College responds to DHSC consultation on General Medical Council reforms

Disagree.

The College disagrees with the proposal that coming into force dates should be included in the Order and supports the suggested approach to have these specified in tertiary legislation.

While a specific coming into force date would provide certainty, transparency and accountability for stakeholders, the College recognises that some flexibility for implementation may be necessary for managing transitional arrangements. Significant regulatory reforms require substantial operational preparation, including updates to systems, guidance, and governance arrangements as well as stakeholder engagement and communications.

Implementation should be supported by clear transition planning, publication of supporting rules and guidance, stakeholder engagement and appropriate lead-in periods to ensure reforms are introduced safely and effectively.

Agree.

The College supports the inclusion of equality, diversity and inclusion requirements within the regulatory framework. Regulators should seek to ensure that their policies, procedures and decision-making processes are fair, transparent and free from unlawful discrimination.

The College considers that equality, diversity and inclusion requirements should support the delivery of effective regulation and public protection and should be accompanied by clear accountability mechanisms, guidance and stakeholder engagement.

Agree.

The College supports the objective of creating a modern, flexible and efficient regulatory framework. We agree that the provisions set out in parts 2 to 4 of the draft order enable GMC to carry out its governance and operating framework functions appropriately.

However, we would suggest adding to Article 7 of the draft Order an explicit requirement for the GMC to considercost-efficiencies in the delivery of its statutory objectives. While maintaining high standards of regulation and public protection must remain paramount, the GMC should also be expected to ensure that its functions are exercised in a proportionate and cost-effective manner, minimising unnecessary burdens on registrants and making efficient use of resources.

Disagree.

The College recognises the intention to provide greater flexibility and operational effectiveness within the proposed constitutional arrangements. However, we would welcome greater clarity regarding unitary boards. We are concerned that the introduction of unitary boards would further reduce the influence of registered members of the professions in shaping the strategic direction and overseeing the performance of their regulators. 

Furthermore, while the draft Order includes requirements for a non-executive chair, UK-wide representation, and for lay non-executive members not to be outnumbered by registrants, it contains no requirement for registrants to serve as non-executive Board members. This omission is not adequately justified by the consultation's assertion that it is “extremely likely” that regulated professionals would be appointed.

The draft Order should require a minimum number of registrant non-executive members. This would help ensure that professional regulation remains a partnership between the public and the professions, and would strengthen the confidence and engagement of those being regulated.

It remains important that regulatory bodies continue to benefit from direct input from individuals with relevant professional expertise alongside lay representation. Decisions are most robust when informed by those with a deep understanding of professional practice, education and patient care.

While greater flexibility may support efficiency, the College would not support any reduction in meaningful professional representation or independent scrutiny. Further clarity regarding governance safeguards would assist stakeholders in assessing whether the proposed arrangements will achieve an appropriate balance between flexibility and accountability.

Agree.

The College agrees that the proposed powers and duties relating to the Privy Council appear broadly sufficient to support the GMC in carrying out its functions appropriately.

Appropriate oversight arrangements are important for maintaining accountability and public confidence, while allowing regulators the operational flexibility required to respond to changing circumstances. The proposed approach appears to strike a reasonable balance between regulatory autonomy and external scrutiny.

The College also supports greater flexibility for regulators to make detailed rules without requiring repeated legislative intervention. However, significant rule changes should continue to be subject to transparent consultation and engagement with registrants, professional bodies, employers, education providers and patient groups, and should be consistent with the purpose and intent of the legislation.

Agree.

The College agrees that the Professional Standards Authority (PSA) should have sufficient powers to obtain information necessary to fulfil its statutory oversight responsibilities effectively.

Independent oversight forms an important component of public protection and confidence in healthcare regulation. However, evidence-gathering powers must remain proportionate and subject to appropriate safeguards relating to confidentiality, privacy, data protection and procedural fairness.

The exercise of such powers should be transparent and clearly linked to the PSA's statutory functions.

Neither agree nor disagree.

The College recognises the potential benefits of enabling the GMC to approve overseas education and training programmes, including supporting workforce mobility, international collaboration and greater consistency of professional standards. However, we note that approval of UK education and training programmes is underpinned by a broader system of oversight, including educational regulatory bodies and national quality assurance frameworks that assess aspects of provision beyond the GMC’s remit. Equivalent arrangements may not exist in all jurisdictions.

Any overseas approval process should therefore be subject to particularly rigorous scrutiny and ongoing oversight to ensure that approved programmes meet standards equivalent to those required within the UK. This should include assurance in relation to curriculum content, supervision, assessment, governance, institutional quality management and patient safety. Approval arrangements should be transparent, evidence-based and supported by robust mechanisms for monitoring and revalidation.

The College also considers that the costs associated with assessing and monitoring overseas programmes should be met by the institutions seeking approval and should not be borne by UK registrants. Careful consideration should be given to the potential implications for professional standards, workforce planning and public confidence in UK education and training systems.

Disagree.

The College supports the GMC retaining responsibility for setting standards and outcomes for education and training. However, it does not consider that regulators should assume primary responsibility for the detailed design, delivery and administration of education and assessment.

Professional regulators play an important role in defining the competencies and standards required for safe practice. Universities, royal colleges, specialist professional bodies and approved education providers are generally better placed to determine how those standards are delivered through curriculum design, educational methods and assessment processes. In addition, education providers are already subject to oversight by established educational regulatory and quality assurance bodies, such as the Office for Students and equivalent organisations across the UK, which assess many aspects of educational provision beyond the remit of professional regulators.

The College is concerned that an overly expansive regulatory role may blur the distinction between quality assurance, educational regulation and educational provision. Concentrating standard-setting, approval and operational assessment functions within a single organisation may also reduce confidence in the independence and effectiveness of oversight arrangements and risk duplicating existing regulatory frameworks.

A proportionate framework should focus regulatory activity on standards, outcomes, public protection and quality assurance while preserving the autonomy of approved providers to deliver education and training within that framework.

Agree.

The College agrees that establishing categories of speciality practice through a new order of council may provide greater flexibility and enable the framework to evolve more effectively over time.

However, any transition away from the existing arrangements should be carefully managed to avoid uncertainty for professionals, employers, education providers and patients. Clear communication, appropriate transitional arrangements and stakeholder engagement will be important to maintain confidence in specialist training and recognition pathways.

Disagree.

The College supports regulators having access to a range of proportionate measures to protect the public and manage risk. However, allowing an individual to remain registered while being subject to a complete restriction on practice may be difficult for patients and employers to understand and could create uncertainty about the meaning and implications of registration.

We would welcome greater clarity on the rationale for adopting a different regulatory approach for doctors, as the consultation document does not provide a clear justification for this distinction.

Agree.

We support consistent and transparent registration standards covering knowledge, skills, conduct, ethics and English language proficiency. These requirements should be clearly published and applied consistently.

The College agrees that the draft order provides the GMC with sufficient powers and flexibility to carry out its registration functions effectively, and that regulators are best placed to determine detailed registration requirements and processes. Any significant changes should continue to be subject to stakeholder consultation and engagement, transparent communication and appropriate implementation periods. Registration arrangements should remain proportionate, fair and focused on public protection.

Professional and clinically informed oversight is also essential to ensuring registration standards reflect current practice realities and patient safety requirements.

A single register divided into distinct professional parts may be workable provided that professional distinctions remain explicit; patients can clearly identify professional roles; and specialist status, annotations and scopes of practice are clearly presented. The register must not create confusion between different professional groups, including doctors, physician assistants and physician assistants in anaesthesia, or undermine public understanding of qualifications and scope of practice.

Information published about registrants should be limited to that which is necessary for public protection. Publication of excessive historical or personal data risks being disproportionate and may not enhance patient safety.

We support proportionate data collection and sharing where necessary for regulatory functions and public protection. However, such activity should be proportionate, clearly justified, and compliant with data protection and confidentiality requirements. Regulators should be transparent about the purpose of data collection, and publication of personal data should remain appropriately limited.

We support proportionate emergency registration powers to enable rapid regulatory response during national emergencies, as demonstrated during the COVID-19 pandemic in relation to flexible registration, remote practice, supervision and deployment arrangements. However, such powers should be time-limited, subject to safeguards, and regularly reviewed to ensure continued proportionality and accountability.

Neither agree nor disagree.

The College does not hold a specific view on the continued protection of these individual titles. However, we are of the opinion that decisions on protected titles should be guided primarily by considerations of public understanding, patient safety and the potential risk of confusion. Where titles are no longer widely used or understood in contemporary healthcare practice, there may be a case for legislative simplification, provided that any changes are accompanied by clear communication to avoid misunderstanding among patients and the public.

More broadly, the College supports maintaining robust protection of professional titles where this is necessary for patient safety and public confidence. Protection of function also remains important where specific clinical activities carry significant risk. Any reforms should avoid creating ambiguity regarding who is medically or clinically qualified, who holds specialist accreditation, and the scope of practice of different professional groups, as clear public understanding of professional roles is essential for informed consent and patient trust.

Agree.

The College supports measures that improve public understanding of professional roles, qualifications and regulatory status. We agree that ‘registered medical practitioner’ should become a protected title, as its use by someone who is not a registered doctor would be misleading.

Furthermore, the College considers that any changes to protected titles should be supported by clear evidence that they will improve public understanding, reduce confusion and strengthen public protection.

Should the proposal proceed, it will be important to ensure that terminology is applied consistently and communicated clearly to patients, employers and professionals. The primary objective should be to support informed patient decision-making and confidence in professional regulation.

Neither agree nor disagree.

The College recognises that this recommendation originates from the Leng Review and supports the principle that healthcare professionals should be clear and transparent about their role, qualifications and scope of practice when introducing themselves to patients.

Clear communication about professional roles is essential to help patients understand who is providing their care and to maintain public confidence in the healthcare workforce.

Regardless of the terminology adopted, appropriate statutory protection of professional titles is essential to maintain public confidence and prevent misuse. Any changes should also avoid creating ambiguity regarding who is medically qualified and the distinctions between professional groups.

Neither agree nor disagree.

See our response to Q14.

Agree.

The College agrees that any significant change to professional titles should include an appropriate transition period to allow employers, education providers, regulators, registrants and healthcare organisations sufficient time to update documentation, systems, policies, training materials and public-facing communications.

Appropriate implementation periods are important in reducing confusion, supporting operational readiness and maintaining confidence among patients and healthcare professionals. The College therefore supports a clear and proportionate transition process accompanied by effective communication.

Yes.

The College considers that temporary protection of existing titles alongside any new titles may support continuity and help employers and professionals adapt gradually to new terminology, while reducing the risk of misuse or misunderstanding.

However, introducing parallel protections for multiple titles may increase confusion for patients and the public. Any such arrangements should therefore be time-limited, clearly communicated and subject to regular review.

Agree.

The College supports the inclusion of serious offences within a mandatory removal framework where this is necessary to protect the public and maintain confidence in professional regulation.

Healthcare professionals hold positions of trust and responsibility. Serious criminal offences may call into question an individual's suitability to remain registered and may justify regulatory action without the need for extensive further consideration.

However, the operation of such provisions should remain proportionate and incorporate safeguards relating to procedural fairness, criminal appeals and exceptional circumstances. Automatic outcomes should only apply where justified by the seriousness of the offence and associated risk to the public.

Agree.

The College agrees that mandatory removal for the most serious offences may justify permanent exclusion from professional registration in order to protect the public and maintain confidence in professional regulation.

The College supports the inclusion of limited exceptional circumstances where convictions or sentences are subsequently overturned or substantially altered.

Any restoration process should remain transparent, evidence-based and focused on public protection. Decisions should take account of the seriousness of the original offence, evidence of remediation, ongoing risk and wider public confidence considerations.

Disagree.

The College disagrees with the proposed grounds for action as they are not comprehensive. It is unclear how the GMC would be able to consider convictions and cautions relating to criminal offences not included in Schedule 4. The draft Order appears to restrict the GMC's ability to take account of other criminal conduct that, although not warranting mandatory removal from the register, may nevertheless raise serious questions about a doctor's fitness to practise, such as manslaughter, perverting the course of justice, or drink-driving in the course of professional duties.

Furthermore, grounds for action should be clearly defined, consistently applied, and readily understandable to both the public and registrants. The terminology and thresholds used must be clearly defined to ensure consistent understanding among regulators, professionals and the public. Where broad terms such as “misconduct” or “lack of competence” are used, regulators should publish clear guidance and examples to support consistent interpretation. In addition, health-related concerns should not be automatically conflated with lack of competence.

Agree.

The College supports reforms that make fitness to practise processes fair, transparent, proportionate and efficient, while ensuring appropriate procedural safeguards and appeal rights for registrants are in place. We agree that the proposed fitness to practise framework broadly provides sufficient and proportionate powers to support public protection and effective regulation. Allowing case examiners to agree an accepted outcome with the consent of a registrant is welcomed. Reducing unnecessary hearings may also benefit registrants, complainants and regulators.

The proposed model may improve efficiency, provided clear thresholds and robust procedural safeguards are maintained. Fitness to practise decisions should be informed by individuals with relevant clinical and professional expertise and an understanding of contemporary practice, supported by clear guidance, transparent criteria and timely communication with all parties.

Agree.

The College agrees that regulators should have access to interim measures where necessary to protect patients and maintain confidence in professional regulation.

Where concerns arise during registration proceedings that may present an immediate risk to the public, it is appropriate that proportionate interim measures are available.

The exercise of such powers should remain evidence-based, transparent and subject to review and appeal. Any restrictions imposed should be no more extensive than necessary to manage identified risks.

Agree.

The College agrees that the GMC should have access to sufficient evidence-gathering powers to enable it to fulfil its statutory responsibilities effectively.

Effective regulation depends upon the ability to obtain relevant information during registration, fitness to practise and other proceedings. However, such powers should be exercised proportionately and only where necessary to support regulatory functions.

Appropriate safeguards relating to confidentiality, data protection and procedural fairness should continue to apply.

Agree.

The College supports regulators having sufficient flexibility to develop operational rules within a clear statutory framework.

The ability to update detailed procedures without requiring legislative amendment may improve responsiveness and efficiency. However, significant changes should continue to be informed by engagement with registrants, professional bodies, employers, education providers and patient representatives. 

Agree.

The College agrees that regulators should have powers to review and revise decisions where material new evidence or information becomes available.

Such powers may improve regulatory effectiveness, support public protection and help ensure that decisions remain accurate and fair.

Revision mechanisms should operate transparently and include appropriate safeguards to ensure fairness to registrants and confidence in regulatory processes.

Agree.

The College supports robust and accessible appeal rights as an essential component of fair and proportionate regulation.

Appeal mechanisms provide important safeguards against error, support accountability and help maintain public confidence in regulatory decision-making.

Registrants should continue to have access to independent review of significant regulatory decisions, including decisions relating to registration, fitness to practise, restoration and interim measures.

Strong rights of appeal remain essential safeguards within professional regulation. Registrants should retain rights of appeal against key regulatory decisions, including those relating to registration, fitness to practise outcomes, interim orders and restoration decisions. Appeals should be heard by independent courts, and any internal review mechanisms operated by regulators or oversight bodies should be grounded in principles of fairness, transparency and procedural impartiality.

Neither agree nor disagree.

N/A

Agree.

We agree with the proposed consequential amendment to the National Health Service Reform and Health Care Professions Act 2002, which will allow the PSA to appeal specified fitness to practise and interim registration measure decisions to the relevant courts in England and Wales, Scotland, and Northern Ireland.

The PSA plays an important oversight role and limited appeal powers may provide an additional safeguard where significant concerns arise regarding regulatory outcomes. However, any extension of such powers should remain proportionate and avoid unnecessary duplication, delay or procedural complexity within fitness to practise proceedings. The exercise of appeal powers should remain transparent and subject to appropriate safeguards to ensure fairness to registrants.

Agree.

The College agrees that the GMC should be able to administer internal appeals mechanisms as part of an efficient and effective regulatory framework.

Internal appeals may provide a proportionate means of reviewing decisions and correcting errors without requiring immediate recourse to external proceedings.

However, such arrangements should operate transparently, be supported by clear procedures and safeguards, and complement rather than replace independent external rights of appeal. Professional expertise should continue to inform decision-making where appropriate, and public confidence should remain a central consideration.