Our annual report 2017 - gmc-uk.org · In addition to this report, we have also produced a separate...

Our annual report 2017

About us 02

Our role 02

Delivering our role 03

The impact of our work 03

Medical Practitioners Tribunal Service 03

Our priorities for 2018 03

Delivering our corporate strategy in 2017 04

Our five strategic aims for 2014–17 04

Helping to raise standards in medical education and practice 05

Improving how we handle concerns about patient safety 08

Using information in smarter ways 13

Working more closely with patients, doctors and medical students 16

Working better together 20

Delivering our role 26

Setting the standards for doctors 26

Overseeing doctors’ education and training 26

Taking action where concerns are raised 27

Managing the UK medical register 30

Helping to raise standards through revalidation 30

Our structure, governance and management 32

2017 financial review 42

Audit and Risk Committee’s report 48

Independent auditors’ report to the trustees of the General Medical Council 51

Accounts 2017 54

Reference and administrative information 82

General Medical Council | 01

CONTENTS

Contents

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About this report

In this report we explain the work we have delivered in the final year of our previous corporate strategy 2014–17, highlighting our progress against each of our strategic aims. We also explain

how we have delivered our statutory functions, and provide a clear picture of our financial performance and position as of the end of 2017.

02 | General Medical Council

ABOUT US

Our roleWe are an independent statutory organisation that helps to protect patients and improve medical education and practice across the UK.

n We decide which doctors are qualified to work here and we oversee UK medical education and training.

n We set the standards that doctors need to follow, and make sure they continue to meet these standards throughout their careers.

n We take action to prevent a doctor from putting the safety of patients, or the public’s confidence in doctors, at risk.

Council is our governing body. Its role is to provide strategic direction, hold the executive to account and take major high-level policy decisions. It comprises 12 members, six of whom are medical members and six of whom are lay members. They are also the trustees of the GMC, which is a registered charity. You can read more about Council in the section ‘Our structure, governance and management’ from page 32 of this report.

We have a dedicated presence in all four countries of the UK with offices in Wales, Scotland and Northern Ireland,1 and in England in London and Manchester.

Our Corporate strategy 2014–17 2 outlined how we aimed to change to meet an increasingly challenging external environment. We have now produced a new corporate strategy for 2018–20, which takes a fresh look at our aims for the next three years. Our main objective however remains the same – to protect the public.

Our trustees present this report and financial statements for the year ending 31 December 2017. They confirm they have taken into account the Charity Commission’s public benefit guidance when reviewing

our aims and objectives; and have had regard to this guidance when exercising any powers or duties; or when making a decision to which the guidance is relevant. The trustees are satisfied that at all times we have operated for public benefit; and the activities as described in this report and accounts fully meet the public benefit requirements and support our charitable purpose.

The statements are in the format required by the Charities SORP (FRS 102) Accounting and Reporting by Charities: Statement of Recommended Practice.

Delivering our roleIn its latest annual assessment of how we have performed as a regulator, the Professional Standards Authority (PSA) reviewed our performance across our core functions and confirmed that we successfully met all the 24 standards for good regulation for 2016/17. These include standards relating to fairness, transparency, public protection and timeliness. The full report is available on the PSA website.3

You can read more about our core operational functions on page 26 of this report.

The efficiency savings we have made over the last couple of years have enabled us to offer significant fixed-term discounts on our registration fees for newly qualified doctors. Doctors who qualified in the last five years now receive a £275 discount on the annual retention fee for full registration, and all doctors will receive a £35 discount on their annual retention fee. These fee changes came into effect on 1 April 2018, and we believe they will help ease the financial pressures that many doctors are facing.

1 See www.gmc-uk.org/about/how-we-work/who-we-work-with

2 See www.gmc-uk.org/-/media/documents/corporate-strategy-2014-17_pdf-74182279.pdf

3 See www.professionalstandards.org.uk/publications/detail/performance-review-gmc-2016-17

http://www.gmc-uk.org/Corporate_strategy_2014_17.pdf_54828872.pdf

http://www.gmc-uk.org/about/how-we-work/who-we-work-with

http://www.gmc-uk.org/-/media/documents/corporate-strategy-2014-17_pdf-74182279.pdf

http://www.professionalstandards.org.uk/publications/detail/performance-review-gmc-2016-17


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ABOUT US

The impact of our workIn addition to this report, we have also produced a separate impact report which gives further insight into some of the ways we made a difference to protecting the public and improving standards of medical education and practice. The report is organised around five key themes:

n protecting the safety of the public and supporting the medical workforce

n working with doctors to maintain and improve standards

n assuring the quality of education and training

n sharing intelligence and collaborating with partners

n delivering responsive and proportionate regulation

This is available on our website, and includes statistics, case studies and illustrations of our work in action.

Medical Practitioners Tribunal ServiceOn 31 December 2015, the Medical Practitioners Tribunal Service (MPTS) was written into the Medical Act 1983, creating the MPTS as a statutory committee of the GMC.

This change has strengthened the operational separation of the MPTS from the GMC’s investigation function. MPTS tribunals make independent decisions, which the GMC can now appeal against to the relevant court when it believes patients have not been adequately protected.

The MPTS is now required to provide its own annual report to Parliament. You can read more about the service’s performance in MPTS Parliamentary Report 2017.4

Our priorities for 2018Our priority during 2018 will be to deliver high quality services across our core regulatory functions.

Alongside this, we will start to deliver against our new Corporate Strategy 2018–20,5 which sets out how we use our insights to refocus medical regulation to support a high quality workforce in delivering good medical practice. Our four strategic aims under this plan are:

n supporting doctors in maintaining good practice.

n strengthening collaboration with our regulatory partners across the health service.

n strengthening our relationship with the public and the profession.

n meeting the changing needs of the health services across the four countries of the UK.

We will also continue to set and monitor standards for doctors; oversee UK medical education; decide who is qualified to work here; and take action to prevent doctors putting patients’ safety, or public confidence, at risk.

Our Business Plan 2018 sets out our priority work for the year.

4 See www.mpts-uk.org/about/1606.asp

5 See www.gmc-uk.org/about/how-we-work/corporate-strategy-plans-and-impact/corporate-strategy

http://www.mpts-uk.org/about/1606.asp

http://www.gmc-uk.org/about/how-we-work/corporate-strategy-plans-and-impact/corporate-strategy


DELIVERING OUR CORPORATE STRATEGY IN 2017

Our five strategic aims for 2014–17

01 HELPING TO RAISE STANDARDS IN MEDICAL EDUCATION AND PRACTICE We will develop our standards, our guidance and the way we support particulargroups of doctors to help them deal with professional challenges. We will makesure medical education equips doctors to meet these standards.

03 USING INFORMATION IN SMARTER WAYSWe will use and share information in smarter ways to support high standards of medical practice and to help reduce risks to patients. Putting the information we hold to best use will help to create a more open system and to safeguard the interests of patients.

04 WORKING MORE CLOSELY WITH PATIENTS, DOCTORS ANDMEDICAL STUDENTS ON THE FRONTLINE OF CAREWe will have more contact with doctors, medical students and patients so thatwe have a better understanding of their lives and work. More of them will beaware of our guidance and use it to help them maintain standards of patient care.

05 WORKING BETTER TOGETHERWe recognise there are often barriers to better collaboration within and betweenorganisations – we will work across teams within the GMC and with otherorganisations to make the best use of all available knowledge and skills to help usdeliver effective regulation.

02 IMPROVING HOW WE HANDLE CONCERNSABOUT PATIENT SAFETYWe will continue to press for much-needed reform of the legislative system tohelp us handle the complaints we receive about doctors fairly and effectively. We will make sure that concerns about doctors are first addressed locally wherever possible. We will continue to develop new ways to reduce the stress for those involved in our fitness to practise procedures.



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Helping to raise standards in medical education and practice

We revised our Outcomes for graduates guidance

In 2017 we embarked on a significant project to review and update our 2009 standards Outcomes for graduates, which was completed in 2018.

The outcomes detail the knowledge, skills and behaviours that all new UK medical graduates must be able to demonstrate when they leave medical school.

In 2017 we asked a range of interested parties, including postgraduate training bodies, employers and students, for their feedback on the content and format of the current outcomes. As a result of their comments we produced a revised draft which we then consulted on in late 2017. The consultation closed in January 2018 and we published a new version of the guidance in June 2018.

The updated outcomes will better prepare UK medical graduates for postgraduate training; and make sure the outcomes of their training takes account of the many changes in healthcare over recent years.

We are continuing our work to develop a UK-wide Medical Licensing Assessment

In 2017, we consulted on proposals to introduce a new Medical Licensing Assessment (MLA) with the aim of ensuring all doctors can meet a common

threshold for safe practice. You can read more about the consultation on our website.6

We were pleased to receive over 400 responses from a wide range of individuals and organisations, and that the majority of responses supported our aim for the MLA. The consultation responses also raised a variety of practical and logistical points that helped us to develop our thinking. We took our thinking to our Council in December 2017. Council asked us to begin a programme of development and piloting, working collaboratively with stakeholders, to have the MLA in place from 2022.

The MLA will apply to all UK qualified doctors and international medical graduates. Under current law, we cannot apply the MLA to doctors from the European Economic Area (EEA) and Switzerland but this may change when the UK exits the European Union.

There will be two parts to the MLA: a common test of applied knowledge (AKT) and a requirement to pass clinical and professional skills assessment (CPSA). We will be building on current tests and assessments delivered at medical schools and the GMC’s Professional and Linguistic Assessment Board (PLAB) test to assess international medical graduates. We will establish new requirements and performance measures to reduce unnecessary variation and increase effective practice with the aim that everyone can be confident that doctors starting UK practice have met a consistent, safe standard.

You can read more about the MLA on our website.7

6 See www.gmc-uk.org/-/media/documents/m05---report-on-the-medical-licensing-assessment-consultation_pdf-72007373.pdf

7 See www.gmc-uk.org/education/standards-guidance-and-curricula/projects/medical-licensing-assessment

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http://www.gmc-uk.org/-/media/documents/m05---report-on-the-medical-licensing-assessment-consultation_pdf-72007373.pdf

http://www.gmc-uk.org/education/standards-guidance-and-curricula/projects/medical-licensing-assessment



We are continuing to develop our standards in curricula and assessments, and promote flexibility in postgraduate training

In May 2017, we launched a comprehensive package of educational reforms designed to strengthen postgraduate medical education and training. These reforms reflect the views of stakeholders across the UK, as set out in in Professor David Greenaway’s independent report - The Shape of Training8 - published in 2013. The report identified the changing needs of patients across the UK, and highlighted the need for more doctors who are capable of providing general care in broad specialties across a range of different settings. We had highlighted these issues in our own report to the health ministers of the four UK governments in March 2017, Adapting for the future.9

We are making changes to curricula requirements that will allow equivalent training between related specialties to be better recognised. The changes will help ensure that doctors in training who wish to transfer between specialties can do so without the snakes-and-ladders effect of having to start again from the beginning in the ‘new’ specialty, without recognition of the training they received in the previous specialty. This new approach will help doctors transfer their skills more easily. It will also be more efficient for the healthcare system because there won't be the need to repeat training or learning already achieved.

Central to our reforms are new standards for curricula, Excellence by design.10 These standards

bring a new approach to learning based on high-level outcomes, and address the need for future generations of doctors to be trained to meet the needs of a changing population.

Together with the Academy of Medical Royal Colleges (AoMRC) we also developed a ‘Generic professional capabilities framework’11 (GPC). This framework describes the essential professional knowledge, skills and capabilities that doctors must demonstrate.

Our new curriculum standards require colleges and faculties to embed and contextualise the GPC framework within every curriculum. We have produced guidance to support colleges and faculties in implementing the framework,12 and designing and maintaining postgraduate assessment programmes.13

After the launch of the new standards for curricula and GPC framework in May 2017, we continued to progress further work to deliver greater flexibility in postgraduate medical education and training. In November 2017, we published an updated position statement on less than full time (LTFT) training. This sets out conditions to make sure that the duration, level and quality of LTFT training is not less than that of continuous training. We also asked the UK government to make the law from which we draw our powers and responsibilities less restrictive so we can be more agile in approving training.

During 2018 we will continue to work with the UK Medical Education Steering Group (UKMERG), the AoMRC and other key partners to take forward our

8 See www.shapeoftraining.co.uk/reviewsofar/1788.asp

9 See www.gmc-uk.org/-/media/documents/adapting-for-the-future-a-plan-to-improve-postgrad-med-training-flexibility_pdf-69842348.pdf

10 See www.gmc-uk.org/Excellence_by_design___standards_for_postgraduate_curricula_0517.pdf_70436125.pdf

11 See www.gmc-uk.org/education/postgraduate/GPC.asp

12 See www.gmc-uk.org/education/postgraduate/GPC_guidance.asp

13 See www.gmc-uk.org/education/postgraduate/assessment_guidance.asp

http://www.shapeoftraining.co.uk/reviewsofar/1788.asp

http://www.gmc-uk.org/-/media/documents/adapting-for-the-future-a-plan-to-improve-postgrad-med-training-flexibility_pdf-69842348.pdf

http://www.gmc-uk.org/Excellence_by_design___standards_for_postgraduate_curricula_0517.pdf_70436125.pdf

http://www.gmc-uk.org/education/postgraduate/GPC.asp

http://www.gmc-uk.org/education/postgraduate/GPC_guidance.asp

http://www.gmc-uk.org/education/postgraduate/assessment_guidance.asp



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plans for education reform and to promote greater flexibility for doctors in training. This will include developing a framework for credentials, which will recognise doctors’ capabilities in areas outside postgraduate training and in areas where there are patient safety risks. Ultimately, these reforms will benefit not only the profession but patients and the wider health service because doctors will be better able to care for conditions that cross specialty boundaries. This is something we know the healthcare workforce of the future will need to be able to do.

We are making changes to the way revalidation works for doctors and patients

Revalidation14 is the system by which doctors who wish to maintain their licence to practise medicine in the UK must demonstrate on an ongoing basis that they are up to date and fit to practise. We introduced revalidation for the first time in 2012.

Patients play an important role in revalidation by providing feedback on their experience of being cared for. As part of the revalidation process, all licensed doctors are required to have an annual appraisal and patient feedback is key to helping doctors (and their appraisers) to develop plans for how they can improve and build on what they do well during the next year.

To check how revalidation is working in practice, we commissioned an independent review by Sir Keith Pearson in 2016. The resulting report, Taking revalidation forward,15 was published in January 2017 and concluded that revalidation is beginning

to impact positively on clinical practice, professional behaviour and patient safety but also identified some difficulties and challenges and made a series of recommendations.

We produced our action plan in July 2017 in conjunction with a wide range of bodies, including the four governments of the UK, to address the recommendations in Sir Keith’s report. The plan, published after extensive engagement, sets out our commitment to provide clearer guidance to doctors and responsible officers on what is required from them and to make the process more understandable to patients and the public. We will also seek to track the impact of revalidation more closely.

Since publishing our action plan, we have held focus groups with members of the public to help us develop materials explaining revalidation. We have also updated the format and content of our website to provide more helpful and easily accessible information for patients and doctors on revalidation.

To improve doctors’ experience of the process, in April 2018 we revised our guidance on supporting information for appraisal and revalidation and expanded our online connection tool to help doctors identify their designated body.

We will continue to work closely with our partners to address the recommendations in Sir Keith’s report. Later in 2018 we will explore how we might develop our patient feedback requirements for revalidation so that they work better for patients and doctors. We will also develop our approach to tracking revalidation to make sure it meets its objectives at local and national level.

14 See www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation

15 See www.gmc-uk.org/-/media/documents/Taking_revalidation_forward___Improving_the_process_of_relicensing_for_doctors.pdf_68683704.pdf

http://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation

http://www.gmc-uk.org/-/media/documents/Taking_revalidation_forward___Improving_the_process_of_relicensing_for_doctors.pdf_68683704.pdf



We issued revised guidance on confidentiality

In April 2017 we published revised and expanded guidance on confidentiality for all doctors practising in the UK and accompanying learning resources to support doctors in applying the guidance. The new guidance and learning resources can be found on our website.16

Improving how we handle concerns about patient safety

We’ve improved how we assess complaints when we receive them to ensure we only carry out a full fitness to practise investigation where necessary

The legislation that underpins our fitness to practise process, introduced in 2004, requires that we open a full investigation if we receive any allegation that a doctor’s fitness to practise is impaired. Much has changed since 2004, including a spike in complaints that has resulted in our being required to investigate a significant number of concerns that, from our experience, we know are unlikely to require action to protect the public. In the interim, the introduction of far better local clinical governance systems and, in particular, the introduction of responsible officers who have statutory responsibility for dealing with concerns about doctors has improved local frameworks for handling concerns.

We have, for many years, been asking the government for updated legislation to reflect these and other significant changes in the healthcare landscape. In particular, we have asked for the legal requirement to investigate all allegations of impaired fitness to practise to be changed to a discretion so we can ensure we only investigate where it is necessary to protect the public. This would enable us to work more closely with healthcare providers and make sure some of the matters we are currently required to investigate are dealt with locally instead.

16 See www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp

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We are still awaiting that legislative change and, with the challenges related to Brexit, there is currently no indication that we will get those changes in the near future.

Since 2010, we have been reforming our fitness to practise process, working in new ways within our existing legislation to reduce the impact of the fitness to practise process on doctors and patients. In particular, we have focussed on streamlining and speeding up the process, providing more support for doctors and patients involved and improving the sensitivity of our approach to reduce the impact on vulnerable people.

In 2014 and 2015 we piloted and introduced a new approach to how we filter cases at the outset of the process. On receipt of an allegation we assess whether we could, through making swift initial enquiries, obtain information that will clarify whether an investigation is needed. In 2017 we piloted expanding that approach by carrying out provisional enquiries on cases involving a single clinical incident or procedure. Of the 86 single incident cases covered by the pilot, two thirds were closed with no further action as a result of those enquiries without the need for a full investigation to be conducted.

The median time taken for these provisional enquiries was 9 weeks, which compares to 31 weeks for a full investigation. The pilot suggests that by targeting single clinical incident cases we could increase the number of cases resolved swiftly by provisional enquiries without the need for a full investigation. This would enable us to reduce delay for patients and reduce stress for doctors, and to focus our resources more effectively on matters that require us to take action to protect patients or public confidence in doctors.

Based on these results, we are now looking to pilot whether we can extend provisional enquiries to single clinical concerns – that is, cases involving more than one incident but confined to a single course of treatment of a single patient by a single doctor. At the moment these full investigations take between 180 and 234 days to complete yet over 90% end with no further action being required.

In September 2017 we also began a pilot to determine if we could extend provisional enquiries to some cases where there are health concerns. This is where we believe a doctor’s ill health may be affecting their ability to practise safely but there is a lack of detailed information about their health.

This involves, with a doctor’s consent, obtaining reports from the doctor’s GP, physician or occupational therapist or checking the doctor’s medical records.

We believe this approach could lead to fewer doctors undergoing a full investigation and would help reduce anxiety and stress for doctors who are unwell.

So far, our use of provisional enquiries has resulted in between 60-70% of those cases closing with no further action following receipt of additional information and has been shown to avoid the need for around 400 full investigations a year. As a result of this and other changes, the number of full investigations we launched in 2017 was 1485 compared to 2381 in 2015. Since we introduced the provisional enquiry process in July 2016, we have avoided 69% of single clinical incident investigations during this time.

We have continued to see an over-representation of black and minority ethnic (BME) doctors in the fitness to practise referrals that we receive.

6% fewer complaints in 2017 than in 2016



We take our responsibility to be a fair and transparent regulator very seriously. We conduct detailed research on an ongoing basis to improve our understanding of what drives over-representation of different groups throughout our fitness to practise procedures, and whether cases are treated fairly. The consistency of our fitness to practise decision-making is also audited independently to ensure it is in line with our published guidance, and is not discriminatory. These audits have always found our decisions to be consistent with this guidance, and that the guidance itself does not introduce bias.

However, we want to know more about what is driving this continued over-representation of some doctors, as well as understand whether we are seeing an under-representation of other groups. This is why we have asked Roger Kline and Dr Doyin Atewologun to lead a major project to better understand why some doctors are referred to us for fitness to practise issues more than others. Their research will allow us to work more closely with clinical leaders to properly develop supportive and open workplaces, where doctors’ interactions with the GMC, and with processes owned by the GMC, are appropriate and fair.

We are continuing to implement our programme to support vulnerable doctors in fitness to practise processes

We made significant progress during 2017 in implementing our programme to support vulnerable doctors. The programme was launched in 2016 after we invited a leading mental health expert, Professor Louis Appleby, to oversee a review of the impact of our fitness to practise process on vulnerable doctors.

In 2017 we updated our guidance to decision-makers to support, where possible, local handling

of cases involving ill health. We also introduced new guidance for staff on recognising the signs of ill health and on communicating with doctors in distress or at potential risk of self harm. We set up a special investigation team, with staff who have received enhanced training in sensitive communication, to handle cases where there is a concern about the doctor’s health. Doctors referred to this team are provided with the name of an officer who acts as their single point of contact throughout the investigation process.

We’ve introduced safeguards for whistleblowers who raise concerns in the public interest

Whistleblowers should be free to raise concerns that are in the public interest without fear of victimisation. We commissioned an independent review by Sir Anthony Hooper who made recommendations on how to address the risk of a fitness to practise referral being used to disadvantage a doctor who has raised public interest concerns, for example about public safety.

As a result during 2017 we ran pilots across each of the UK’s four countries of safeguards for whistleblowers who are referred to our fitness to practise procedures. Training about the issues that arise in whistleblowing cases has been provided to our staff across the organisation.

We will be conducting a full evaluation of the pilot once a sufficient number of cases have been through the system. We expect this will be by the end of 2018.

We also have a new legal duty to produce an annual report outlining all whistleblowing disclosures that we receive and what action we have taken as a result. The report will explain how such information


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helps us achieve our statutory duties. A key aim of the report is to reassure those making disclosures that we take our duties in this area very seriously, and that we will listen to them and act on the information they provide us.

The new duty came into effect from April 2017 and we will publish our first annual report in October 2018.

We have changed our process and rules on publication and disclosure of fitness to practise findings

In addition to our statutory duties to publish information about our investigation process, we have discretionary powers to publish or disclose information about a doctor’s fitness to practise where we consider it to be in the public interest.

Following an extensive consultation, in 2017 we designed and developed a number of changes to the way we disseminate that information. The changes resulting from this work will make clearer what we have done to protect the public while at the same time being fair to doctors.

For instance, in February 2018 we introduced a limit on the length of time that the history of a doctor’s fitness to practise record remains on our online register. Previously, all sanctions remained there indefinitely. The time limits vary depending on the circumstances of the action taken.

Additionally, in February 2018 we reduced the length of time for which warnings are published on the online record, from five years to two.17

And we now publish all decisions taken at the end of an investigation in conjunction with the publication of decisions made by the Medical Practitioners Tribunal Service, on a new ‘GMC decisions’ page on our website.18 Any warnings received or any decision to agree or vary undertakings will be published on this page for 12 months (excluding cases relating solely to a doctor's health).

Appealing Medical Practitioners Tribunal decisions

To ensure decisions made by tribunal hearings are impartial, the Medical Practitioners Tribunal Service (MPTS) is operationally separate from us. For more information about its activities during 2017, you can read its separate annual report.

In December 2015 the UK Parliament (supported by the Department of Health, the Health Select Committee and the Law Commission) gave the GMC the right to appeal the ‘independent’ decisions of the MPTS. We can now appeal tribunal decisions which in our view do not give sufficient protection to patients and the public or which jeopardise the public’s confidence in the profession. Prior to this only doctors and the Professional Standards Authority had this right. As the Government said at the time: ‘We remain confident that introducing a right of appeal for the GMC is appropriate given the increased separation between the investigation and adjudication functions’.19

17 This applies only to new cases

18 See www.gmc-uk.org/concerns/hearings-and-decisions/gmc-decisions

19 Department of Health (January 2015): The General Medical Council and Professional Standards Authority: Proposed changes to modernise and reform the adjudication of fitness to practise cases Consultation Response Report. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/396205/Consultation_Response.pdf

http://www.gmc-uk.org/concerns/hearings-and-decisions/gmc-decisions

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/396205/Consultation_Response.pdf





Appealing an MPT decision is a serious undertaking and we only make use of this mechanism sparingly. Over the course of 2017 we lodged 19 appeals against MPT decisions – around 7% of the total appealable decisions made in this period. Of these, 13 of our appeals were successful, two were unsuccessful and four were withdrawn.20 Of the 13 successful appeals, all but one involved allegations of dishonesty or sexual misconduct. The one exception to this, the case of Dr Bawa-Garba, involved a conviction for gross negligence manslaughter. During 2017, 25 doctors lodged appeals against MPT decisions.

Convictions of gross negligence manslaughter against doctors are extremely rare. We have taken action against only eight such cases since 2004. However the case of Dr Bawa-Garba has led the medical profession to express concern that doctors are at increased risk of being criminalised for poor practice. It is clear to us that there is a need to examine the wider issues around gross negligence manslaughter, including the expertise and consistency which is applied in the initiation and investigation of cases locally. Our view is that there is considerable variation in how the law applies across the UK.

As a result we have commissioned a cross-UK, independent review into how gross negligence manslaughter, and culpable homicide in Scotland, are applied to medical practice, in situations where the risk of death is clearly a constant and in the context of widespread pressure. The review, led by Dame Clare Marx, will examine what needs to be done to improve how existing law, procedures and processes are applied, whilst still protecting the public and maintaining confidence in the medical profession. The review will look at how the GMC should handle cases involving gross negligence manslaughter and culpable homicide. In a separate piece of work we will consider how human factors training can be incorporated into our work.

20 In one of the four withdrawn appeals, the doctor agreed to have their name voluntarily erased from the medical register. We have sought and been granted permission to appeal to the Court of Appeal in respect of one of the two unsuccessful appeals.


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21 See www.gmc-uk.org/about/what-we-do-and-why/data-and-research/gmc-data-explorer

22 Most licensed doctors have a connection with one organisation that provides them with an annual appraisal and helps them with revalidation. This organisation is called their ‘designated body’.

23 See www.gmc-uk.org/education/how-we-quality-assure/national-training-surveys/national-training-surveys---doctors-in-training/survey-results

Using information in smarter ways

We have created a new GMC Data Explorer tool

Our new interactive search tool, GMC Data Explorer,21 helps us share information about our activities more widely and easily among the many external users of our data.

We collect a wealth of data about doctors and the organisations where they train and practise and we are committed to sharing that information with others to help improve patient safety and aid workforce planning.

GMC Data Explorer, which was launched in September 2017, allows users to find information quickly and reliably about the make-up of our medical registers and revalidation activity. They can also learn about doctors’ training and fitness to practise, including where they qualified, current location and the number of doctors with open cases and active sanctions at each designated body.22

We will be promoting the GMC Data Explorer more widely in 2018 and will be surveying users to see what they think of it and how we can improve it further.

We produced our National training survey and The state of medical education and practice in the UK reports

Our 2017 National training survey and The state of medical education and practice in the UK reports

brought together a wealth of information on doctors’ experience of medical education and practice and helped to highlight where things can be improved.

National training survey

Our comprehensive survey of trainees and trainers23 seeks to learn more about the training experience and the environment in which doctors in training and trainers work. The findings help us identify good practice and pinpoint where training fails to meet our standards.

As in previous years, the response rate to the survey in 2017 was very high with 98% (over 53,000) of trainees and 54% (over 24,000) of trainers responding.

The surveys showed that service pressures continue to impact negatively on doctors’ educational experience. Almost 80% of trainers said they regularly work beyond their rostered hours and a third said they don’t have time in their job plan for their education role. Around 40% of trainees said their workload is heavy or very heavy. Both trainers and trainees criticised poorly designed rotas which exacerbated these problems.

Despite this we were heartened to learn that most trainees rate the quality of teaching they receive as good or very good and 80% say the quality of their experience is good or excellent.

The training survey also enables us to spot when things go wrong. This includes taking action in partnership with others to address serious concerns about postgraduate training environments where

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53,000

doctors in training completed our National training survey

Over

http://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/gmc-data-explorer

http://www.gmc-uk.org/education/how-we-quality-assure/national-training-surveys/national-training-surveys---doctors-in-training/survey-results



survey results indicated that our standards were not being met. For example, North Middlesex University Hospital NHS Trust was highlighted as having particularly negative results in emergency medicine; we worked closely with partner organisations to make sure doctors in training had the required level of support and supervision.

Another issue highlighted to us through data was at East Kent Hospitals University NHS Foundation Trust. We supported Health Education England to remove trainees from a hospital environment that was not meeting standards and they were placed elsewhere in the trust where appropriate supervision and support were available. We are still monitoring these two trusts closely to ensure that training environments meet our standards and to ensure that any positive changes are embedded.

It is clear that many of these problems stem from wider pressures in the system that make it more difficult to introduce sustainable solutions. However, we are clear that when our standards are not being met, we will take action to make sure patient safety is maintained and proper support is available to trainees. All organisations that train doctors have a clear responsibility to meet our standards.

We will be doing more work to strengthen our understanding of organisations that find themselves in these situations in 2018. We are now working more formally with partner organisations, for example through the NHS Joint Oversight Group in England, which brings together evidence from across the health system to drive forward joint solutions for organisations in difficulty. This, and our increasingly better access to data, should mean we

are better able to predict and intervene in problems at an earlier stage.

We already have information sharing agreements with individual professional and system regulators. During 2017, we took part in a cross regulator working group to produce a protocol on emerging concerns. This will allow any of the signatory organisations to call meetings between appropriate healthcare regulators to share information at a much earlier stage than current arrangements allow. A pilot of the protocol took place in North London and it worked well. The final draft of the protocol was approved by professional and systems regulators across the UK in May 2018.

The state of medical education and practice in the UK

Our latest report on the state of medical education and practice24 showed that the state of ‘unease’ we referred to in the 2016 edition was still affecting the medical profession across the UK. The ongoing pressures and challenges within healthcare systems continued to impact the morale and wellbeing of doctors at all stages of their careers.

The findings underline our view that we have reached a ‘crunch point’ in relation to the UK’s medical workforce. The service pressures that doctors are facing look set to become steadily greater over the next 20 years unless action is taken.

One of our chief concerns is that the supply of doctors in the UK medical workforce is failing to keep pace with demand. The number of licensed25

doctors on the medical register grew by 2.7% in the last five years – but this contrasts with a 28% rise

24 See www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk

25 Doctors wishing to practice medicine in the UK must hold registration with a licence to practise.

http://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk


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in A&E numbers in England over the same period. Meanwhile dependence on non-UK qualified doctors appears to be growing but there is some uncertainty about this supply in the future as a result of a number of factors, including the UK’s decision to leave the EU.

Also of significant concern is the intense pressure doctors in training and those who train them are reporting. 22% of trainees who responded to the 2017 survey said they felt short of sleep while working, while 70% of trainers (usually senior doctors) felt their daytime workload was ’heavy’ or ‘very heavy’. Almost one third of trainers felt their job plans did not contain enough dedicated time for their role as an educator.

All this has big implications for future workforce planning. We have identified a number of priorities that UK health departments need to begin to plan for. These include ensuring a healthy supply of good doctors, reducing the pressure on these doctors and making employment and training more supportive and flexible.

We also face a major task in supporting the medical profession to meet the needs of patients and health care. Each country of the UK has to think carefully about how many doctors will be needed, where they should be located and what expertise they should have to work as flexibly as possible.

We will continue to support the UK health departments through our leadership in the healthcare system, the critical role we play in medical education and training, and the data and insights we share with those responsible for workforce planning.

We have been preparing for the new General Data Protection Regulation

As a major data controller we worked hard during 2017 to make sure we were fully compliant with new data protection regulations that came into force in May 2018. The new regulation gives everyone greater power and control over their own personal data.

The General Data Protection Regulation (GDPR) means we have had to adjust the way we hold and store any information about an identifiable living person. This includes subject access requests (SARs) and ‘the right to be forgotten’.

There are also implications for the way we seek consent. Under the GDPR, we are required to process personal data using our statutory powers rather than seek consent. Traditionally we have sought consent from complainants to proceed with a fitness to practise investigation. Now, we simply explain to potential complainants what happens when we investigate and they can choose whether or not to submit a complaint on that basis. This has simplified our fitness to practise process.

In 2017 we set up an internal, cross-directorate GDPR board to prepare for the changes and appointed a Data Protection Officer who will act as intermediary between all the relevant stakeholders with a key role in fostering a data protection culture. By May 2018, all staff had completed mandatory e-learning to make sure we process data correctly under the new regime. We are also holding workshops and training sessions for those most affected.



Working more closely with patients, doctors and medical students

We are continuing our work to support doctors and medical students at every stage of their careers, and to involve patients in the decisions we make

UK–wide engagement

In 2017 we engaged with the following across the UK:

n 26,185 doctors

n 23,255 students and educators

n Over 1,000 patients, patient organisations and members of the public.

We held 84 Welcome to UK practice26 sessions across the four countries, attended by 1,766 doctors. A total of 98% thought they were good or very good and 96% would recommend them to colleagues.

We also held 1,437 Employer Liaison Service meetings with employers and responsible officers about fitness to practise concerns.

England

n Our Regional Liaison Service (RLS) in England ran a total of 1,252 events covering a range of topics to explain our role and generate better understanding of how to put our guidance into practice. We engaged with 22,813 doctors and 18,807 medical students.

n We consistently receive good feedback on our engagement activities but we want to go

further in understanding their impact. In 2017 we commissioned an independent evaluation into the impact and effectiveness of our ‘Duties of a doctor’ support programme, which is run by our Regional Liaison Service as a trust- based outreach activity in England. The ongoing research by University College London (UCL) is providing us with valuable insight into the effectiveness of the programme in engaging doctors in pertinent topics related to their practice.

Wales

n We engaged directly with 597 doctors, holding 17 facilitated sessions to support them in their professional practice. We also facilitated four sessions specifically for medical students.

n We attended the Hay Festival to seek the public’s views on our plans for new confidentiality guidance.

Northern Ireland

n We engaged directly with 2,421 doctors and students to support them in their professional practise through 364 individual sessions in 70 full or half-day workshops. This included 100% of FY2 trainees and those in the first 3 years of specialty training.

Scotland

n Almost 4,000 medical students took part in our student professionalism programme in 2017, delivered in partnership with Scotland’s five medical schools. The programme is designed to support medical students in preparing for professional practice from year one.

50,000

doctors, students, educators, patient organisations and members of the public engaged with

Over

26 See www.gmc-uk.org/about/what-we-do-and-why/learning-and-support/workshops-for-doctors/welcome-to-uk-practice

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26,185

1,000 8423,255doctors.

Overpatients, patient organisations and members of the public.

Welcome to UK practice sessions were held across the four countries.

students and educators.

In 2017 we engaged with the following across the UK:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

England

Our Regional Liaison Service ran a total of 1,252 events.

We consistently receive good feedback on our engagement activities.

Wales

We engaged directly with 597 doctors.

We attended the Hay Festival to seek the public’s views on our plans for new confidentiality guidance.

Scotland

Almost 4,000 medical students took part in our student professionalism programme.

Over 2,000 doctors participated in our professionalism programme.

Northern Ireland

We engaged directly with 2,421 doctors and students.



n Over 2,000 doctors participated in our professionalism programme delivered with the support of Scotland’s Health Boards in 2017. The programme aims to support professionalism and support doctors in complex areas of practice such as consent, confidentiality, End of Life Care, raising concerns and leadership and management.

My GMP app for doctors and medical students

At the end of 2016, we launched My GMP - a new app for doctors giving them quick and easy access to our ethical guidance whether they are online or offline. In 2017, we added our guidance for medical students to My GMP, making it easier for them to access and follow it during placements or on the go in a busy environment.

Meeting with patients and carers who have raised concerns

We hosted 197 patient liaison meetings at our offices across the UK. These meetings help patients or carers involved in a current GMC investigation understand what to expect, and give them the chance to seek more information and explain their concerns more fully.

Supporting doctors’ wellbeing

In early 2018 we launched a new independently – led programme of work to support doctors’ wellbeing. We held a symposium with a number of key stakeholder organisations to help us identify what our areas of focus should be, and we also ran workshops at our annual conference to explore the underlying causes of the stress, pressure and difficulties doctors face. We’re now using all of this feedback to help shape a programme of work on the subject, independently led by Dame Denise Coia and Professor Michael West.

In 2017 we started a review of health and disability guidance for medical schools

We have been working to revise our guidance on supporting medical students and doctors with disabilities or health concerns so they don’t face unnecessary barriers in their medical careers.

Our main aim is to reflect developments since the last revision in 2014 and to expand the guidance to include postgraduate education and training. We want to make sure learners know what support is available to them and that they are able to receive it in the best form for them.

We also plan to produce a ‘hub’ of helpful materials for students, doctors and educators. These will include examples of good practice, personal stories and other resources.

As part of this process we commissioned independent external research and held nine roundtable events between October and December 2017, where we heard about the level of support

197

patient liaison meetings held at our offices across the UK


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27 For the full report, see www.gmc-uk.org/-/media/documents/M05___GMC_annual_report_of_corporate_complaints.pdf_72440101.pdf

people with disabilities currently receive in medical education and training. We have also assembled a core group of experts to advise us on the direction of the guidance.

We plan to run a public consultation on our Gateways to the professions guidance in 2018, and to publish a revised version following this.

We remain committed to learning from and acting on customer complaints

We take feedback from our customers very seriously. We have teams across the organisation who respond quickly to complaints and questions about our work from doctors, patients and members of the public. We also have a central team who manage our response to escalated complaints.

During 2017 we received 1,618 complaints about our customer service – a 19.5% drop compared to 2016 (2,010). We responded to 99% of these complaints within 10 working days. We replied to 81% (1,319) with further explanation and 10% (172) were concluded with a formal apology for a service failure.

As part of our ongoing commitment to listen and learn from our customers, we again sought and were awarded accreditation to the international standard for quality management and customer satisfaction, ISO 10002, and remain fully compliant with the British Standards Institute standard. We have also been audited27 by independent consultants Verita, who confirmed that our handling of complaints was mature and comparable to best practice.

Update on our Digital transformation 2020 work

We are now half way through our four-year digital strategy which aims to transform the way we engage with our customers, including medical students, doctors and members of the public, and provide a better customer experience on all our digital channels.

Our strategy, Digital transformation 2020, aims to speed up and simplify our internal processes, making the content we offer sharper and easier to find and use. It also seeks to foster a digital first approach to communication where staff are encouraged to consider the digital possibilities at the start rather the end of any transaction. The strategy should also improve collaboration with partner organisations.

From September 2017 we began preparing for one of the key strands of the strategy – the launch of a new GMC website, which went live in April 2018. The new website is clearer and easier to use and includes a number of new features enabling users to self-serve and to see all of the information relevant to their individual circumstances in one place.

http://www.gmc-uk.org/-/media/documents/M05___GMC_annual_report_of_corporate_complaints.pdf_72440101.pdf


Working better together

We continue to engage with partners at home and overseas

England

n With the launch of the Department of Health’s ‘Promoting Professionalism, Reforming Regulation’ consultation at the end of October 2017, we made contact with key parliamentarians and a range of wider health stakeholders. As we entered this crucial phase of legislative reform, we set out the GMC’s overarching objectives and encouraged our stakeholders to respond to the government’s consultation.

n We had a presence at the annual party conferences of the Conservatives, Labour, Liberal Democrats and the Scottish National Party during 2017.

n We gave evidence to Parliament on the implications of Brexit for the regulation of health professionals, highlighting the UK’s reliance on overseas doctors.

Scotland

n In 2017 we responded to nine consultations relating to education, support or regulation of the medical profession in Scotland. In particular we engaged extensively with the Scottish Government on Realistic Medicine, the Apologies Act and clinical governance.

n We continued to work with the Scottish Government and other healthcare regulators in Scotland to make sure Scotland’s Apologies Act does not adversely affect doctors and other healthcare professionals in the country. As a result of this sustained effort, healthcare professional regulators have been exempted, as the Scottish Parliament recognised the unintended consequences the Act would have on regulatory processes aimed at protecting patients.

n We were also one of four main organisers of the Scottish Government Regulation Conference attended by 320 delegates. We hosted a roundtable on the Medical Licensing Assessment as part of a series of stakeholder roundtables.

Wales

n During 2017 we worked with partners to influence the public policy debate in Wales. We worked closely with Health Inspectorate Wales and the Community Health Councils (CHC’s) to consider our respective responses to the White Paper ‘Services Fit for

the Future’ to ensure this important consultation reflects our shared interests in health services which are good for doctors and for patients.

n We responded to the Welsh Language Bill Consultation, working closely with other UK professional regulators and the Welsh Language Commissioner so that any Bill is appropriate and proportionate to the needs of regulators.


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n We held the first quality improvement and medical engagement conference in partnership with BMA Cymru and the Welsh NHS Confederation.

Northern Ireland

n We engaged with a range of stakeholders across 45 external events including the LMC conference, NICON annual conference, BMA SAS conference and the NIMDTA Educational Excellence day.

n Recognising the particular and significant implications of the UK’s decision to leave the European Union for Northern Ireland, we held a series of meetings with politicians, regulators and officials to discuss issues relating to cross-border delivery of healthcare and the safe education, training and movement of doctors in that context.

n We hosted a roundtable, attended by the Department of Health Northern Ireland, medical Royal Colleges and the BMA, on the draft Mental Capacity Act (NI) code of practice which has particular implications for a range of aspects of medical practice and patient care, including consent.

Advisory fora

In March 2017 and October/November 2017 we held advisory fora at our Scotland, Wales and Northern Ireland offices. These fora provide structured, formal opportunities for our strategic partners in each country to come together to discuss our work. This is important to make sure we are regulating effectively in response to the unique political, structural and professional context of each country.

Engaging overseas

nWe hosted 13 visiting delegations from overseas

nWe produced three editions of our Crossing Borders Update for health profession regulators

n In October 2017 we hosted the International Association of Medical Regulatory Authorities (IAMRA) conference on revalidation and continued competence. Over 100 delegates from 19 countries attended.


13 visiting delegations hosted from overseas.



Enact Engage

We want to introduce a clearer sense of purpose, ensuring that our

strategic aims are embedded in everything we do, and we are able to measure the impact of our actions.

We want to be pacier, more agile and foster greater cross–organisational

working. This will help us to improve our decision – making, enable us to prioritise our activities and allocate

resources more effectively, and support us in delivering better

customer service.

We aim to develop our staff so that decisions are made by the right

people at the right time, and so that collectively we can maximise

our potential.

We should have greater engagement with the wider healthcare system

and our key stakeholders, enabling us to be more targeted and

impactful in our communications, and helping us to better understand

the perspectives of others.

Envision Empower

Our Transformationprogramme

Our Transformation programme


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Change programme

In 2017 we continued to implement our ambitious Change programme aimed at making sure we remain financially stable for the foreseeable future, and have the means to increase our organisational agility, capacity and capability. In 2016, we relocated 150 roles from London to Manchester, reducing our property footprint in London, and introduced changes to our pension scheme.

The cost savings made as a result of the Change programme in 2017 have enabled us to offer significant fixed–term discounts on our registration fees for newly qualified doctors, and to reduce the annual retention fee for all doctors.

Transformation programme

Building on the changes initiated as part of the Change programme, and in preparation for our new corporate strategy 2018–2020, we launched an ambitious new programme of transformation in the second half of 2017. This programme, which involves changes to the way we work as individuals and as teams, will over time help us become a more agile and relevant regulator, better able to shape and respond to developments within healthcare.

Our Transformation programme has four main strands:

Envision. We want to introduce a clearer sense of purpose, ensuring that our strategic aims are embedded in everything we do, and we are able to measure the impact of our actions.

n In 2017, we developed plans for our new Strategy and Policy Directorate. The new directorate, which came into effect in January 2018, will allow

us to co-ordinate our policy work across the organisation. We will be alert at an earlier stage to cross-cutting themes and will be better able to analyse our data.

n We have also created a Policy leadership group to provide a collective vision for GMC policy in the context of our corporate strategy, and to help coordinate and guide policy activities across the organisation in pursuit of this aim.

n We plan to develop an evaluation framework that will improve our ability to track the impact of our actions on our stakeholders. This will dovetail with a new “benefits first” approach to how we initiate new work and measure the impact of that work.

Empower. We aim to develop our staff so that decisions are made by the right people at the right time, and so that collectively we can maximise our potential.

n In 2017 we piloted a new feedback model to support staff in their continuous development.

n In 2017 we reviewed our performance and development process and, listening to feedback from staff, made it more streamlined and focussed on personal development. We launched our new performance and development process in early 2018.

n In 2018 we will seek to improve the ways we attract, develop and retain our people. As part of this drive we aim to achieve Investors in People accreditation.



Enact. We want to be pacier, more agile and foster greater cross-organisational working. This will help us to improve our decision-making, enable us to prioritise our activities and allocate resources more effectively, and support us in delivering better customer service.

n In 2017 we began work to streamline our governance processes and structures, which will help us to improve the effectiveness and timeliness of our decision making.

n In 2017 we began work to develop new tools enabling our external stakeholders to easily explore our key performance and service level results, and what contributes to them.

n We also began work to review our performance measures to see whether they can be better aligned with our strategic objectives and key areas of risk in our core functions.

n In 2018 we will develop proposals for a new portfolio approach to planning and reporting across the organisation.

n We are also investing in technology platforms to help us collaborate more easily and we are defining ways in which we can build responsiveness and flexibility in how we work and interact with partners.

Engage. We should have greater engagement with the wider healthcare system and our key stakeholders, enabling us to be more targeted and impactful in our communications, and helping us to better understand the perspectives of others.

n In 2017, we developed plans for our new Strategic Communications and Engagement Directorate, which came into effect in January 2018. The mission of the new directorate is to strengthen engagement with all our key interest groups, including doctors, employers and the public. The new directorate will also enhance our impact and influence in the wider world as well as fostering communications and engagement between different parts of the organisation.

n We have continued to make good progress with our Digital Transformation 2020 programme, with the goal of transforming the way we communicate, engage and transact with our customers online, providing them with a better experience. In 2017, teams from across the organisation prepared for the launch of our new website, which went live in April 2018.

n In 2018 we will launch our Patient and Public engagement programme, in which we will seek to create new strategic partnerships with health organisations and new communication channels for patients and members of the public to provide us with feedback and have input into all aspects of our work.


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We have continued our work on being a fair regulator and employer

Our equality and diversity strategy sets out our vision to be a fair regulator and employer and to be recognised as such. Examples of the work delivered during 2017 include:

n We developed our Equality, diversity and inclusion strategy for 2018-2020. This sets out the vision, objectives and approach to embedding these principles in our activities over the next three years as part of our new corporate strategy.

n We commissioned research to understand how other organisations make sure their decision-making is fair and consistent. It examined the techniques and models organisations use that we could learn from and any barriers or challenges that they face. We will use the findings of this research to inform our regulatory activities.

n We continued to roll out our programme of training on unconscious bias and fair decision-making for staff and associates involved in making decisions about doctors. The training focuses on their role in making sure our regulatory activities are delivered fairly.

n We continued our engagement with networks of doctors, including the Black and Minority Ethnic Doctors Forum, to make sure our work is informed by a diverse range of opinions and perspectives.

n We launched our lesbian, gay, bisexual and trans queer and others (LGBTQ+) staff network and worked with Stonewall to develop LGBTQ+ role models and allies. This will, we believe, create a more inclusive workplace.


DELIVERING OUR ROLE

Setting the standards for doctorsOur standards define what makes a good doctor by setting out the professional values, knowledge, skills and behaviours required of all doctors working in the UK.

The core professional standards expected of all doctors are set out in our guidance, Good medical practice.28 We want to do everything we can to make sure our guidance is widely known, understood, and applied by doctors in their day-to-day lives.

Our Regional Liaison Service (RLS) and our offices in Northern Ireland, Scotland and Wales continued to play a key part in 2017 in raising awareness and understanding of our standards. In 2017 our RLS ran 907 events about standards topics.

In 2017, our Education team answered over 670 enquiries from doctors, helping them to deal with the ethical challenges they face.

Overseeing doctors’ education and trainingWe set the educational standards for all UK doctors through undergraduate and postgraduate education and training. Our quality assurance process helps us to make sure our standards are met by organisations that manage and deliver training. As part of the process, we visit medical schools and training environments to check that our standards for education are being met. Our Council approves all institutions that are able to award a UK primary medical qualification.

In 2017 we carried out 32 quality assurance visits and found:

n 54 areas of good practice

n 33 areas where our standards were met but we identified improvements that could be made

n 68 areas that required improvement.

We also dealt with 94 issues that needed enhanced monitoring,29 with 39 of these being resolved in 2017. Enhanced monitoring is the quality assurance process we use when there is evidence that our standards are not being met within a training environment. We closely monitor these environments and provide support to deaneries, local education and training boards and medical schools to manage concerns about quality and safety in medical education and training, and to drive improvement.

28 See www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice

29 See www.gmc-uk.org/education/reports-and-reviews/enhanced-monitoring-reports. The 94 issues include new concerns, existing concerns and resolved concerns

http://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice

http://www.gmc-uk.org/education/reports-and-reviews/enhanced-monitoring-reports

DELIVERING OUR ROLE


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Taking action where concerns are raisedWhen a serious concern is raised about a doctor’s behaviour, health or performance, we investigate to see if the doctor is putting the safety of patients, or the public’s confidence in doctors, at risk.

In 2017 we reviewed a total of 8,546 concerns about doctors. After carefully considering all of these, we identified 1,485 concerns were sufficiently serious to open a full investigation into the doctor’s fitness to practise.

It is incumbent upon us to use our resources effectively and not place unnecessary stress on doctors or complainants. Where concerns don’t pose a risk to public safety or the public’s confidence in the profession, our staff have signposting guidance to support complainants in identifying alternative organisations who may be able to address their concerns.

The median time taken to conclude an investigation fell from 38 weeks in 2016 to 31 weeks in 2017. The median time taken to conclude provisional enquiry cases that were opened in 2017 was 9 weeks.

2017 Outcomes of triage

8,546 concerns about doctors were reviewed in 2017

2017 Outcomes of triage

319CONCERNSCLOSED

6,133 CONCERNS CLOSED

6,452 CONCERNS CLOSED

493 REFERRED TO EMPLOYER OR RESPONSIBLE OFFICER

179INVESTIGATIONSOPENED

113PROVISIONALENQUIRIES STILL IN PROGRESS

1,306INVESTIGATIONS OPENED

1,485 INVESTIGATIONS OPENED

3REFERRED TO EMPLOYER OR RESPONSIBLE OFFICER

496REFERRED TO EMPLOYER OR RESPONSIBLE OFFICER

614 CONSIDERED UNDER PROVISIONALENQUIRY*

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8,546 CONCERNS REVIEWED AT TRIAGE

DELIVERING OUR ROLE


2017 Outcomes of investigating concerns

of cases were concluded or referred at the investigation stage within six months94%

* This figure shows the total outcomes from ongoing and new investigations in 2017 which have a case examiner decision. Because investigations opened in 2017 will not necessarily reach an outcome in the same year, the figure does not track a single cohort of complaints. Therefore, the total number of outcomes from investigations in 2017 (1,381) is lower than the number of investigations initiated from triage (1,485).

† This figure represents the number of decisions made to refer a doctor to a medical practitioners tribunal. 200 doctors were referred to an MPT by Case Examiners and the remaining 40 by the Registrar in relation to convictions. In addition there were 10 cases where our original decision was to agree undertakings with the doctor, but subsequently the doctor refused undertakings and was then referred to a tribunal.

2017 Outcomes of investigating concerns

1,381 OUTCOMES*

106 UNDERTAKINGSWhen there is a realisticprospect of a fitness topractise tribunal findinga doctor’s fitness to practiseimpaired, and bindingundertakings by the doctorwill be sufficient toprotect patients.

with no further action. When there is no evidence that the doctor’s fitness to practise is impaired or they have not followed our standards.

225 CONCLUDEDwith advice.

101 WARNINGS issued. When there is no evidence that the doctor’s fitness to practise is impaired, but the concerns raised indicate a significant departure from our standards.

240REFERRED †

for a fitness to practise tribunal. When there is a realistic prospect of establishing that a doctor’s fitness to practise is impaired to a degree warranting action on registration.

709 CONCLUDED

DELIVERING OUR ROLE


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This figure relates to the outcomes of tribunals held during 2017 following referral during or prior to 2017.

You can read more about how we responded to concerns about doctors in our impact report.

2017 Outcomes from MPTS fitness to practice tribunals

* A doctor who has been erased cannot apply to be restored to the medical register until five years have elapsed. At that stage a tribunal will decide whether the doctor is fit to resume unrestricted practice.

2017 Outcomes from MPTS fitness to practise tribunals

13CONDITIONSto place conditions onthe doctor’sregistration.

76SUSPENDEDthe doctor’s registration.

27NO ACTIONWhen there is no evidence that the doctor’s fitness to practise is impaired or they have not followed our standards.

195 OUTCOMES

4 IMPAIRED no action. In exceptionalcircumstances a tribunal may take no action, if it is satisfied a finding of impairment is sufficient to protect patient safety.

13 WARNINGSWhen there is no evidence that the doctor’s fitness to practise is impaired, but the concerns raised indicate a significant departure from our standards.

62ERASED*

the doctor’s name from the medical register, so that they can no longer practise.

DELIVERING OUR ROLE


Managing the UK medical registerWe check each doctor’s identity and qualifications before we allow them to practise in the UK. We maintain a list of all the doctors who meet our requirements – this is called the List of Registered Medical Practitioners and is often referred to as the medical register.

In 2017 we granted 20,623 applications for registration from doctors seeking to join the register for the first time:

n 14,127 applications were from doctors who qualified in the UK30

n 2,197 in the European Economic Area (EEA) or Switzerland

n 4,299 from the rest of the world.

We also maintain a Specialist Register and a GP Register. In 2017, we granted 7,757 new applications for entry onto the Specialist Register or the GP Register.

In 2017 we responded to 99% of registration applications within five working days. We answered 91% of emails and letters within four working days, 85% of calls within 20 seconds and saw 94% of visitors to our offices within 10 minutes. There were 735 calls to our confidential helpline.

Helping to raise standards through revalidationAll doctors who are registered with a licence to practise have to revalidate every five years. In December 2017 we marked the fifth anniversary of our introduction of revalidation.

In that time we have revalidated over 185,000 doctors. We are confident that revalidation is now embedded locally and is starting to have a positive impact in the workplace and on doctors’ practice. We continue to make improvements to the revalidation process and our stakeholders’ experience of this through our Taking revalidation forward programme. You can read more about this on page 7 of this report.

In 2017, we received 30,014 revalidation recommendations. Of these, we:

n revalidated 21,647 doctors

n deferred the revalidation of 7,505

n received 94 recommendations of non-engagement.31

We made decisions on 98% of revalidation recommendations within five working days. We also withdrew the licences of 405 doctors for failing to meet our requirements for revalidation.32

20,623 applications for registration were granted in 2017

30 This figure includes UK qualified doctors who applied to move from provisional to full registration after completing Foundation Year 1.

31 For an explanation of non-engagement with revalidation, see www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/revalidation-resources#gmc-guides-to-revalidation

32 For an explanation of the licence withdrawal process, see www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/revalidation-resources/revalidation-licence-to-practise-withdrawing-giving-up-restoring-appeals

http://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/revalidation-resources#gmc-guides-to-revalidation

http://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/revalidation-resources#gmc-guides-to-revalidation

http://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/revalidation-resources/revalidation-licence-to-practise-withdrawing-giving-up-restoring-appeals

http://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/revalidation-resources/revalidation-licence-to-practise-withdrawing-giving-up-restoring-appeals

DELIVERING OUR ROLE


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ENGLAND

UK 132,267

IMG 50,839

EEA 16,936

Total 200,042

SCOTLAND

UK 17,030

IMG 2,246

EEA 1,190

Total 20,466

N. IRELAND

UK 5,228

IMG* 340

EEA† 537

Total 6,105

WALES

UK 6,839

IMG 2,634

EEA 644

Total 10,117

OTHER

UK 1,015

IMG 2,336

EEA 2,473

Total 5,824TOTAL

UK 162,379

IMG 58,395

EEA 21,780

Total 242,554

* IMG = International medical graduate.

† EEA = European Economic Area graduate.

‡ To establish where a doctor is located we use their registered address. The ‘other’ category mostly represents doctors who are based overseas, but a small number are where the postcode is not included in the Office of National Statistics look up.

Number of licensed doctors at 31 December 2017

* IMG = International medical graduate.

† EEA = European Economic Area graduate.

‡ To establish where a doctor is located we use their registered address. The ‘other’ category mostly represents doctors who are based overseas, but a small number are where the postcode is not included in the Office of National Statistics look up.


OUR STRUCTURE, GOVERNANCE AND MANAGEMENT

Council and other governance groups Council is our governing body. Its role is to provide strategic direction, hold the executive to account and take major high-level policy decisions. It comprises 12 members, six of whom are medical members and six of whom are lay members. The GMC is a registered charity and our Council members are also the trustees of the organisation. Council contains members from the four countries of the UK.

The trustees between 1 January 2017 and 31 December 2017 were:

n Mr Steven Burnett, FIA

n Dr Shree Datta, MBBS BSc (Hons) MRCOG LLM MD

n Lady Christine Eames, OBE LLB MPhil

n Professor Anthony Harnden MB ChB MSc FRCGP FRCPCH

n Professor Michael Farthing, MD DSc (Med) FRCP FMedSci MD (demitted as a member of Council on 28 November 2017)

n Rt. Hon. Baroness Hayman, MA PC GBE

n Professor Deirdre Kelly, CBE MD FRCP FRCPI FRCPCH DL

n Professor Paul Knight, OBE, MBChB, FRCP (Edinburgh, Glasgow, London) FRCPI

n Dame Suzi Leather, DBE MBE MA BA BPhil CQSW LLD (Hon) FRCOG (Hon)FRSH (Hon) DL

n Dame Denise Platt, DBE BSc Econ

n Amerdeep Somal LLB

n Professor Sir Terence Stephenson, BSc (Hons) DM FRCPCH FRCP FRACP (Hon) FRCPI (Hon) FRCS (Hon) FHKAP (Hon) FRCGP (Hon) FRCA (Hon) FCAI (Hon) FRCS Edin (Hon) FRCOG (Hon) FAcadMEd (Hon) FRCP Edin (Hon).

The trustees were all independently appointed by the Privy Council through a process that followed the Professional Standards Authority’s guidance for making appointments to healthcare professional regulatory bodies.

Council business is conducted in an open and transparent manner and the agenda and papers for each meeting are published on our website.



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We carried out an induction programme to support the four Council members who started their role on 1 January 2017: Mr Steven Burnett, Professor Anthony Harnden, Professor Paul Knight and Amerdeep Somal LLB. This included:

n briefings relevant to their roles and responsibilities

n visits to the GMC and MPTS offices to see our operations

n one-to-one meetings with the Chair

n meetings with the Senior management team

n bespoke induction and training sessions on the work associated with the committees on which they became members.

All Council members participated in appraisal reviews in 2017, which included consideration of any learning and development needs and revisiting actual or perceived conflicts of interest to make sure any conflicts identified are manageable.

Council members were asked to declare any conflicts of interests. The register of interests, which contains the declared interests of Council members, is published on our website.33

Council conducted its regular governance review in the second half of 2017 which also incorporated a review of Council effectiveness. The review, which included an independent report on the governance framework by GE Healthcare Finnamore, showed that the GMC is a well-governed organisation and demonstrates not only competence but best practice in many areas.

The updated version of the Charity Governance Code was shared with members and circulated to Audit and Risk Committee members in July 2017.

The governance review concluded that trustees are confident in their compliance in most areas. However, it was felt trustees needed to be more alert to the annual consideration and review of both positive and negative feedback, including complaints received. Council considered that it wanted to further develop the culture of openness by learning from mistakes and errors and subsequently opted to receive a fuller picture of the kinds of complaints received by the organisation twice a year from 2018 onwards, instead of annually.

Two other notable exceptions to the code are that of deputy chairs and of nomination committees. Our Council and committees operate without a formally appointed vice or deputy chair. However, arrangements are in place for chairs to nominate a deputy to assist during periods of absence. The GMC’s Governance Handbook makes provision for the Chair to nominate another member of Council as deputy to serve as Chair in the interim. In 2017 the Chair nominated Denise Platt, Chair of the Remuneration Committee, as deputy Chair of Council to serve for 18 weeks from 27 March 2017 to 31July 2017 ahead of the Chair resuming his role in full from 1 August 2017. Council was notified of the exercise of these powers in advance of the authority being delegated.

In addition our appointments process is well established and thorough and is overseen by the Professional Standards Authority. As such a nominations committee is not considered necessary.

The diagram shows the different governance groups that assist Council in discharging its responsibilities. These have all been agreed by Council to help it oversee our work effectively.

33 See www.gmc-uk.org/about/how-we-work/governance/council/council-member-register-of-interests

http://www.gmc-uk.org/about/how-we-work/governance/council/council-member-register-of-interests



Council governance

MPTS Committee

GMC/MPTSLiaison Group

Audit and Risk Committee

Remuneration Committee

Investment Sub-Committee

Board of Pension Trustees

Council

GMC Services International Ltd

Board

Executive governance

Executive Board

Directorate work plans

Formal engagement

Advisory boardsEducation and Training

Revalidation (until March 2017)

Task and finish groups

External input to programme or project boards

Advisory forumsScotland

WalesNorthern Ireland

Liaison groups



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The Audit and Risk Committee was chaired by Professor Michael Farthing during 2017 until he demitted as a member of Council and as Chair of the Committee on 28 November 2017. The new Chair of the Audit and Risk Committee is Professor Deirdre Kelly who took up her position in January 2018. You can find the Audit and Risk Committee’s report on page 48.

The current external co-opted members of the Committee are Ms Elizabeth Butler and Mr John Morley.

Remuneration Committee

The Remuneration Committee is chaired by Dame Denise Platt. It advises Council on the remuneration, the terms of service and the expenses policy for Council members, including the Chair. It also determines the appointment process for the Chief Executive and MPTS Chair and the remuneration, benefits, and terms of service for the Chief Executive, Chief Operating Officer/Deputy Chief Executive, directors, and MPTS Chair and MPTS Committee members. It is also responsible for making sure the assessment and measurement of performance and the assessment of recruitment and succession planning take place within an appropriate framework for the senior management roles within its remit. The Committee reports annually to Council.

Investment Sub-Committee

The Investment Sub-Committee is chaired by Dame Suzi Leather.

Professor Anthony Harnden and Professor Paul Knight were appointed as members from 1 January 2017.

External co-opted member Mr Jeremy Beckwith demitted as a member of the Sub-Committee on 15 January 2017. The current external co-opted members are Mr Tim Scholefield and Mr Keith MacKay.

Dame Denise Platt was appointed as a member of the Sub-Committee on 23 February 2017 and Professor Paul Knight demitted as a member on 12 December 2017.

The Sub-Committee is responsible for implementing and reviewing our investment policy, making sure the management of assets is consistent with the investment policy, appointing and managing fund managers and monitoring performance.

The Sub-Committee also has responsibility for overseeing the GMC’s investment in GMC Services International Limited (GMCSI), including ensuring compliance with the GMC’s Investment policy, and scrutinising GMCSI’s business plan, assessing the potential levels of investment risk and return.

The Sub-Committee reports on investment performance to Council through the Chief Operating Officer’s report, as well as reporting annually on its activities to Council.



GMC Services International

On 16 December 2016, Council agreed to the establishment of GMC Services International Limited (GMCSI) as a wholly-owned trading subsidiary of the GMC. The main objective of GMCSI is to introduce new revenue streams and so reduce our reliance on doctors’ fees.

With the breadth and depth of regulatory experience of the GMC behind it, GMCSI is uniquely placed to deliver advisory services to regulators and other organisations around the world. Acting as an advisor and adopting a collaborative and listening approach, it does not seek to impose a UK-centric model, but rather to help other organisations achieve the outcomes and results they are looking for in the field of professional healthcare regulation.

Robust and effective governance arrangements are in place to ensure that our interests are protected and that our relationship with GMCSI is managed effectively.

While Council has overall responsibility for GMCSI, the Audit and Risk Committee considers the risks to the GMC from the operation of GMCSI, conducting routine internal audit and spot checks as appropriate.

The Board was initially chaired by Professor Jim McKillop until the appointment of Andrew McCulloch as chair on 1 June 2017.

During 2017, the Board comprised (in addition to the Chair): Susan Goldsmith, Paul Buckley, Steve Burnett (from 21 February), Michael Farthing (from 21 February to 26 April), Vikas Shah (from 1 June) Deirdre Kelly (from 1 June to 12 December) and Paul Knight (from 13 December).

Board of Pension Trustees

The GMC’s defined benefit staff superannuation scheme is managed and administered by a board of trustees in accordance with the scheme’s trust deed and rules. Lord Kirkwood of Kirkhope chaired the Board until 28 February 2017, after which Professor Jim McKillop became the Chair. The trust makes sure the pension scheme’s assets are kept separate from those of the employer.

The scheme’s trustees are responsible for the proper running of the scheme, including the collection of contributions, the investment of assets and payment of the pension benefit commitments made by the employer.

Mr Steven Burnett was appointed as a new employer-nominated member from 1 January 2017.

Medical Practitioners Tribunal Service

The Medical Practitioners Tribunal Service (MPTS) is responsible for overseeing the adjudication of fitness to practise hearings and in 2017 was led by the Chair of the MPTS, Dame Caroline Swift.

The MPTS Committee and joint GMC/MPTS Liaison Group continue as part of the governance framework. The GMC/MPTS Liaison Group oversees the working relationship between the MPTS and the functions of the GMC with which it interacts. The GMC / MPTS Liaison Group is chaired by Professor Sir Terence Stephenson, Chair of Council. The MPTS Committee is chaired by Dame Caroline Swift.

In July the MPTS Committee submitted its first annual report34 to the UK Parliament. This was an important milestone, delivering on the recent Section 60 amendments to the Medical Act

34 See https://www.mpts-uk.org/about/1606.asp



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requiring it to provide Parliament with its own report as a statutory committee of the GMC.

Gavin Brown was appointed as the Executive Manager of the MPTS on 11 September 2017, joining from a senior role in the Ministry of Justice at HM Prisons and Probation Service. This new title replaces that of Assistant Director, to reflect the distinct role leading the operationally separate MPTS.

A recruitment campaign took place in late 2017 to appoint a new MPTS Committee member after one member’s term of appointment came to an end in November 2017. Ms Joy Hamilton was appointed as a new lay member and took up the role from January 2018.

Executive Board

The Executive Board was established as part of a wider package of changes within the organisation to support our ambition to become a more agile, confident and connected regulator. Council approved the establishment of the Executive Board and the dissolution of the Strategy and Policy Board and Performance and Resources Board in April 2017.

The Board is chaired by the Chief Executive Charlie Massey and has been established as a decision-making forum to promote collective executive decision-making by the senior management team (SMT). The structure makes sure that the Chief Executive is part of significant discussions on strategy, policy, performance, risk, staffing and talent management.

UK Advisory Fora

In 2013 we established advisory fora in Scotland, Wales and Northern Ireland, which are chaired by Professor Sir Terence Stephenson, Chair of Council. The fora support Council’s role in making sure we have effective engagement and consultation with interest groups and that our policies are suited to all parts of the UK.

The fora are an addition to our existing arrangements for engagement and are intended to give a structured setting for us to engage on medium- and long-term priorities, and to share and discuss any early-stage views on policy development. The fora report on their work to the Executive Board twice a year.

Education and Training Advisory Board

The Education and Training Advisory Board is chaired by Professor John Connell. It gives us advice on the delivery of undergraduate and postgraduate medical education and training, and career progression.

The board’s advice is crucial in developing our policy and in making sure that Council is fully briefed before major decisions are made. The board’s invited membership reflects the diverse range of those who have an interest in medical education and training across the UK. The board reports on its work to the Executive Board following each meeting, three times a year.



Revalidation Advisory Board

The Revalidation Advisory Board’s last meeting took place in March 2017. It had been chaired by Sir Keith Pearson since March 2013 to provide advice about how effectively revalidation has been operating since it was introduced in December 2012.

The board gave insight from a range of perspectives about how the system is working on the ground and how different groups, including doctors, responsible officers, patients, the public and employers, are experiencing revalidation.

In considering how to co-ordinate and oversee the progress and delivery of our Taking revalidation forward action plan, it was decided that a fresh approach would be appropriate. The Revalidation Oversight Group was established for this purpose and is chaired by our Chief Executive Charlie Massey. It includes representatives of all four UK health departments, the BMA, training bodies, primary care and employer representatives, as well as patient representatives. Sir Keith Pearson is a member of the group, acting as a specialist adviser.

Assessment Advisory Board

The Assessment Advisory Board is chaired by Professor Val Wass. It gives us expert advice on the development and operation of GMC-led assessments and assessments that we oversee.

The membership of the board includes a range of experts in assessment and assessment design, including those with expertise in differential attainment and statistical analysis of examination performance (psychometrics). Its work is reported to the Executive Board quarterly.



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Member attendance at Council,1 boards and committees in 2017

Member and trustee Number of meetings attended

Mr Steven Burnett

Council 6/7

Board of Trustees of the GMC’s Superannuation Scheme 4/5

UK Advisory Forums – Wales 1/2

Dr Shree Datta

Council 7/7

Remuneration Committee 1/2

Investment Sub-Committee 3/4

Lady Christine Eames

Council 7/7

Audit and Risk Committee 5/6


UK Advisory Forums – Northern Ireland 2/2

Professor Michael Farthing2

Council 5/6


Professor Anthony Harnden

Council 7/7



Baroness Helene Hayman

Council 7/7


1 Includes six Council meetings and one strategic away day. Council member attendance at the forum meetings is on a voluntary basis on the invitation of the Chair of Council.

2 Demitted as a Council member on 28 November 2017. Attendance data reflects the total number of meetings where attendance was possible.



Member and trustee Number of meetings attended

Professor Deirdre Kelly

Council 6/7

Board of Trustees of the GMC’s Superannuation Scheme 4/5


Professor Paul Knight OBE

Council 7/7



UK Advisory Forums – Scotland 2/2

Dame Suzi Leather

Council 7/7



Dame Denise Platt

Council 7/7

Investment Sub-Committee3 3/3Remuneration Committee 2/2

Amerdeep Somal LLB

Council 7/7



Professor Terence Stephenson4

Council 5/7

GMC/MPTS Liaison Group 1/2

UK Advisory Forums – Northern Ireland 0/2

UK Advisory Forums – Scotland 2/2

UK Advisory Forums – Wales 2/2

3 Attendance data reflects the total number of meetings where attendance was possible.

4 Professor Sir Terence Stephenson had a period of absence due to ill health during 2017, during which Dame Denise Platt acted as Deputy Chair.



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External co-opted members

External co-opted members sit on both the Investment Sub-Committee and Audit and Risk

Committee. Their attendance at meetings during 2017 is listed below:

Management

In 2017 our staff were under the direction of Chief Executive Charlie Massey and Chief Operating Officer and Deputy Chief Executive Susan Goldsmith.

On 31 December 2017 the directors were:

n Paul Buckley, Director of Strategy and Communication

n Una Lane, Director of Registration and Revalidation

n Dr Colin Melville, Director of Education and Standards

n Anthony Omo, General Counsel and Director of Fitness to Practise

n Neil Roberts, Director of Resources and Quality Assurance.

Paul Reynolds, our new Director of Strategic Communications and Engagement, joined the GMC on 9 January 2018.

In memoriam

Dr Vicky Osgood, Director of Education and Standards between July 2014 and December 2016, sadly passed away on 23 March 2017.

Investment Sub-Committe

Mr Tim Scholefield 4/4

Mr Keith MacKay 4/4


Ms Elizabeth Butler 6/6

Mr John Morley 4/6


2017 FINANCIAL REVIEW

The accounts for the year ended 31 December 2017 have been prepared in accordance with the Charities Statement of Recommended Practice (FRS 102).

Our total income and expenditure in 2017In 2017, we generated a total income of £112.5 million, and our total expenditure was £99.1 million. Our income in 2017 increased by £5.5 million compared with 2016, largely due to growth in the number of registered doctors coupled with the full year impact of the fee changes introduced part way through 2016.

Our expenditure in 2017 reduced by £1.6 million compared with 2016, largely as a result of our change programme to relocate activities from London to Manchester.

Each year we set a business plan and budget based on our strategic aims and a forecast of likely work volumes. Our actual performance against our plans is set out earlier in this report, and our actual income and expenditure compared to our budget in 2017 is summarised below.

Our actual income in 2017 was £3.8 million more than we budgeted. The number of registered doctors increased over the year, and demand for our Professional and Linguistics Assessment Board (PLAB) tests was higher than anticipated. We also achieved better investment returns on the cash balances we held during the year.

Our operational expenditure in 2017 was £5.2 million under budget. The main reasons were:

n Fitness to practise costs are a significant proportion of our total expenditure. Expenditure in 2017 was £2.4 million under budget. Legal costs were lower than budgeted due to fewer

hearing days; we reviewed our processes leading to a reduction in the volume of health assessment reports required; and savings were achieved through staff vacancies.

n Accommodation costs were £1 million under budget in 2017, largely through savings on lease assignment costs on the disposal of the first floor of our London office.

n MPTS costs were £0.8 million under budget due to a reduction in the average hearing length, driven by a combination of improvements in case management, sending out case papers in advance, better management of adjourned hearings, and fewer longer complex hearings.

n We set aside £2 million to give us flexibility to respond to new initiatives and opportunities that present themselves during the course of the year. We spent £1.5 million on a range of projects in 2017, including our digital transformation strategy, taking revalidation forward, organisational development, customer services and developing regulation policy. £0.5 million of the resources set aside were not spent at the end of the year.

n Education and standards costs were £0.4 million under budget mainly due to staff vacancies on core activities and some UK Medical Licensing Assessment project roles being recruited to later than originally planned.

n Our strategy and communication costs were £0.4 million under budget through staff vacancies and savings on marketing and research projects.

n Our resources and quality assurance costs were £0.3 million over budget mainly due to additional recruitment costs given the high level of staff vacancies across the organisation in 2017, coupled with additional pension advice costs.



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ABOUT US

The GMC’s defined benefit pension scheme was closed to new joiners on 1 July 2013 and replaced by a defined contribution scheme. In 2017 Council agreed to close the defined benefit scheme to future accruals from 1 April 2018 to address the combination of growing financial risk due to the increased size of the scheme; affordability due to the projected increases in contributions that would be required to maintain the scheme’s viability; and to remove the inequity with members of the defined contribution scheme. Council made a payment of £2.4 million into the defined benefit scheme in 2016, and agreed further payments of £0.5 million per annum for five years, starting in 2017. In March 2018 Council agreed to make further payments totalling £5 million over the years 2018 and 2019.

During 2017, we spent £6 million on major projects to improve our information systems infrastructure and accommodation.

The charity had no fundraising activities requiring disclosure under S162A of the Charities Act 2011.

Trustees’ responsibilities for the financial statementsThe trustees are responsible for preparing the trustees’ annual report and the financial statements in accordance with applicable law and United Kingdom Generally Accepted Accounting Practice (United Kingdom Accounting Standards). The law applicable to charities in England, Wales and Scotland requires the trustees to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the charity and the group and of the incoming resources and application of resources of the group for that period.

In preparing these financial statements, the trustees are required to:

n select suitable accounting policies and then apply them consistently

n observe the methods and principles in the Charities SORP

n make judgements and estimates that are reasonable and prudent

n state whether applicable accounting standards have been followed, subject to any material departures being disclosed and explained in the financial statements

n prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charity will continue in business.

The trustees are responsible for keeping adequate accounting records that are sufficient to show and explain the charity’s transactions and disclose, with reasonable accuracy at any time, the financial position of the charity and enable them to ensure that the financial statements comply with the Charities Act 2011, the Charity (Accounts and Reports) Regulations 2008, the Charities and Trustee Investment (Scotland) Act 2005, the Charities Accounts (Scotland) Regulations 2006 (as amended), the Privy Council Directions issued under the Medical Act 1983 and the provisions of the charity’s constitution. They are also responsible for safeguarding the assets of the charity and the group and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

Related party transactionsWe require all trustees and senior managers must disclose details of any organisations in which they (or their close family members and business partners) hold a position of authority or other



material interest and whose business could bring them into financial contact with the GMC. Details of any actual transactions between the GMC and related parties in the year must also be disclosed. We also publish a register of interests on our website.

In 2017 all disclosures were made and there were no issues of concern.

Reserves policy and going concernOur level of reserves and our reserves policy are reviewed annually, and any financial implications are addressed as part of the budget-setting process.

Our total reserves are made up of free reserves, reserves backed by fixed assets, and pension reserves.

We hold free reserves:

n to fund working capital and manage the normal day-to-day cash flow of the business because our expenditure is broadly linear whereas income is concentrated in summer and winter peaks

n to provide funds to address the risks we have identified that may result in an unexpected increase in expenditure and/or a reduction in income

n to provide funds to respond to new initiatives and opportunities

n to fund the time period between taking a decision to increase income and it taking full effect.

There is no standard formula that can be used to calculate the ideal level of free reserves. We follow the Charity Commission’s guidance and set a target range based on our cash flow requirements and an assessment of the risks facing the organisation.

We aim to hold free reserves at a level that is not excessive, but does not put our solvency at risk.

We operate a defined benefit pension scheme. In line with the accounting standard FRS 102, the value of the pension scheme assets and liabilities is recognised on the balance sheet. While the operation of the defined benefit pension scheme does create a financial risk for the organisation, any deficit or surplus in the scheme can be managed over the medium term, and so has no immediate impact on our cash flow requirements. Any risks associated with changes in the level of pension scheme assets and liabilities are therefore disregarded for reserves policy purposes.

A significant proportion of our total reserves is represented by fixed assets, which cannot easily be converted into cash at short notice without adversely affecting our ability to fulfil our charitable aims. The value of fixed assets is therefore disregarded for reserves policy purposes.

Based on our analysis of cash flows and the risks facing the organisation, our policy is to maintain free reserves in the range of £25 million to £45 million. However, we recognise that the level of reserves will inevitably fluctuate year on year, reflecting variations in actual levels of income and expenditure compared with the budget. Our policy is to maintain actual free reserves in line with the target level over the medium term. If our actual reserves vary significantly from the target range set out in the reserves policy, we will address the variation as part of the annual budget-setting process to bring actual reserves back into line within a reasonable period.

Our total reserves at the end of 2017 were £77.9 million, made up of free reserves of £51 million, plus £14.2 million of reserves represented by fixed assets, and a pension reserve of £12.7 million.



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The defined benefit pension scheme surplus of £12.7 million comprised assets of £233.3 million and liabilities of £220.6 million, valued in accordance with the financial reporting standard FRS 102. This is set out in more detail in note 16 of the accounts.

We have delivered significant operational savings since 2015, including relocating 150 roles from London to Manchester, reducing our property footprint in London, streamlining our fitness to practice procedures and introducing changes to our pension scheme. These savings have helped us fulfil our commitment to reduce the cost of regulation on doctors.

Council decided to reduce the 2018–19 annual retention fee for all doctors and introduce a package of additional fee reductions for doctors in their early years on the register. We estimate that our free reserves will peak at around £56 million at the end of 2018, as our income will remain higher than expenditure in the short term. Over the medium term we estimate that our free reserves will reduce steadily to around £28 million by the end of 2022, due to the ongoing impact of the fee reductions coupled with year on year growth in our expenditure.

The majority of our income comes from registration fees paid by doctors. All doctors must be registered with us to practise medicine in the UK, and so our income is relatively certain. The trustees are therefore of the view that the GMC is a going concern.

There are no material uncertainties related to events or conditions that cast significant doubt on our financial stability over the medium term.

Investment policyOur investment policy separates our funds into four categories:

n those which are required as working capital for the normal day-to-day operation of the business

n those which we may invest under management

n those which we may invest in a trading subsidiary and

n any residual cash balance.

We hold £20 million as working capital for normal cash flow purposes. This equates to 10 weeks of expenditure, which provides sufficient flexibility to avoid temporary borrowing and/or the need to liquidate investments to deal with short-term variations in operational income and expenditure.

After taking account of our working capital requirement we have determined that we will invest up to £50 million under management. This amount is reviewed annually by Council. We currently have £10 million invested under management.

We have a low risk appetite. We wish to protect against volatility, capital loss and the erosion of asset value by inflation. When investing funds under management our objectives are: to provide protection against inflation; to generate a modest level of income; and to diversify our funds to reduce the risk of capital and/or revenue loss.

Our target rate of return on funds invested under management is inflation (CPI) plus 2% over a rolling five-year period.

We have adopted a comprehensive ethical investment approach. We believe that investing in certain companies or sectors would conflict with our charitable aims, or may create reputational damage.



We do not wish directly to profit from, or provide capital to, activities that are materially inconsistent with our charitable aims and so we specifically exclude investment in companies that derive more than 10% of their revenue from: tobacco, alcohol, gambling, pornography, high-interest rate lending, cluster munitions and landmines, and the extraction of thermal coal or oil sands. We do not invest in companies that are under investigation for, or have been found guilty of, tax evasion in the last three years.

We may invest in companies whose activities are consistent with, or supportive of, our charitable aims. We expect companies in which we invest to demonstrate responsible employment and corporate governance practices, to be conscientious with regard to environmental and social issues, and to deal fairly with customers and the communities in which they operate. We may also use our position as an investor to actively engage with and influence the corporate behaviour of those companies we invest in.

We will invest only through fund managers who demonstrate the strongest environmental, social and governance (ESG) credentials. When appointing fund managers we will take into consideration how they incorporate an assessment of companies performance on ESG issues into their stock selection.

Where we have the power to do so, we may invest funds in a trading subsidiary of the GMC. We currently have £0.6 million invested as share capital in GMC Services International Limited.

Any residual cash not held as working capital or invested is held in medium term deposits and/or interest-bearing accounts.

Our Council is responsible for determining and reviewing the overall investment policy, objectives, risk appetite and target returns. Council has delegated to the Investment Sub-Committee responsibility for implementing the investment policy, appointing and managing fund managers, monitoring performance and reporting to Council.

Our 2017 accounts show cash required for normal day-to-day working capital on our balance sheet within current assets, and cash held for the longer term is shown as investments.

In 2017, our funds under management generated a return of 5.7% against a target of 5%. We generated interest of £0.6 million on our remaining cash balances, equivalent to an average annual rate of return of 0.7%.

GMC Services International LimitedThe trading subsidiary was incorporated as a private company limited by shares on 16 December 2016. It is a wholly owned subsidiary of the GMC and provides services on a commercial basis, including consultancy, training and accreditation. One of its main objectives is to introduce new revenue streams and so reduce the GMC’s reliance on core financial resources. It will do this by gifting its profits back to the GMC for the purpose of delivering the GMC’s charitable aims.

The GMC invested £0.6 million as share capital in GMCSI. In 2017, its first year of trading, GMCSI generated income of £483,118 and incurred costs of £542,598. This resulted in a net loss of £59,480 and so no profits were gift-aided back to the GMC. This is not unusual in the first year of a new start-up. GMCSI ended the year with net assets of £540,520.



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GMCSI is projected to generate profits over the medium term.

The accounts presented here have been prepared on a consolidated basis for the GMC and GMCSI combined. Separate company accounts have been prepared for GMCSI.

Key management personnel – remuneration policyThe Remuneration Committee is responsible for determining the remuneration, benefits, and terms of service for the Chief Executive, Chief Operating Officer/Deputy Chief Executive, Chair of MPTS and directors. The committee sets all aspects of salary or honoraria, the provision of any other benefits, and any other arrangements or contractual terms for this group of staff.

The committee considers that we should provide remuneration and rewards that will attract and retain the high-calibre staff necessary to enable us to fulfil our statutory remit and deliver our strategic objectives.

In setting the base pay for individual posts the committee will take external advice on roles within its remit and align salaries with an appropriate market rate subject to resource considerations.

An annual consolidated pay award is considered with reference to the organisation’s level of performance, the financial implications of any award, the award agreed for other GMC employees and wider market trends. An annual variable non-consolidated element is considered, reflecting personal performance, with regard to the same considerations applied to any consolidated award. We review the effectiveness of these arrangements on an annual basis.

Staff within the Remuneration Committee’s remit will usually be entitled to the benefits package available to all GMC employees on the same terms. The committee retains the ability to withdraw, adjust or change any benefits for staff within its remit, subject to any consultation and contractual requirements. The committee considers any additional benefits in kind (such as relocation payments) on a case-by-case basis.

New external staff appointees within the committee’s remit are automatically enrolled into our defined contribution pension scheme. Where employees have existing agreed pension arrangements, such as membership of our defined benefit scheme, they retain this for the course of their employment, subject to any changes to the rules agreed by trustees and the employer.

The committee ensures that the equality and diversity implications of remuneration policy and related decisions are considered appropriately. Specifically:

n any salary differentials are supported by a formal job evaluation or independent external market advice

n any decisions relating to variable pay are supported by an objective assessment of performance

n any adjustment or changes to remuneration arrangements do not discriminate unlawfully

n other decisions relating to terms of service are supported by appropriate advice on any equality and diversity implications.


AUDIT AND RISKCOMMITTEE’S REPORT

The Audit and Risk Committee plays a key role in the GMC’s governance structure, providing Council with independent assurance on the effectiveness of arrangements to ensure the:

n integrity of the financial statements

n effectiveness of the systems of internal control, governance and risk management

n adequacy of both the internal and external audit services.

The Committee bases its advice and decisions on guidance issued by the Financial Reporting Council, the Charity Commission, Office of the Scottish Charity Regulator and, where appropriate, independent external advice.

There are eight members on the Committee - six Council members and two co-opted members- all of whom bring valuable scrutiny and challenge to the Committee’s work on finance, risk and governance. In 2017, the Committee held six meetings and submitted two formal reports on its work and findings to full Council. It also met six times in seminar sessions, providing opportunities to learn more about, and scrutinise, specific areas of the business and their risks.

Key activities during the year included:

n discussing wider strategic risks and challenging the Corporate Risk Register at every meeting

n continued support for risk maturity in line with the principles of effective risk management set out in the international guidance standard ISO 31000:2009

n overseeing delivery of the 2017 internal audit programme, scrutinising all audit findings to satisfy itself that the actions proposed were appropriate, and monitoring the implementation of recommendations to make sure they were being managed effectively by senior management

n approving the external audit letter of engagement and reviewing the outcome of the external auditor’s work

n reviewing the delegated authorities which are set out in the Schedule of Authority and form part of the Governance Handbook

n commissioning an independent test of the GMC’s cyber security control arrangements, reflecting the increased media coverage of high profile attacks.

AUDIT AND RISK COMMITTEE’S REPORT


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Risk management statement

Context

The GMC operates in a complex healthcare and regulatory landscape. Our objective is to keep the public safe and we work with doctors to do this. We have to manage the risks and implications of external events and internal activities sensitively but also recognise that there are opportunities for us as a regulator for protecting the public as well as an employer with over 1,000 staff.

Our Risk Management Framework is the guiding document which sets out our approach to managing the opportunities and risks we face both as an organisation but also in playing our part in the wider health environment. Council and the Audit and Risk Committee have discussed risks and opportunities regularly throughout the year. The Executive Board plays an active role in managing risks, regularly monitoring not only existing corporate risks, opportunities and mitigating actions but also emerging ones. Keeping our finger on the pulse means we are able to respond quickly and appropriately to early warning signs, enabling us to better plan for, and manage, issues when they arise. Directorates and teams also continue to identify and monitor local operational and project risks through risk registers, escalating matters to the Executive Board when needed to make sure we take the right action at the right time.

Managing risks in 2017

Our Corporate Risk Register is published regularly on the GMC’s website through the Chief Operating Officer’s report to Council. During the year we have continued to manage a number of strategic risks,

including understanding the potential implications for the GMC of the continuing uncertainty over Brexit negotiations. We recognise the UK medical workforce supply pressures and are committed to making sure the flow of doctors from outside the UK is as smooth as possible when we leave the EU.

We also recognise the risks from continuing pressures on the wider health service and the impact these have on those working in it. Our Corporate strategy 2018-2020 recognises all these risks and sets out the opportunities we need to respond to in this changing environment so that we become more inclusive, agile and engaged with public, patients and the profession.

As well as continuing to manage ongoing risks, we have also addressed a number of emerging strategic risks during 2017, including:

n recognising the challenges and impact on our work from Health Education England’s organisational restructure

n ensuring we are robust and resilient in handling statutory decisions when under particular media and external scrutiny.

At an operational level we have managed and mitigated a number of risks, the most significant of which was preparing for the introduction of the General Data Protection Regulation (GDPR) (Regulation (EU) 2016/679) on 25 May 2018.

We also understand the value of good customer service and have been working hard to improve all the touch points where doctors and others interface with the GMC. In January 2018 we launched our public and patient engagement programme. Our digital transformation is also continuing including improvements to the GMC website, so that



information that meets the needs of all those we work with and for is streamlined, easy to find and simple to use.

We have a strong culture of continuous improvement and strive to reflect on what works well and where we need to learn and improve. This has enabled us to continue to make progress, on, for example, provisional enquiries and single clinical incidents.

In 2017 we began a review of our approach to the quality assurance of medical education. There is more to do in this area which we will be addressing in the coming year. We have, however, made progress in developing a single medical licensing assessment and continue to work with training bodies to respond to any concerns about patient safety and the training quality and experience for medical students and doctors in training.

We recognise the value of a highly trained workforce and invest in rigorous recruitment, extensive corporate and local induction programmes and ongoing training and development for all staff. This includes regular mandatory information security training so we remain certified to the Information Security Management international standard ISO 27001 as well as BS 10008, a standard that underpins the legal admissibility and evidential weight of electronic information and the documents that are scanned to our systems. These are important, internationally recognised standards which give confidence to the public and the profession in the information processes and systems we use to deliver our work.

We also know from our staff survey, which from 2018 will be run on an annual basis, that our staff are motivated, understand the value of the role the

GMC plays and are committed to delivering high quality, customer-focussed services.

But as ever, we must remain vigilant. Our activities, responses and engagement must be even more relevant, appropriate and proportionate in an ever-turbulent landscape.

Longer term risks and opportunities

Council’s strategic away day in July 2017 provided an opportunity to explore the future of medicine, the changing role of doctors and public expectations of them over the next 30-40 years. Understanding the implications and operating environment for professional medical regulation helped to inform our corporate strategy 2018-2020. We considered the key drivers of change and the potential implications for patients, workforce, technology and the NHS, and how they might influence the action we take in the next three years on, for example, the design and exercise of our levers and influence in medical education and training.

We are only one of many players in the healthcare system with a shared objective of public safety. We therefore have an important role in bringing issues to the attention of others where we can make a contribution but have limited control ourselves. We need to understand what more we can do, strengthening our collaboration with others to maximise the contribution professional regulation can make to finding solutions, working with regulators, improvement bodies and other partners across Scotland, Wales and Northern Ireland.



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Risk statement summary

In the face of continuing and hardening external pressures and challenges, we, like other bodies in the healthcare sector, must remain agile in our responses. We must listen to our stakeholders and remain resolute in our desire to protect the public and support doctors at all stages of their careers. Dynamic and effective risk management is key to making sure our role and our activities remain relevant to the needs of society. As we have made clear in our corporate strategy 2018-2020, a shift in emphasis from acting when things have gone wrong to supporting all doctors in delivering the highest standards of care is the best way to keep the public safe and maintain their confidence in the medical profession.

Approved by the trustees on 6 June 2018 and signed on their behalf by:

Professor Sir Terence StephensonChair of Council

Independent auditors’ report to the trustees of the General Medical Council Opinion

We have audited the financial statements of the General Medical Council for the year ended 31 December 2017 which comprise the Statement of Financial Activities, the Balance Sheet, the Cash Flow Statement and notes to the financial statements, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102, the Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).

This report is made solely to the charity’s trustees, as a body, in accordance with Part 4 of the Charities (Accounts and Reports) Regulations 2008 and Regulation 10 of the Charities Accounts (Scotland) Regulations 2006. Our audit work has been undertaken so that we might state to the charity’s trustees those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charity and the charity’s trustees as a body, for our audit work, for this report, or for the opinions we have formed.

In our opinion the financial statements:

n give a true and fair view of the state of the group’s and of the parent charity’s affairs as at 31 December 2017 and of the group’s incoming resources and application of resources, for the year then ended;



n have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and

n have been prepared in accordance with the requirements of the Charities Act 2011 and the Charities and Trustee Investment (Scotland) Act 2005 and regulations 6 and 8 of the Charities Accounts (Scotland) Regulations 2006.

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report. We are independent of the group in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Conclusions relating to going concern

We have nothing to report in respect of the following matters in relation to which the ISAs (UK) require us to report to you where:

n the trustees’ use of the going concern basis of accounting in the preparation of the financial statements is not appropriate; or

n the trustees have not disclosed in the financial statements any identified material uncertainties that may cast significant doubt about the group’s or the parent charity’s ability to continue to adopt

the going concern basis of accounting for a period of at least twelve months from the date when the financial statements are authorised for issue.

Other information

The trustees are responsible for the other information. The other information comprises the information included in the annual report, other than the financial statements and our auditor’s report thereon. Our opinion on the financial statements does not cover the other information and we do not express any form of assurance conclusion thereon.

In connection with our audit of the financial statements, our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements or a material misstatement of the other information. If, based on the work we have performed, we conclude that there is a material misstatement of this other information; we are required to report that fact.

We have nothing to report in this regard.

Matters on which we are required to report by exception

We have nothing to report in respect of the following matters in relation to which the Charities (Accounts and Reports) Regulations 2008 require us to report to you if, in our opinion:



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n the information given in the financial statements is inconsistent in any material respect with the trustees’ report; or

n sufficient and proper accounting records have not been kept by the parent charity; or

n the financial statements are not in agreement with the accounting records and returns; or

n we have not received all the information and explanations we require for our audit.

Responsibilities of trustees

As explained more fully in the trustees’ responsibilities statement set out from page 43, the trustees are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and for such internal control as the trustees determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.

In preparing the financial statements, the trustees are responsible for assessing the group’s and the parent charity’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the trustees either intend to liquidate the charity or to cease operations, or have no realistic alternative but to do so.

Auditor’s responsibilities for the audit of the financial statements

We have been appointed as auditor under section 151 of the Charities Act 2011, and section 44(1)(c) of the Charities and Trustee Investment (Scotland) Act 2005 and report in accordance with the Acts

and relevant regulations made or having effect thereunder.

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

A description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.

Crowe U.K. LLP Statutory Auditor London Date:

Crowe U.K. LLP is eligible for appointment as auditor of the charity by virtue of its eligibility for appointment as auditor of a company under section 1212 of the Companies Act 2006.


ACCOUNTS 2017STATEMENT OF FINANCIAL ACTIVITIES FOR THE YEAR ENDED 31 DECEMBER 2017

Total 2017 Total 2016

Note £’000 £’000

IncomeFrom Charitable activities

Registration 2 105,271 100,786

Specialist and GP registration 2 3,425 3,475

Revalidation 2 205 253

Other trading activities 3 243 303

Commercial trading operations 3 483 -

Investments 3 1,699 1,662

Other 3 1,195 479

Total incoming resources 112,521 106,958

Expenditure Raising funds

Commercial trading operations 5 542 -

Investment management costs 5 35 -

577

Charitable activities

Fitness to practise 48,220 49,191

Registration and revalidation 20,139 20,003

Medical Practitioners Tribunal Service 11,785 13,297

Education 7,919 7,580

External relationships 6,362 6,490

Communications 2,472 2,617

Standards 1,612 1,565

98,509 100,743

Total expenditure 5 99,086 100,743

Net income 13,435 6,215

Other recognised gains and lossesActuarial (loss)/gain on defined benefit pension scheme 16 (969) (10,139)

Net movement in funds 12,466 (3,924)

Total funds brought forward 65,482 69,406

Total funds carried forward 77,948 65,482

The General Medical Council incorporated a wholly owned trading subsidiary on 16 December 2016 with the purpose of providing services on a commercial basis including consultancy, training and accreditation. The Charity has taken exemption from presenting its unconsolidated profit and loss account. The charity movement in funds for the year is £12,525,000.

Consolidated statement of financial activities

ACCOUNTS 2017


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Balance sheet

2017 2016

Group Charity Group Charity

Note £’000 £’000 £’000 £’000

Fixed assetsIntangible fixed assets 7 9,232 9,232 8,412 8,412

Tangible fixed assets 8 4,962 4,962 6,312 6,312

Investments 9 53,579 54,179 60,007 60,007

67,773 68,373 74,731 74,731

Current assetsDebtors and prepayments 10 20,913 20,906 19,775 19,775

Cash and bank balances 50,323 49,601 30,787 30,787

71,236 70,507 50,562 50,562

LiabilitiesCreditors: amounts falling due within one year 11 (72,294) (72,106) (71,813) (71,813)

Net current liabilities (1,058) (1,599) (21,251) (21,251)

Total assets less current liabilities 66,715 66,774 53,480 53,480

Provisions for liabilities and charges 12 (1,468) (1,468) (1,509) (1,509)

Net assets excluding pension scheme asset 65,247 65,306 51,971 51,971

Defined benefit pension scheme asset 16 12,701 12,701 13,511 13,511

Total net assets 77,948 78,007 65,482 65,482

Unrestricted income funds 65,247 65,306 51,971 51,971

Pension reserve 12,701 12,701 13,511 13,511

Total funds 13 77,948 78,007 65,482 65,482

The financial statements were approved by the trustees and authorised for issue on 6 June 2018.They were signed on behalf of trustees by:

Professor Sir Terence StephensonChair of Council

ACCOUNTS 2017


Consolidated cash flow statement

2017 2016

£’000 £’000 £’000 £’000

Cash flows from operating activities:

Net cash provided by/(used in) operating activities (note 1 below) 25,579 12,385

Cash flows from investing activities:

Dividends, interest and rents from investments 632 700

Purchase of property, plant, equipment and intangibles (6,675) (8,337)

Net cash provided by/(used in) investing activities (6,043) (7,637)

Change in cash and cash equivalents 19,536 4,748

Note 1

Cash flow from operating activities £’000 £’000

Net incoming/(outgoing) resources 13,435 6,215

Investment income and interest (1,092) (1,651)

Net investment movement 6,428 (7)

Non-cash items – depreciation and amortisation 7,108 7,143

Non-cash items – assets written off 97 287

Pension past service cost and curtailment – –

Pension scheme current service cost 7,116 8,319

Pension scheme contribution (6,815) (9,514)

Decrease/(Increase) in debtors (1,138) 87

Increase in creditors 440 1,506

Net cash provided by (used in) operating activities 25,579 12,385

Note 2

Short-term deposits

Cash at bank and in hand

Total

Cash and equivalents £’000 £’000 £’000

Balances at 1 January 2017 – 30,787 30,787

Net increase/(decrease) in cash and cash equivalents – 19,536 19,536

Balances at 31 December 2017 – 50,323 50,323

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Notes to the accounts

1. Principal accounting policies(i) Accounting convention

Our financial statements have been prepared on a going concern basis and in accordance with the Charities Statement of Recommended Practice (FRS 102), applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland, the Charities Act 2011, the Charities and Trustee Investment (Scotland) Act 2005, the Charities Accounts (Scotland) Regulations 2006 and UK Generally Accepted Practice as it applies from 1 January 2015. The GMC meets the definition of a public benefit entity under FRS 102. There are no material uncertainties about the charity's ability to continue as a going concern. The charity had no fundraising activities requiring disclosure under s162A of the Charities Act 2011.

(ii) On 16 December 2016 the GMC incorporated a trading subsidiary, GMC Services International LTD, company number 10530157, which is wholly owned by share capital by the General Medical Council.

(iii) The principal accounting policies adopted in the preparation of the financial statements, which have been applied consistently, are detailed below.

Incoming resources

Income is included in the statement of financial activities when all of the following criteria are met:

n Entitlement – control over the rights or other access to the economic benefit has passed to the GMC

n Probability – it is more likely than not that the economic benefits will flow to the GMC

n Measurement – the value can be measured reliably.

The following specific policies apply:

Annual retention fees relate to services to be provided over a 12-month period. Income is deferred and released to the statement of financial activities on a straight-line basis over the period to which the income relates.

Registration fees, including provisional registration fees, are recognised when registration is granted.

Professional and Linguistic Assessments Board (PLAB) fees are recognised when the examinations are sat.

Income from investments and funds held on deposit is recognised when it is receivable and the amount can be accurately measured.

All income is recognised gross.

Basis for recognising liabilities

Expenditure includes staffing costs, office costs, committee costs, legal costs, accommodation costs, purchase of assets, and financial, actuarial and professional costs.

Resources expended are included in the statement of financial activities on an accruals basis. All liabilities are recognised as soon as there is a legal or constructive obligation committing the charity to expenditure.

ACCOUNTS 2017


Basis for allocation of resources expended

The majority of our resources are expended directly in pursuit of our charitable aims, and are identified as such in the statement of financial activities.

Accommodation costs, governance costs and other support costs are apportioned to charitable activities on the basis of staff head count across the organisation.

Irrecoverable VAT

Any irrecoverable VAT is charged to the statement of financial activities as part of the relevant item of expenditure, or capitalised as part of the cost of the related asset where appropriate.

Taxation

We can take advantage of the exemptions from taxation on income and gains available to charities, so no taxation is payable on the net incoming resources.

Debtors

Trade and other debtors are normally recognised at the settlement amount due after any trade discount offered. Prepayments are normally valued at the amount prepaid net of any trade discounts due.

Creditors and provisions for liabilities

Creditors and provisions are recognised when the charity has a present legal or constructive obligation as a result of a past event. They are recognised when it is probable that a transfer of economic benefit will be required to settle the obligation and a reliable estimate can be made of the amount of the obligation. Creditors and provisions are normally recognised at their settlement amount after allowing for any trade discounts due.

Critical accounting judgements and key sources of estimation uncertainty

The key sources of estimation uncertainty that have a significant effect on the amounts recognised in the financial statements are:

All unsettled claims for legal costs made against the GMC are reviewed on a case-by-case basis at the year end.

Provisions are based on historical experience and a detailed assessment of the specific details of current cases. The final settlement of cases is dependent on a number of factors, so the accuracy of the provision is subject to a significant degree of uncertainty.

Provisions for property dilapidation costs are assessed on a case-by-case basis, close to the lease end date when a reasonable estimate of costs can be made.

Provisions for holiday pay are based on the actual level of accrued days and salaries of each staff member.

Tangible fixed assets

Tangible fixed assets are stated at cost, net of depreciation and any provision for impairment. Expenditure is only capitalised where the cost of the asset or group of assets acquired exceeds £5,000.

Intangible fixed assets

Intangible fixed assets comprise computer software. They are stated at cost, net of depreciation and any provision for impairment. Expenditure is only capitalised where the cost of the asset or group of assets acquired exceeds £5,000.

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Depreciation

Depreciation is provided so as to write off the cost, less estimated residual value, of the assets evenly over their estimated lives. In the case of leased assets, the cost is written off over the period of the lease. The period of the lease is determined as the period up to the first break clause, unless our intention is not to exercise the break.

The estimated useful lives are as follows:

n Leasehold buildings and leasehold improvements – the period of the lease or the useful economic life of the asset.

n Furniture, fixtures, and office fittings - the lesser of five years or the remaining term of the lease.

n Information Technology (IT) equipment and software - three years.

n Intangible assets (IT equipment) – three years.

n Other office equipment - three years for IT-related items and five years for all other items.

Depreciation rates are reviewed on a regular basis comparing actual lives of assets with the accounting policy rates.

Operating leases

Rent payable under operating leases is charged to the statement of financial activities on a straight-line basis over the period of the lease.

Financial instruments

The charity has financial assets and liabilities of a kind that qualify as basic financial instruments. Basic financial instruments are initially recognised at transaction value and subsequently measured at amortised cost. Financial assets held at amortised cost consist of cash and bank balances, short-term deposits, investments held in cash deposits together with trade and other debtors. Financial liabilities held at amortised cost comprise trade and other creditors, tax and social security creditors and accruals.

Investments

Our investment policy separates our funds into four categories: those which are required as working capital for the normal day to day operation of the business; those which we invest under management; those which we may decide to invest in a trading subsidiary; and the remaining cash balance which fluctuates during the year.

Funds held as cash for the normal day to day operation of the business is shown on the GMC’s balance sheet within current assets, while funds held for the longer term is shown as investments.

ACCOUNTS 2017


Pensions

We have a defined benefit pension scheme for permanent employees. The scheme was closed to new members on 30 June 2013, and replaced by a defined contribution scheme. The surplus or deficit of the defined benefit scheme is recognised on the balance sheet. Changes in the assets and liabilities of the scheme are disclosed and allocated as follows:

Charges relating to current or past service costs, and gains and losses on settlements and curtailments, are included within staff costs and charged to the statement of financial activities.

Interest on the net defined benefit asset/liability is shown as a net amount of other finance costs or as an incoming resource alongside investment income and interest. Actuarial gains and losses are recognised immediately in other recognised gains and losses on investments.

The assets, liabilities and movements in the surplus or deficit of the scheme are calculated by qualified independent actuaries as an update to the latest full actuarial valuation. Details of the defined benefit scheme assets, liabilities and major assumptions are shown in the notes to the accounts.

Our defined contribution pension scheme was set up on 1 July 2013. Contributions to the scheme are charged to the statement of financial activities in the year in which they are payable to the scheme.

A small number of staff who transferred to the GMC on the merger with the Postgraduate Medical Education and Training Board (PMETB), contribute to the NHS multi-employer scheme and contributions to the scheme are charged to the statement of financial activities in the year in which they are payable to the scheme.

Funds and reserves

Our funds are unrestricted, and can be expended at the trustees’ discretion, in pursuit of our charitable aims.

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2. Income from charitable activities

Total Total2017 2016

£’000 £’000

Registration

Annual retention fees 96,977 94,105

Registration fees 3,675 3,446

Provisional registration fees 675 685

PLAB fees 3,827 2,423

Other fees 117 127

105,271 100,786

Specialist and GP registration

Certificates of Completion of Training fees 2,580 2,661

Certificate of Eligibility for Specialist Registration/ Certificate of Eligibility for General Practitioner Registration fees

807 776

Other fees 38 38

3,425 3,475

Revalidation

Revalidation annual return 135 183

Revalidation assessment 70 70

205 253

ACCOUNTS 2017


3. Income from raising funds 2017 2016

£’000 £’000 £’000 £’000

Activities for raising funds

Other trading activities* 243 303

Commercial trading operations† 483 -

Other‡

Transaction fees 866 12,385

Reimbursement of legal fees 329 1,195 198 479

1,921 782

Investment income

Other finance income – pension scheme (note 16) 460 951

Bank interest 632 700

Investment income§ 607 11

1,699 1,662

* Other trading activities include sales of the medical register, external hire of the Clinical Assessment Centre, the reimbursement of costs of visiting

overseas medical schools and the reimbursement of costs of staff seconded to external bodies.

† Income from commercial trading operations is derived from GMC Services International Ltd, a wholly owned subsidiary, which provides services on a

commercial basis including consultancy, training & accreditation.

‡ Other generated funds include £5,000 of grant funding which will be utilised in 2018.

§ Investment management fees of £34,300 were incurred to generate the investment income return of £607,000.

4. Financial InstrumentsTotal Total

2017 2016

£’000 £’000

Financial assets measured at amortised cost 110,735 97,293

Financial liabilities measured at amortised cost 12,505 14,231

Financial instruments held at fair value 10,579 10,007

The entity’s income, expense, gains and losses in respect of financial instruments are summarised below:

Total interest income for financial assets held at amortised cost 632 700

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5. Total expenditure Direct Direct Allocated Total Total

staffing costs costs costs 2017 2016

£’000 £’000 £’000 £’000 £’000

Expenditure on:

Commercial trading operations 206 336 542

Investment management costs 35 35

Total expenditure on raising funds 206 371 - 577

Fitness to practise 20,101 8,850 19,269 48,220 49,191

Registration and revalidation 7,950 3,415 8,774 20,139 20,003

Medical Practitioners Tribunal Service 3,188 5,273 3,324 11,785 13,297

Education 4,297 567 3,055 7,919 7,580

External relationships* 3,344 630 2,388 6,362 6,490

Communications 1,326 170 976 2,472 2,617

Standards 889 20 703 1,612 1,565

Total charitable expenditure 41,095 18,925 38,489 98,509 100,743

Total group expenditure 41,301 19,296 38,489 99,086 100,743

* External relationships include the work done by our Regional Liaison Service, strategic relationships, our devolved offices, and our European and international development activities.

Support costs allocated to charitable activitiesManagement

£’000

IT

£’000

Human resources

£’000

Finance

£’000

Procurement

£’000

Facilities

£’000

Governance Total2017

£’000

Total2016

£’000

Fitness to practise 3,303 5,600 1,969 872 187 4,515 2,823 19,269 18,383

Registration and revalidation

1,504 2,550 897 397 85 2,056 1,285 8,774 8,691

Medical Practitioners Tribunal Service

570 966 340 150 32 779 487 3,324 3,222

Education 524 888 312 138 30 716 447 3,055 2,626

External relationships 409 694 244 108 23 560 350 2,388 2,269

Communications 167 284 100 44 9 229 143 976 920

Standards 120 204 72 32 7 165 103 703 656

Total charitable expenditure

6,597

11,186

3,934

1,741

373

9,020

5,638

38,489

36,767

Support costs and governance costs are managed centrally, and then allocated to charitable activities on the basis of staff head count across the

organisation.

ACCOUNTS 2017


Group expenditure by type

Charitable activities

Expenditure on raising funds

£’000 £’000 Total

Staffing costs 57,669 206 57,875

Office costs 2,506 30 2,536

Council and committee costs 406 5 411

Panel and assessment costs 12,816 - 12,816

Legal costs 4,061 - 4,061

Accommodation costs 5,967 - 5,967

Financial, actuarial and professional costs 5,218 336 5,554

Purchase of assets – charged to revenue 2,660 - 2,660

Assets written off 98 - 98

Depreciation 2,753 - 2,753

Amortisation 4,355 - 4,355

98,509 577 99,086

Total resources expended includes:

Operating lease costs: leasehold property and equipment 2,271 3,489

Audit fees 42 42

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6. Staff

2017 2016

£’000 £’000

Total costs of all staff

Salaries 42,176 43,478

Social security costs 4,267 4,029

Superannuation costs – defined benefit scheme 5,872 6,957

Superannuation costs – defined contribution scheme 2,026 1,633

Redundancy costs 76 -

Other staffing costs 3,458 3,190

57,875 59,287

2017 2016

Average staff numbers in the year by category

Fitness to practise 446 444

Medical Practitioners Tribunal Service 77 78

Registration and revalidation 203 210

Standards 16 16

Education 71 63

Communications 23 22

External relations 55 55

Governance* 61 56

Resources 183 171

1,135 1,115

* Governance includes staff seconded to GMC Services International Ltd on a full time basis.

ACCOUNTS 2017


The number of staff whose taxable emoluments fell into higher salary bands was:

2017 2016

GMC

£60,000–£70,000 39 28

£70,001–£80,000 26 28

£80,001–£90,000 14 11

£90,001–£100,000 7 11

£100,001–£110,000 7 8

£110,001–£120,000 8 7

£120,001–£130,000 4 4

£130,001–£140,000 2 -

£140,001–£150,000 - 1

£160,001–£170,000 - -

£180,001–£190,000 1 2

£190,001–£200,000 4 2

£200,001–£210,000 1 1

£230,001–£240,000 1 -

MPTS

£60,000–£70,000 2 1

£70,001–£80,000 1 1

£90,001–£100,000 - -

£100,001–£110,000 - 1

£110,001–£120,000 - -

2017 2016

Number of staff included above for whom retirement benefits are accruing

GMC defined benefit pension scheme 90 87

GMC defined contribution pension scheme 25 18

NHS defined benefit pension scheme 1 1

Not in scheme 1 -

117 106

The key management personnel of the charity includes the Chief Executive, Chief Operating Officer and six directors.

The total employee benefits of key management personnel were £1,401,116. (2016 £1,645,208). There were no related party transactions in the

year that require disclosure.

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7. Intangible fixed assets

Group and charity

Computer software and systems development

£’000

Cost

Balance at 1 January 2017 34,366

Additions 5,175

Disposals (266)

Balance at 31 December 2017 39,275

Amortisation

Balance at 1 January 2017 34,366

Amortisation charge for year 5,175

Disposals (266)

Balance at 31 December 2017 39,275

Net book value at 1 January 2017 8,412

Net book value at 31 December 2017 9,232

Intangible assets incorporates all IT software development costs including, but not limited to, the development of our strategic applications,

Siebel, Livelink and Agresso, the development of IT security systems, facilities management systems and website. Intangible assets also include

the systems to support working from home and mobile applications.

ACCOUNTS 2017


8. Tangible fixed assets

Group and charity

Buildings

Fixtures, furniture and

equipment IT equipment Total

£’000 £’000 £’000 £’000

Cost

Balance at 1 January 2017 5,702 8,958 9,148 23,808

Additions - 994 506 1,500

Disposals (212) (557) (858) (1,627)

Balance at 31 December 2017 5,490 9,395 8,796 23,681

Depreciation

Balance at 1 January 2017 5,656 4,642 7,198 17,496

Depreciation charge for year 14 1,286 1,453 2,753

Disposals (212) (460) (858) (1,530)

Balance at 31 December 2017 5,458 5,468 7,793 18,719

Net book value at 1 January 2017 46 4,316 1,950 6,312

Net book value at 31 December 2017 32 3,927 1,003 4,962

9. Investments

2017 2016


£’000 £’000 £’000 £’000

The valuation at the end of the year consisted of:

Cash deposits 43,000 43,000 50,000 50,000

Investment in Subsidiary - 600

Managed funds* 10,579 10,579 10,007 10,007

53,579 54,179 60,007 60,007

* Managed funds are placed with CCLA and are split between their deposit fund and ethical fund.

2017 2016

£’000 £’000 £’000 £’000

The valuation at the end of the year consisted of:

Cash deposits 43,000 43,000 50,000 50,000

Investment in Subsidiary - 600

Managed funds* 10,579 10,579 10,007 10,007

53,579 54,179 60,007 60,007

* Managed funds are placed with CCLA and are split between their deposit fund and ethical fund.

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10. Debtors 2017 2016


£’000 £’000 £’000 £’000

Amounts falling due within one year

Registration debtors 16,530 16,530 16,128 16,128

Prepayments and accrued income 3,982 3,982 3,367 3,367

Other debtors 401 394 280 280

20,913 20,906 19,775 19,775

11. Creditors

2017 2016


£’000 £’000 £’000 £’000

Amounts falling due within one year

Trade creditors 908 908 793 793

Other creditors - 1 1

Tax and social security 1,480 1,479 1,456 1,456

Holiday pay 653 653 591 591

Accruals 10,944 10,757 12,847 12,847

Deferred income 58,309 58,309 56,125 56,125

72,294 72,106 71,813 71,813

ACCOUNTS 2017


Charity deferred income Income from annual retention fees is deferred and released to the statement of financial activities on a straight-line basis over the period to

which the income relates. All deferred income brought forward from the previous year is automatically released to the statement of financial

activities in the following year.

Annual retention

fees

PLAB fees

Specialist and GP

registration fees

Revalidation assessment

fees

Transaction charges

Total

£’000 £’000 £’000 £’000 £’000 £’000

Deferred income at 1 Jan 2017 54,593 1,162 16 26 328 56,125

Resources deferred during the year 55,962 1,907 15 59 366 58,309

Amounts released from previous years (54,593) (1,162) (16) (26) (328) (56,125)

Deferred income at 31 December 2017

55,962

1,907

15

59

366

58,309

12. Provisions

Group and charity

2017 2016

£’000 £’000

Dilapidations 1,146 519

Legal claims 150 420

Change programme 172 570

1,468 1,509

Dilapidations - each year we review our property leases and make a provision for dilapidations, where the cost can be reasonably estimated.

Legal claims - each year the GMC makes a provision for potential costs related to ongoing legal cases.

Change Programme - On 10 December 2015 the GMC decided to embark on a major Change Programme to reduce costs and increase income

over the medium term. A provision has been created in 2017 for the remaining restructuring costs associated with this Change Programme.

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Dilapidations Legal claims

Change programme

Total

£’000 £’000 £’000 £’000

Provisions at 1 Jan 2017 519 420 570 1,509

Provisions created during the year 1,146 150 172 1,468

Amounts released from previous years (519) (420) (570) (1,509)

Provisions at 31 Dec 2017 1,146 150 172 1,468

13. Group fund movements in the year

Group and charity

Unrestricted funds* Pension fund

2017 Total

£’000 £’000 £’000

At 1 January 2017 51,971 13,511 65,482

Net incoming/(outgoing) resources 13,276 (810) 12,466

At 31 December 2017 65,247 12,701 77,948

* Unrestricted funds include £5,000 of grant funding which will be utilised in 2018.

Unrestricted funds Pension fund

2016 Total

£’000 £’000 £’000

At 1 January 2016 47,902 21,504 69,406

Net incoming/(outgoing) resources 4,069 (7,993) (3,924)

At 31 December 2016 51,971 13,511 65,482

14. Capital commitments

Capital expenditure contracted but unspent at 31 December 2017 amounted to £162,408. The equivalent figure for 2016 was £265,306.

ACCOUNTS 2017


15. Operating lease commitments

Land and buildings Equipment

2017 2016 2017 2016

£’000 £’000 £’000 £’000

Expiry date

Within one year 4,319 4,252 97 31

In years two to five 16,770 16,843 242 -

After more than five years 5,404 9,540 - -

26,493 30,635 339 31

16. Superannuation schemes

The GMC has three staff pension schemes.

GMC Group Personal Pension Plan

This is a defined contribution pension scheme, which was set up on 1 July 2013. We started auto enrolment on 1 November 2013. At the end of 2017 there were 505 members of staff contributing to this scheme. It meets the government’s requirements following the introduction of automatic enrolment. Individuals can choose to make additional contributions by deduction from salary to the scheme. Under the terms of FRS102, contributions are accounted for as a defined contribution scheme based on actual contributions paid through the year.

NHS Multi-Employer Scheme

We have 3 members of staff who contribute to the NHS multi-employer scheme, which is a defined benefit scheme. These staff transferred to the GMC on the merger with PMETB. The scheme operates as a pooled arrangement, with contributions paid at a centrally agreed rate. The trustees are unable to confirm the GMC's share of the underlying assets and liabilities of the NHS scheme and so, under the terms of FRS102, contributions are accounted for as if the scheme were a defined contribution scheme based on actual contributions paid through the year.

GMC Staff Superannuation Scheme

This is a funded scheme of the defined benefit type, providing retirement benefits based on final salary. The top-up arrangement is an unfunded scheme.

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OVERN

ANCE AN

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ENT

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2017 FINAN

CIAL REVIEW

This scheme was closed to new members on 30 June 2013, and replaced by the GMC Group Personal Pension Plan. At the end of 2017, there were 617 members of staff contributing to this scheme. In 2017 Council agreed to close the scheme to future accruals from 1 April 2018.

The FRS 102 valuation has been based on a full assessment of the liabilities for the Scheme as at 31 December 2015. The present values of the defined benefit obligation, the related current service cost and any past service costs were measured using the projected unit credit method.

Actuarial gains and losses have been recognised in the period in which they occur (but outside the profit and loss account) through the Other Comprehensive Income (OCI).

The GMC recognises surplus in accordance with the requirements of IFRIC 14. The trustees of the Scheme do not have the unilateral right to commence wind-up of the Scheme. Thus, the GMC assumes that the Scheme continues in existence until the last benefit payments are made to members, at which point any residual assets are returned to the GMC in line with the rules of the Scheme. The GMC is not yet clear on whether the IASB’s proposed amendments to IFRIC 14 will affect its ability to receive a refund of surplus. Once the amendments have been finalised, the GMC will review the likely impact.

Regular employer contributions to the Scheme in 2017 are estimated to be £2,565,000.

The GMC made an additional top-up payment to the scheme of £0.5m in 2017 and will contribute a top up payment to the scheme of £0.5m in each of the next 4 years. In March 2018 Council agreed to make further payments to the scheme totalling £5 million over the years 2018 and 2019.

Responsibility for investing pension scheme assets rests with pension trustees. The Pensions Act 1995 requires trustees to draw up a Statement of Investment Principles, setting out the scheme’s investment strategy. Pension trustees are required to consult the employer (GMC) when drawing up the strategy, but do not require the employer’s formal agreement. Following consultation with the GMC, in 2014 the pension trustees adopted a fiduciary management approach to the investment of the scheme’s assets

The principal assumptions used by the independent qualified actuaries to calculate the liabilities under FRS102 are set out below.

ACCOUNTS 2017


Main financial assumptions

31 December 2017 31 December 2016 31 December 2015

%pa %pa %pa

Retail Prices Index inflation 3.5 3.5 3.4

Consumer Price Index inflation 2.6 2.6 2.5

Rate of general long-term increase in salaries

5 5 4.9

Pension increases (excess over guaranteed minimum pension)

2.6 2.6 2.5

Discount rate for scheme liabilities 2.5 2.7 3.8

Mortality assumptions

The mortality assumptions are based on standard mortality tables which allow for expected future mortality improvements. The assumptions are that a member currently aged 65 will live on average for a further 22.7 years if they are male and for a further 25.1 years if they are female.

For a member who retires in 2036 at age 65 the assumptions are that they will live on average for a further 24.3 years after retirement if they are male and for a further 26.7 years after retirement if they are female.

Scheme asset allocation

31 December 2017 31 December 2016

£’000 % £’000 %

Delegated consulting services 232,219 99% 209,586 98%

Other 1,094 1% 3,974 2%

Total 233,313 100% 213,560 100%

The Delegated Consulting Service (DCS) is a fiduciary management solution that invests in a wide range of underlying assets in order to meet the Scheme's specific investment objectives. The underlying asset allocation changes over time, based on the views of the fiduciary manager within the overall bounds set by the trustees. Under this approach the majority of scheme assets are invested in pooled funds. The managers of the pooled funds are required to have in place a policy on social, environmental and ethical considerations.

None of the Scheme assets are invested in the Company’s financial instruments or in property occupied by, or other assets used by, the GMC.

ACCOUNTS 2017


ABOU

T US

DELIV

ERING

OU

R CO

RPORATE STRATEG

Y IN

2017D

ELIVERIN

G O

UR RO

LEO

UR STRUCTURE,G

OVERN

ANCE AN

D

MAN

AGEM

ENT

AUDIT AND RISK

COM

MITTEE REPO

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ADM

INISTRATIV

E IN

FORM

ATION

ACCOU

NTS 2017

2017 FINAN

CIAL REVIEW

Reconciliation of funded status to balance sheet

31 December 2017 31 December 2016 31 December 2015

£’000 £’000 £’000

Fair value of assets 233,313 213,560 165,150

Present value of funded defined benefit obligations

(219,419) (198,851) (142,670)

Funded status 13,894 14,709 22,480

Present value of unfunded defined benefit obligation

(1,193) (1,198) (976)

Asset/(liability) recognised on the balance sheet

12,701 13,511 21,504

Amounts recognised in income statement

Year ending 31 December 2017


Operating cost: £’000 £’000

Current service cost 7,116 8,319

Past service cost - -

Financing cost:

Interest on net defined benefit liability/(asset) (460) (951)

Pension expense recognised in profit and loss 6,656 7,368

Amounts recognised in Other Comprehensive Income (OCI)



£’000 £’000

Asset gains/(losses) arising during the year 10,790 33,929

Liability gains/(losses) arising during the year (11,759) (44,068)

Pension expense recognised in profit and loss (969) (10,139)

ACCOUNTS 2017


Changes to the present value of the defined benefit obligation during the year



£’000 £’000

Opening defined benefit obligation (DBO) 200,049 143,646

Current service cost 7,116 8,319

Interest expense on DBO 5,353 5,432

Actuarial (gains)/losses on liabilities 11,759 44,068

Net benefits paid out (3,665) (1,416)

Past service cost

Closing defined benefit obligation 220,612 200,049

Changes to the fair value of scheme assets during the year



£’000 £’000

Opening fair value of scheme assets 213,560 165,150

Interest income on scheme assets 5,813 6,383

Gain/(loss) on scheme assets 10,790 33,929

Contributions made by the company 6,815 9,514

Net benefits paid out (3,665) (1,416)

Closing fair value of scheme assets 233,313 213,560

Actual return on scheme assets



£’000 £’000

Interest income on scheme assets 5,813 6,383

Gain/(loss) on scheme assets 10,790 33,929

Actual return on scheme assets 16,603 40,312

ACCOUNTS 2017


ABOU

T US

DELIV

ERING

OU

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RPORATE STRATEG

Y IN

2017D

ELIVERIN

G O

UR RO

LEO

UR STRUCTURE,G

OVERN

ANCE AN

D

MAN

AGEM

ENT

AUDIT AND RISK

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2017 FINAN

CIAL REVIEW

17. Honoraria 2017 2016

Trustees £ £

Professor Sir Terence Stephenson (Chair) 110,000 110,000

Dr Shree Datta 18,000 18,000

Lady Christine Eames 18,000 18,000

Professor Michael Farthing* 16,500 18,000

Baroness Helene Hayman 18,000 18,000

Professor Deirdre Kelly 18,000 18,000

Dame Suzi Leather 18,000 18,000

Dame Denise Platt† 30,692 18,000

Professor Paul Knight‡ 18,000 -

Amerdeep Somal LLB‡ 18,000 -

Professor Anthony Harnden‡ 18,000 -

Mr Steve Burnett‡ 18,000 -

Mrs Enid Rowlands§ - 18,000

Professor Jim McKillop§ - 18,000

Professor The Lord Ajay Kakkar** - 13,500

Mr Julian Lee†† - 7,500 * Professor Michael Farthing demitted as a Council member on 28 November 2017.† Includes additional £12,692 remuneration for her role as deputy Chair of Council between 27 March and 31 July 2017.

‡ Professor Paul Knight, Amerdeep Somal LLB, Professor Anthony Harnden and Mr Steve Burnett were appointed on 1 January 2017.

§ Mrs Enid Rowlands and Professor Jim McKillop both demitted on the 31 December 2016.

** Professor The Lord Ajay Kakkar demitted as a Council member on 30 September 2016.†† Mr Julian Lee demitted as a Council member on 31 May 2016.

Honoraria payments are permitted by the governing document of the General Medical Council, The Medical Act 1983, paragraph 17,

schedule 1.

ACCOUNTS 2017


2017 2016

Medical Practitioners Tribunal Service advisory committee members

£ £

His Honour David Pearl* - -

Dame Caroline Swift 65,876 -

Mr Richard Davies 3,720 3,720

Mr Tim Howard† - 1,240

Dr Patricia Moultrie 3,720 3,720

Professor Jacky Hayden‡ 3,720 1,240

Mrs Judith Worthington 3,720 3,720

* His Honour David Pearl was the Chair of the MPTS in 2016 and was paid as an employee. His remuneration is included in note 6 of these

accounts. He stepped down on 31 December 2016 and has been replaced by Dame Caroline Swift who took up the role on 1 January 2017.† Mr Tim Howard demitted as a member on 29 April 2016.‡ Professor Jacky Hayden was appointed on 1 September 2016.

2017 2016

Audit and Risk Committee co-opted members £ £

Ms Elizabeth Butler 2,325 1,705

Mr John Morley 1,395 2,170

2017 2016

Investment Sub-Committee co-opted members £ £

Mr Tim Scholefield 2,170 1,395

Mr Keith Mackay* 2,170 620

Mr Jeremy Beckwith* - 310

* Mr Keith Mackay and Mr Jeremy Beckwith were appointed on 1 September 2016.

Mr Jeremy Beckwith demitted as a member of the Sub-Committee on 15 January 2017.

2017 2016

Audit and Risk Committee co-opted members £ £

Dr Andrew McCulloch* 1,705 -

Professor Vikas Shah† - -

* Dr Andrew McCulloch was appointed as a director and chairman of GMCSI on 1 June 2017.

† Professor Vikas Shah was appointed as a director of GMCSI on 1 June 2017 but has yet to claim fees or expenses.

ACCOUNTS 2017


ABOU

T US

DELIV

ERING

OU

R CO

RPORATE STRATEG

Y IN

2017D

ELIVERIN

G O

UR RO

LEO

UR STRUCTURE,G

OVERN

ANCE AN

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MAN

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ENT

AUDIT AND RISK

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2017 FINAN

CIAL REVIEW

18. Travel and subsistence expenses claimed in 2017

2017 2016

Trustees £ £

Professor Sir Terence Stephenson (Chair) 14,192 16,080

Dr Shree Datta 830 621

Lady Christine Eames 5,877 6,791

Professor Michael Farthing* 277 296

Baroness Helene Hayman 453 300

Professor Deirdre Kelly 3,626 3,027

Dame Suzi Leather 3,220 3,727

Dame Denise Platt 849 157

Professor Paul Knight† 4,125 -

Amerdeep Somal LLB† 4,574 -

Professor Anthony Harnden† 1,263

Mr Steve Burnett† 3,403 -

Mrs Enid Rowlands‡ - 1,493

Professor Jim McKillop‡ - 6,769

Professor The Lord Ajay Kakkar§ - -

Mr Julian Lee** - 595

Total 42,689 39,856

* Professor Michael Farthing demitted as a Council member on 28 November 2017.† Professor Paul Knight, Amerdeep Somal LLB, Professor Anthony Harnden and Mr Steve Burnett were appointed on 1 January 2017. ‡ Mrs Enid Rowlands and Professor Jim McKillop both demitted on the 31 December 2016.§ Professor The Lord Ajay Kakkar demitted as a Council member on 30 September 2016.** Mr Julian Lee demitted as a Council member on 31 May 2016.

ACCOUNTS 2017


Medical Practitioners Tribunal Serviceadvisory committee members

2017 £

2016 £

His Honour David Pearl* - 5,050

Dame Caroline Swift 2,360 -

Mr Richard Davies 679 539

Mr Tim Howard † - 403

Dr Patricia Moultrie 825 1,586

Professor Jacky Hayden ‡ 296 -

Mrs Judith Worthington 660 731 * His Honour David Pearl was the Chair of the MPTS and is paid as an employee. His remuneration is included in note 6 of these accounts. He

stepped down on 31 December 2016 and has been replaced by Dame Caroline Swift who took up the role on 1 January 2017.

† Mr Tim Howard demitted as a member on 29 April 2016.

‡ Professor Jacky Hayden was appointed on 1 September 2016.

Audit and Risk Committee co-opted members 2017 £

2016 £

Ms Elizabeth Butler 345 221

Mr John Morley 445 209

Investment Sub-Committee co-opted members2017

£2016

£

Mr Tim Scholefield - -

Mr Keith Mackay* 458 68

Mr Jeremy Beckwith* - 9

* Mr Keith Mackay and Mr Jeremy Beckwith were appointed on 1 September 2016.

Mr Jeremy Beckwith demitted as a member of the Sub-Committee on 15 January 2017.

ACCOUNTS 2017


ABOU

T US

DELIV

ERING

OU

R CO

RPORATE STRATEG

Y IN

2017D

ELIVERIN

G O

UR RO

LEO

UR STRUCTURE,G

OVERN

ANCE AN

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MAN

AGEM

ENT

AUDIT AND RISK

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MITTEE REPO

RT

REFERENCE AN

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ADM

INISTRATIV

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FORM

ATION

ACCOU

NTS 2017

2017 FINAN

CIAL REVIEW

2017 2016

GMC Services International Ltd £ £

Dr Andrew McCulloch* 43 -

Professor Vikas Shah† - -

* Dr Andrew McCulloch was appointed as a director and chairman of GMCSI on 1 June 2017.† Professor Vikas Shah was appointed as a director of GMCSI on 1 June 2017 but has yet to claim fees or expenses.

Senior Management Team2017

£2016

£

Charlie Massey - Chief Executive* 12,022 1,915

Niall Dickson – Chief Executive* - 22,013

Susan Goldsmith – Chief Operating Officer and Deputy Chief Executive 11,854 12,048

Paul Buckley – Director of Strategy and Communication 4,588 5,322

Judith Hulf – Senior Medical Advisor and Responsible Officer† - 5,542

Neil Roberts – Director of Resources and Quality Assurance 14,091 13,792

Colin Melville - Director of Education and Standards 27,964 -

Una Lane – Director of Registration and Revalidation 7,005 10,647

Anthony Omo – Director of Fitness to Practise 11,279 11,941 * Niall Dickson stepped down as Chief Executive and Registrar on 31 October 2016. Charlie Massey took up the role on 1 November 2016.

† Judith Hulf, in her capacity as Senior Medical Advisor and Responsible Officer, covered Vicky Osgood's absence, who departed on 30 June

2016. Colin Melville has been appointed as Director of Education and Standards and started on 1 January 2017.

Variations in expenses reflect that the trustees, committee members and the Senior Management Team live in different parts of the UK and

are required to travel around the UK on GMC business, including to our offices in London, Manchester, Edinburgh, Belfast and Cardiff, and

occasionally outside the UK.

Adjustments are also made for those with disabilities, which may mean that additional expenses are incurred for travel and accommodation

according to specific needs.


REFERENCE AND ADMINISTRATIVE INFORMATION

We are independent of UK government and the medical profession and accountable to Parliament. Our powers are given to us by Parliament through the Medical Act 1983.

We are registered with the Charity Commission for England and Wales (1089278), and with the Office of the Scottish Charity Regulator (SC037750). We are not currently required to be registered separately with the Northern Ireland Charity Commission.

Our principal places of business are 3 Hardman Street, Manchester M3 3AW and Regent’s Place, 350 Euston Road, London NW1 3JN. We also have offices in Belfast, Cardiff and Edinburgh and a centre for hearings, where the MPTS is based, at St James’s Buildings, 79 Oxford Street, Manchester M1 6FQ.

Our trustees have a duty to act impartially and objectively, and to take steps to avoid any conflict of interest arising as a result of their membership of, orassociation with, other organisations or individuals. As trustees members have a duty to avoid putting themselves in a position where their personal interests conflict with their duty to act in the interests of the charity, unless authorised to do so. To make this fully transparent, we publish a register of members’ interests on our website.

Day-to-day management of the organisation is delegated to the Chief Executive, Charlie Massey and Chief Operating Officer and Deputy Chief Executive, Susan Goldsmith. You can read more about our governance and management arrangements from page 32.

We work with the Professional Standards Authority (PSA), an independent body, which is accountable to Parliament and scrutinises and oversees our work, together with other health and social care professional regulatory bodies in the UK.

Information requests

In 2017, we received 388 subject access requests under the Data Protection Act 1998. This was a decrease of 1.5% from 2016. The number of information requests that we received under the Freedom of Information Act 2000 in 2017 was 693. This was an 8.5% decrease from 2016.

n We achieved 83.8% against our target of responding to 80% of subject access requests within 40 days.

n We achieved 92.4% against our target of responding to 87.5% of freedom of information requests within 20 working days.

Paying for goods and services

We paid 94% of valid and undisputed invoices within 30 days and did not pay any interest to suppliers due to late payment in excess of 30 days.

Professional advisers

Bankers Royal Bank of Scotland 250 Bishopsgate London EC2M 4AA

Solicitors The majority of our legal work is carried out by our in-house legal team.

Auditors Crowe U.K. LLP St Bride’s House 10 Salisbury Square London EC4Y 8EH

Actuary and pension Aon Hewitt scheme adviser Parkside House, Ashley Road

Epsom, Surrey KT18 5BS

Email: [email protected] Website: www.gmc-uk.org Telephone: 0161 923 6602

General Medical Council, Regent’s Place 350 Euston Road, London NW1 3JN.

Textphone: please dial the prefix 18001 then 0161 923 6602 to use the Text Relay service

Join the conversation

To ask for this publication in Welsh, or in another format or language, please call us on 0161 923 6602 or email us at [email protected].

Published September 2018

© 2018 General Medical Council

ISBN: 978-0-901458-98-8

The text of this document may be reproduced free of charge in any format or

medium providing it is reproduced accurately and not in a misleading context.

The material must be acknowledged as GMC copyright and the document title specified.

The GMC is a charity registered in England and Wales (1089278) and

Scotland (SC037750).

Code: GMC/AR2017/0918

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