A responsibility too far?

The introduction of responsible officers will bring huge challenges for the medical profession, writes MPS Director of Policy and Communications, Dr Stephanie Bown

From April 2009, all doctors in England will relate to a responsible officer – a senior doctor with local responsibility for overseeing the revalidation process and handling complaints against them.

Jurisdiction

Responsible officers will be under a statutory duty to co-operate with the GMC to provide fair and effective regulation of doctors

The change comes as a result of the Health and Social Care Act. The Act introduces the role of responsible officers for the whole of the UK. In England, Wales and Northern Ireland, responsible officers will have additional functions for some clinical governance activities. Scotland is considering its own arrangements.

The precise details of the scheme in each country will be decided by a combination of secondary legislation and regulations by ministers. As an aside, this tendency for healthcare policy and regulation to be different for England, Wales, Scotland and Northern Ireland is making life increasingly complicated for both doctors and MPS. The Department of Health estimates that the responsible officer scheme will cost between £3.1 and £16.7 million a year to run. Its consultation on the responsible officer regulations closed at the end of October. You can read MPS’s full response here.

Duties

Responsible officers will be under a statutory duty to co-operate with the GMC to provide fair and effective regulation of doctors, and this new role will have wide-ranging powers and responsibilities. These include managing the interface between employers and the regulators in addressing concerns about doctors, overseeing local revalidation processes and being a focal point for holding and sharing information on complaints and concerns about doctors.

So armed, the responsible officer will have powers to make recommendations (or not) to the GMC on your revalidation and to refer you to the council. Your responsible officer will also be able to issue you with “recorded concerns”. Many of the details of how this will work in practice still have to be ironed out.

Who will perform this role?

The expansion of the role represents a huge impact on a doctor’s freedom to practise and conflicts are bound to arise

It has been suggested that the medical directors of local primary and secondary care trusts will take on the role of responsible officer. According to the Department of Health they will require “training to move into the responsible officer role”. This seems a bit ambitious – the expansion of the role represents a huge impact on a doctor’s freedom to practise and conflicts are bound to arise.

MPS has seen wide variation in the abilities of medical directors – some are very good, but others struggle to maintain their professionalism. Doctors facing the threat of investigation frequently feel there is a background agenda fuelled by interpersonal disputes, power struggles and politics. Giving medical directors the additional powers of a responsible officer may heighten these fears.

Match-making

Ultimately, all doctors will have to “find” their responsible officer. For many doctors this will be simple, since doctors will relate to the responsible officer for the organisation that employs them or contracts with them. There are nearly 250,000 registered medical practitioners in the UK, and around 128,000 doctors are employed by the NHS. Another 42,000 doctors are fully employed GPs. This leaves up to 70,000 doctors, including as many as 15,000 locum GPs, who will have to find their own responsible officers. Many of these doctors may be semi-retired or working overseas.

The introduction of responsible officers, and re-licensing later next year, will no doubt mean that they choose just to register with the GMC, rather than jumping through the hoops required to gain a licence to practise. However, there will still be many thousands of doctors – private practitioners, locum GPs and others – who will have to find a responsible officer.

In MPS’s response to the Department of Health’s consultation, we have highlighted the importance of ensuring that, wherever possible, doctors should have as their responsible officer a fellow professional with similar experience. I am not convinced that the scheme’s architects have grasped the amount of work that is going to be involved.

Will it work?

To deal with problems locally is an understandably appealing ideal. Solving problems locally should mean a speedy resolution by individuals familiar with the context. Unfortunately it will only work if the skills and experience are available locally, and to a nationally consistent standard. For the system to work, dedicated resources, time and training, with support at every level, will be essential.