future, if not for today. I am not clear about how far we are, literally, going to maintain a self-regulated professional structure and how far we are shifting from a statutory framework to Government regulation. I listened with interest to what the hon. Member for Oxford, West and Abingdon (Dr. Harris) said. He accused the Government of imposing Government regulation, but I am not sure whether the Government are proposing that. However, there is a difficulty: if we go too far and the statutory framework becomes too intrusive and prescriptive, it will become, in effect, the same thing. What is intended is professional self-regulation that secures a high level of confidence and good results, within a statutory framework that gives us powers of intervention.