The recent amendment to the Medical and Health (Licence to Practice and Revalidation) Rules 2014, require the adoption of revalidation procedures as defined by the Board.
Registration is not only required by law, but also is a pre-requisite by insurers of medical indemnity and therefore practice without registration can result in severe penalties, which may include imprisonment and civil damages.
Any registered medical practitioner (a Doctor) who wishes to practise in Gibraltar is required to be part of a clinical governance system with annual appraisals and reporting systems back to their own individual Responsible Officer.
Clinical Governance System & Responsible Officer
Clinical governance is the system through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence can flourish.
The Medical and Health (Responsible Officers) Rules 2014 recognizes the role in Gibraltar of Designated bodies (DB) as bodies that deliver and assure the quality of clinical governance processes for doctors. The Responsible Officer Rules currently list at the Schedule, as Designated bodies, the GHA, Postgraduate medical deaneries established in the UK and bodies which employ or contract with medical practitioners.
The Designated body is required to appoint one or more Responsible Officers (RO).
The RO will satisfy him/herself that the Designated body operates clinical governance systems that promote and protect the interests of patients and creates an environment which supports doctors in meeting their professional obligations. The DB will put in place Policies and Protocols that are adhered to and regularly monitored and revised, if necessary. It is the intention that the GMRB will have oversight of the DB’s clinical governance systems to make sure that they are fit for purpose.
All doctors in Gibraltar will need to have a prescribed connection with a DB.
This connection is usually obvious and Rule 9 of the Medical and Health (Responsible Officers) Rules 2014 describes the likely circumstances by which a medical practitioner will form a prescribed connection. It is important that each doctor knows who their DB is as this will almost certainly dictate who their RO is.
Good Medical Practice
The Board has adopted the General Medical Council’s guidelines, Good Medical Practice (March 2013) as its own code for registered medical practitioners.The General Medical Council’s current professional guidance may be obtained from its website:
Scope of practice
Most doctors who engage in the appraisal process are accustomed to detailing their scope of practice at the start of the appraisal. This ensures that the subsequent appraisal takes account of all aspects of that doctor’s medical practice so that training and reflection has been assessed appropriate to the individual doctor’s activities. When the appraiser makes a recommendation to revalidate, that recommendation is based on the declared scope of practice. If the doctor engages in other professional activities that are not declared within their scope of practice, there is no supervision or review of this activity and could even result in harm to the patient.
It is therefore vital that your scope of practice is fully declared to your appraiser and on your GMRB registration application. In effect, if your appraiser sees an activity as a separate professional activity, this should be included in your GMRB registration application form under the scope of practice or further expanded in the comments section at the end.
As an example, if you are a GP, you only need to note GP. However, if you carry out minor surgery lists, cosmetic procedures etc these should be added separately in your scope of practice.
Or, if you are an ENT Surgeon and you do some sessions as a GP, they should both be noted.
Policy and Procedure on the Registration of Medical Practitioners
- OVERVIEW
1.1. This policy has been drawn up to provide transparency and consistency in the decision-making process concerning the registration of medical practitioners by the Gibraltar Medical Registration Board.
1.2. It is specifically informed by reference to Section 9 of the Medical and Health Act, 1997 but also seeks to mirror the UK’s General Medical Council’s approach to registering the target professionals.
1.3. The Gibraltar Medical Registration Board (“GMRB”) has received legal advice from Kevin Warwick, Senior Crown Counsel, HM Government of Gibraltar and this approach has guided the development of this Policy.
- REGISTRATION
2.1. The overarching aim of the registration of medical practitioners is to ensure that doctors are suitably qualified. Section 9 of the Medical and Health Act, 1997 allows the full registration of a person of good character if they meet the qualification requirements of s9(1)(a), (b) or (c).
2.2. The GMRB will ensure that the registrant can prove an acceptable qualification in accordance with the criteria laid out in the Act.
2.3. The Registrant will need to prove identity (passport or ID card), provide a Certificate of Good Standing and pay the proscribed fee.
2.4. If the Registrant meets these requirements, the GMRB will authorize registration of the Registrant.
2.5. The GMRB will advise the Registrant as soon as possible (and, in any event, within the Specified Period as defined in the Act) that they have been added to the General Register of Medical Practitioners maintained by the GMRB.
2.6. The GMRB will, at the same time, advise the Registrant of their rights and the limitations of registration on the General Register of Medical Practitioners.
2.7. A doctor who wishes to practise medicine in Gibraltar needs to hold a valid licence to practise in addition to their registration with the GMRB. It is the licence to practise which allows them to carry out certain activities such as prescribing medicines and treating patients.
2.8. A doctor’s status on the medical register will show if they hold a licence or not.
2.9. Employers and healthcare providers must make sure that their doctors hold appropriate registration for their role, type of post or practice and the GMRB will expect the Registrant and/or their RO to provide full scope of practice for all doctors wishing to obtain a licence to practise from the GMRB.
- OBTAINING A LICENCE TO PRACTISE
3.1. As a registrant with the GMRB, doctors will have all completed the registration process as set out in the Medical and Health Act 1997 but, in addition, it is their personal responsibility to ensure that they comply with the Medical and Health (Licence to Practise) Rules 2014 made under s22 of the Act.
3.2. By virtue of Rule 3(1) doctors are only entitled to practise in Gibraltar once in possession of a valid licence issued by the Registrar of the General Medical Council, unless:
(a) They practise as a junior doctor with a professional qualification from a non-EEA state subject to a limited registration under the Act and are not in possession of a valid licence from the GMC. In this case the doctor is entitled to practise for a period of no more than 2 years if employed by the GHA as a JHO, SHO or Registrar and receive vocational training and supervision as part of their duties; or
(b) On 1 April 2019 the doctor has substantively registered under the Act for a minimum cumulative period of 13 years and are not entitled to register with the GMC because their primary qualification is not a UK or a European primary qualification, in which case the doctor may continue to practice so long as they are registered with the GMRB; or
(c) The doctor does not have a UK primary qualification but in an EEA state and, to the satisfaction of the GMRB, carry out the majority of their practice in that EEA state. In that case, the doctor is entitled to practise within the scope recommended by their RO and subsequently ratified by the GMRB.
3.3. A person who engages in general medical practice without being registered under sub-section (1)(b) as having a European qualification in specialised medicine in general medical practice or under sub-section (6), shall be guilty of an offence.
- REQUIREMENTS TO OBTAIN A LICENCE TO PRACTISE FROM THE GMRB
4.1. In order to obtain a valid licence to practise from the GMRB, complying with the Medical and Health (Licence to Practise) Rules 2014, under Rule 3(1C), such registered doctors will need to provide evidence of the following:
(a) Evidence of alignment with their RO setting a scope of practice for the Board to ratify.
(b) Knowledge of English;IELTS or Occupational English Test (OET) Except in the case of doctors who are, nationals of a country where English is the first and native language, and were awarded their primary medical degree from such country where English is the first and native language.
(c) Satisfy the Board of an adequate insurance for the practitioner, which is valid for their practice in Gibraltar.
Registration
It is necessary for the form to be completed and submitted electronically through the actual Adobe program. Please make sure all fields of the form are completed and that a new ID signature is created for this specific form (click on the signature box and follow the setup which appears automatically).
Get the free latest version of Adobe Acrobat Reader from:
http://www.adobe.com/go/reader