The Pharmaceutical Journal
Vol 268 No 7201 p797-798
8 June 2002

This article
Reprint
Photocopy

PDF* 40K

How other health professions are coping with the regulatory reforms (3)

It is not only the Royal Pharmaceutical Society that is having to face up to reform. In this third article, Wendy Moore looks at how the various regulatory bodies are restructuring their councils and how members are to be selected and/or elected

The big picture for reform of the professional regulatory bodies is now clear. All the health care regulatory organisations are moving towards streamlined councils with elected professional members and much greater lay representation. All are similarly reforming fitness to practise rules and introducing compulsory continuing professional development (PJ, 6 April, p460 (PDF* 130K) and 20 April, p529).

Doctors

Doctors face possibly the biggest task in revamping their regulatory body, the General Medical Council, and introducing other reforms. Plans to streamline the GMC, from its current 104 members to 35, comprising 19 elected medical representatives, two appointed medical members and 14 lay people, were approved for consultation by the Government last month (PJ, 25 May, p709). The final proposals are expected to go for parliamentary approval in the autumn to produce legislation in November or December.

Assuming legislation goes ahead, elections will probably take place next spring and a revamped GMC could be in place by next summer. Currently, 54 of the medical representatives are directly-elected and 25 are appointed by the medical schools and universities. The last election in 1999 brought forward 336 candidates on a 60-page ballot paper for seats in England alone. This prompted concerns of voter apathy because, according to Mark Paulson, the GMC's governance project manager, "as the number of candidates goes up, the percentage of voters participating goes down".

Not surprisingly, the GMC hopes to streamline the new ballots. There will be two seats for Scotland and one each for Wales and Northern Ireland. The 15 seats for England will be divided into five geographical constituencies — probably north, south, east, west and London — each returning three members.

The GMC also plans to restrict tenure to counteract perceptions that it has become "fossilised", says Mr Paulson. Members will stand for four years, instead of the current five, and only for two consecutive terms before having to stand down for one term. There will be a maximum age limit of 70 years.

Two medical members will be appointed by the Council of Heads of Medical Schools and the Academy of Medical Royal Colleges to the reformed GMC. Lay members will continue to be appointed officially by the Privy Council, based on recommendations from the Health Secretary, as with all the lay members on the regulatory bodies. Future member allowances, currently £250 a day or up to £300 in locum fees, are under consideration.

Following a lengthy and complicated legal wrangle, the GMC is now a registered charity. Its first application for charitable status in 1928 was rejected but in the 1990s the GMC took legal advice and asked the Charity Commission to reconsider its bid. In 2000 it made a formal submission. The Charity Commission then decided that, as a body performing a function in the public interest, the GMC should be considered — and had been operating as — a charity.

Charitable status has several benefits, mainly financial, as well as some responsibilities. The GMC is exempt from income tax, corporation tax, capital gains tax and stamp duty. So far this has saved it more than £7m, up to December 2001, including large sums in backdated tax relief since 1994. In return, the GMC has to ensure all its activities are charitable, and that its trustees — all its council members — avoid any conflict of personal and charitable interest.

Dentists

Dentists are well ahead of the game in reforming their regulatory body, the General Dental Council. Attentions are currently focused on the push to organise elections for the professional members before the end of this year.

The Government has already agreed that the existing GDC, made up of 50 members, will slim down to 29, comprising 15 dentists — including the president — four members from the professions complementary to dentistry (PCD) and 10 lay members. All 19 dental team members will be directly elected. Already 18 of the existing dentist members on the GDC are elected using the single transferable vote. Last elections were held in March 2001. Now the pressing task for the GDC is to organise elections for the 19 dental team members to the new body.

The GDC agreed proposed election rules in March but these must be approved by the Privy Council and go through Parliament before the poll can go ahead. Officers hope the plans will be pushed through the parliamentary process before the summer recess so that council elections can take place immediately after the summer break.

Under the proposals, the 15 dentist council members will be elected from geographical constituencies. There will be 11 seats in England, two in Scotland and one each for Wales and Northern Ireland. The four PCD members will be UK-wide and could come from either of the two PCDs currently registered with the GDC — dental hygienists and dental therapists. In future, as the GDC moves to register dental nurses and technicians, these posts could be elected from any of the PCDs.

There will be no restrictions over who can stand for the dental team posts, so long as the candidate is a registered practitioner nominated by 12 registrants from the constituency in which they are standing. Candidates do not need to live within the constituency in which they stand but cannot stand in more than one constituency. A new regulation will mean that ballot papers will record any action previously taken against a candidate under fitness to practise rules. Members will be elected for five years but may stand for an unlimited number of terms.

The GDC expects the election process to take about three months. The lay members will be appointed by the Privy Council over the same period. Once all 29 new members are in post, there will be a three-month transition and induction period before the existing council hands over to its successors. All being well, the first meeting of the revamped GDC should take place in January 2003.

Possibly exercising dentists' minds more at the moment, however, are the GDC's proposals to more than double the annual retention fee from £135 for dentist members to £350 in future. The rise, which must be approved by the Privy Council, would take place next year. Under the new tariff hygienists and therapists will pay £40 per year.

The hefty increase has been prompted by a large rise in expenditure. GDC outgoings have trebled since 1996, mainly due to a far greater number of conduct hearings. The various reforms are also expected to take their toll on GDC finances. The GDC has gone out of its way to explain the need for the fee rises, including holding a question and answer session at the recent annual conference of the British Dental Association.

Three years ago the Privy Council turned down an appeal from the GDC for a rise in fees to £150 and it is possible that the current proposal will be similarly rejected. But recertification director Chris Collins, who is involved in the reforms, says the fee rise is crucial. "It is imperative, otherwise we cannot do any of the things we want to do or even stand still."

Nurses

Nurses have moved fast in the reforms league and already have a completely new regulatory body, the Nursing and Midwifery Council (NMC) which came into being on 1 April. The body operated in shadow form, working alongside its forerunner, the UK Central Council for Nursing, Midwifery and Health Visiting (UKCC), for the previous 12 months. The slimmer council has 12 registered professionals — four each from nursing, midwifery and health visiting — and 11 lay people, compared to the 60 who served on the UKCC. Each registrant member has an alternate counterpart who can vote in their stead.

The professional members have all been appointed for three years by the Government following nominations from professional bodies, educational institutions and employers' organisations. The lay members were appointed by the Privy Council.

In future, however, all 24 professional members will be elected. One of the first tasks of the NMC is to draw up procedures for the first election to produce a new body in 2005. The NMC aims to put forward election proposals to go out for consultation along with other plans for reforms next year, according to spokesman Stuart Skyte. However, as council members will be elected from their own specialties, the NMC has to reorganise its register first. Currently the register has 15 separate sections which the NMC aims to streamline. Then nurses and midwives will vote for members in their particular specialty and within geographical constituencies for England, Scotland, Wales and Northern Ireland. "An English nurse will vote for an English nurse," explains Skyte. There may also be some UK-wide positions.

It is expected that council members will sit for four years and serve for a maximum of three terms with no age or other restrictions.

Registration fees with the NMC are comparatively low — £60 for three years — despite an increase last October when fees rose for the first time in eight years. The NMC has pledged not to raise fees further before April 2004.

Therapists

The new Health Professions Council came into being on 1 April, like the NMC, with a smaller council of professional members appointed by the Government and lay people appointed by the Privy Council. Proposals to elect all the registrant and alternate members will go out to consultation shortly but there will be at least one registrant and one replacement for each of England, Scotland, Wales and Northern Ireland. Elected members will serve four years up to a maximum three consecutive terms. There is no age limit.

Opticians

The General Optical Council, which regulates opticians, is well advanced in reforming itself, although it now has to concentrate on reforming its regulatory procedures. The new GOC, launched in January this year, has 28 members comprising 15 professional and 13 lay people. Of the professionals, 11 are directly elected. These are six optometrists (three from England, one each from Scotland, Northern Ireland and Wales) and five dispensing opticians (on a UK-wide basis). Elections take place every five years and there is no limit on how many times a candidate can be re-elected although the age limit for standing is 60 with members retiring at 65. In addition, one dispensing optician is appointed by the Association of British Dispensing Opticians in consultation with academic bodies, and three optometrists are appointed by the College of Optometrists and other academic bodies.