Appendix 1: Further background

A1.71 The 1988 Civil Procedure Rules set out that cases could not be referred to the Preliminary Proceedings Committee if, at the time the complaint was first made to the Council, more than five years had elapsed since the events giving rise to that allegation.

A1.72 However, a Medical Screener could direct that a case be referred to the Preliminary Proceedings Committee, if “the public interest requires this in the exceptional circumstances of that case”.

A1.73 This remained the case until December 2015, when the requirement for “exceptional circumstances” was removed. Now, the test is whether proceedings are in the public interest.

A1.74 Before August 2000, interim orders could only be made by the Preliminary Proceedings Committee. These could be for a maximum of six months, but could be renewed for up to three months.

A1.75 The Interim Orders Committee was established in August 2000 as a direct result of the public concern caused by the GMC’s inability to act in the case of Harold Shipman, despite the fact he had been arrested on a charge of murder.¹⁴

A1.76 A case had to be considered by a Screener before it could be referred to the Interim Orders Committee.

A1.77 Screeners have now been replaced by Case Examiners, who provide full written reasons for their decisions.

A1.78 The Interim Orders Committee (now replaced with Interim Orders Tribunals) had the task of deciding whether it was necessary to suspend a doctor’s registration or to impose conditions on a doctor’s registration, pending a final decision in the case.

A1.79 Interim orders are imposed if it is necessary to protect the public, in the public interest or in the doctor’s interest.

A1.80 Interim orders can be imposed for a maximum of 18 months, after which time they must be reviewed in the High Court.

A1.81 When a doctor ceases work in the UK (due to retirement etc), they usually seek to come off the GMC register in a process called “voluntary erasure”.¹⁵

A1.82 If a doctor is under investigation, the GMC will carefully consider whether to allow voluntary erasure to take place.

A1.83 Once a doctor has been erased, the GMC has no jurisdiction and can take no action. The GMC considers many factors, for example that a doctor may wish to reapply for inclusion on the register in the future and the investigation that should have taken place will not have done so.

A1.84 In the wake of the Shipman Inquiry, the GMC brought in “revalidation” from 3 December 2012.¹⁶

A1.85 Under this process, all licensed doctors are required to demonstrate on a regular basis (every five years) that they are up to date and fit to practise in their chosen field and able to provide a good level of care.

A1.86 Mr Dickson described revalidation as “the biggest thing that has been attempted in the last 150 years” (GMC000270, p1). He explained that, before revalidation came into force, the GMC register simply recorded the historical qualification obtained by a doctor.

A1.87 At the time of the events at the hospital, the GMC had no process of revalidation.