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Health and Social Care Bill, Committee Stage, House of Lords

Medical Regulation - Responsible Officer (Clause 114)
April 2008

The BMA’s view is that the responsible officer function should be little more than what a good, well-supported medical director already undertakes in this area of their work. For this reason, and to ensure that effort is not needlessly duplicated, it is the BMA’s view that the role of the responsible officer should lie with the medical director. This does not mean that all the work associated with the function need be undertaken by the medical director or that they may not appoint a deputy specifically to undertake this work.

For the role to continue to be attractive it must contain within it wider pastoral and developmental responsibilities so that the responsible officer has the function of assisting poorly performing doctors not merely identifying and reporting them. The BMA would envisage that the pastoral aspects of the role would be more significant than the regulatory functions. We also recognise that not all doctors will want their Trust’s responsible officer to take on the pastoral aspects of the role for them. Hence, the responsible officer (and individual doctors) must be able to access pastoral support from elsewhere.

• How does the Government envisage the responsible officer function working in organisations or sectors that do not have a medical director or, in some cases, even management structures?
• Will the Government make the post of medical director a mandatory requirement of PCTs as it is of other NHS trusts, including Foundation Trusts?

The BMA recognises that the medical director function in primary care is at an early stage of development and we would welcome working with the Department and others on enhancing and supporting this role, and in attempting to achieve a more standard model across England. The BMA believes that the responsible officer function will require all PCTs to have a medical director, which is not currently the case.

• How does the Government envisage the role of the responsible officer functioning for non-NHS doctors, such as those in the armed forces?

The Government currently proposes that PCT responsible officers should also be responsible for all non-NHS doctors in their area. The BMA opposes this proposal as it believes that the work of a PCT medical director or responsible officer would be onerous enough in simply covering NHS primary care and other NHS doctors working in the community. The BMA proposes that responsible officers should be established on a sectoral basis, such for armed forces doctors, or police surgeons or doctors wholly in private practice.

The responsible officer function
The BMA has identified a number of core activities of medical directors. The following are of relevance to the responsible officer function.

• Providing medical leadership to the medical and clinical workforce.
• Challenging existing approaches where they are shown to be falling short of acceptable standards of healthcare delivery.
• Taking part in the consultant and other medical appointment and performance management procedures.
• Taking the lead role, in supporting and developing clinical governance.
• Taking part in the management of investigations of a clinical nature concerning doctors, such as those arising from audit, complaints or serious untoward incidents (SUIs) where patients are involved.
• Taking a key role in doctors’ disciplinary procedures and in anticipating and preventing, as far as possible, cases of poorly performing doctors.
• Supporting the work and development of clinical directors in the hospital sector (including acting as arbitrator between clinical directors and consultants where necessary, eg over job plans) and the development of clinical leads within PCTs in England and Local Health Boards in Wales.

Appointment of responsible officers

• What appointment procedures does the Minister envisage for responsible officers? Does the Minister agree that the appointments should be part of the procedure for appointing medical directors? Will the Minister give a commitment to work with the BMA in devising these procedures?

The capacity of applicants to perform these roles and functions should be considered when appointing medical directors. Rather than establish separate appointment procedures for responsible officers the BMA would wish to continue its work with the Department in formalising the procedures for medical directors generally.

The support required for the new role includes:

• Back office function/administrators
• Information systems geared to proving the data required
• A body of properly trained appraisers
• Mentors
• Education and Continuing Professional Development resources
• Occupational health and psychological services

Further questions:

• What support does the Minister envisage being required for responsible officers? Will the Minister make it a requirement on Trusts and other employers to provide the support it identifies as being required?
• How does the Minister envisage the responsible officer interacting with the proposed SHA-based GMC affiliate?
• What assessment has the Government made of the cost of establishing and supporting the responsible officer function in UK healthcare?
• What examples of such a model exist in other healthcare systems and what has the Government learnt from their experience?

For further information please contact the parliamentary Unit. Email parliamentaryunit@bma.org.uk