Recommendation 169

Incorporating approved practice settings scheme for post graduate training

Accepted in principle
The Department of Health, through the National Quality Board, should consider making the necessary statutory (and regulatory changes) to incorporate  the approved practice settings scheme into the regulatory framework for postgraduate training.

The National Quality Board brings together a number of key national partners, including the Care Quality Commission, the Nursing and Midwifery Council and the General Medical Council to champion quality and ensure alignment in quality throughout the NHS.

The General Medical Council and the Nursing and Midwifery Council both participate in regional quality surveillance groups.  These groups bring together commissioners, regulators, local Healthwatch representatives and other bodies on a regular basis to share information and intelligence about quality across the system, including the views of patients and the public.

The General Medical Council has made it clear that it recognises the need to contribute to the identification and in some cases the investigation of generic concerns, building on its progress in recent years to become a more proactive and collaborative regulator.  This includes signposting complainants to the appropriate regulator if their concerns are not for the General Medical Council; making referrals to systems or other professional regulators; investigating concerns arising from the media (including those which do not specifically name a doctor) and sharing information with and participating in regional quality surveillance groups and risk summits.

The Nursing and Midwifery Council have made it clear that they are determined to work closely with other regulators, including the Care Quality Commission to share information and analyses, and that it should not have to wait until a disaster has occurred to intervene with its fitness to practise procedures.

In addition, as set out in the responses to recommendations 164 and 165, the General Medical Council has undertaken a fundamental review of Approved Practice Settings and the final recommendation is that the provisions of section of the Medical Act 1983, which deals with Approved Practice Settings, should be repealed through the next available legislative vehicle. In the meantime, the General Medical Council will place the scheme on a firmer footing through alignment with the existing statutory duties for healthcare organisations, namely the Responsible Officer Regulations. This would, in effect, prevent doctors newly registered or recently restored to the register from practising in circumstances where they do not have a prescribed connection to a designated body (a prescribed connection means making sure every licensed doctor is supported with revalidation and that they are always working in an environment that monitors and improves the quality of its services). The General Medical Council will also build on its relationships with systems regulators in each of the four countries – they have an important role in ensuring that organisations comply with the duties for designated bodies set out in the Responsible Officer regulations.


The General Medical Council collects a rich and unique data set that can yield intelligence about systems or generic concerns and has developed a data strategy setting out how it will develop and use data. This work is in its early stages but, over time, is expected to allow the General Medical Council to identify, analyse and understand trends and areas of risk. It will use this intelligence to develop the way it regulates and reflect it back to the medical profession (and, importantly) the wider healthcare system. (See Recommendation 222)

Additionally, the General Medical Council has established an internal Patient Safety Intelligence Forum to coordinate information that may demonstrate concerns about patient safety or medical practice and ensure the appropriate operational and policy response across its functions relevant to operational or thematic risk. This Forum will continue to develop throughout 2015 in parallel with the development of the organisation’s enhanced data strategy.

The General Medical Council has also been strengthening its relationships and ways of working with the Care Quality Commission and other organisations. It has already developed an Operational Protocol with the Care Quality Commission and held a workshop to identify thresholds for sharing information which has led to further opportunities to develop its information sharing protocol.