3 Rachel Podolak Communication, [email protected] 02920 ...€¦ · Strategy and Policy Board, 1...

Strategy and Policy Board, 1 December 2015

Agenda item: 3

Report title: Devolved Office Review

Report by: Rachel Podolak, Head of Welsh Affairs, Strategy and Communication, [email protected] 02920 495 363 x5251

Considered by: Directors’ meeting

Action: To consider

Executive summary This paper provides a high level summary of the recent Moore Stephens Review of the Devolved Offices and lists the strategic questions arising. An action plan is included for consideration.

Recommendations The Strategy and Policy Board is asked to: a Consider the findings of the Moore Stephens Review Report, at Annex A. b Consider the strategic questions arising. c Approve the proposed next steps and action plan, at Annex B.

mailto:[email protected]

Strategy and Policy Board, 1 December 2015 Agenda item 3 – Devolved Office Review

2

Background

1 Since establishment in 2003 (Scotland) and 2005 (Wales and Northern Ireland), the Devolved Offices have largely grown organically. The scope of the offices has expanded to support a much wider portfolio of colleagues and teams as the GMC’s role and size has expanded and diverging policy issues emerged in each country. Alongside this, the way the GMC works in each country via the Employer Liaison Service (ELS) and Education QA teams has also changed. Their activities have been described as ‘multi-dimensional’ and the political systems that they monitor and operate within are complex.

2 Apart from a small internal review in 2008, there has not been a strategic review of the offices to date. This Review was commissioned by the GMC to better understand how, given the changes noted above, each of the Devolved Offices were aligned to GMC strategy and business plans. This was achieved by:

a A series of semi-structured interviews and visits to each office.

b A review of current work and operating procedures in the context of the GMC corporate strategy and business plans.

c An internal and external stakeholder survey to understand current experiences and future needs/ expectations of each office.

3 The Report of the Review is at Annex A.

Findings

4 The Review found that:

a 97% of external stakeholders reported that the Devolved Offices were successful in achieving their purpose. This suggested that external stakeholders were satisfied that there was harmony between what they perceived to be the purpose of each office and what the office was achieving, for example, ‘having a credible link between the stakeholder and the GMC’, and for ‘building relationships’. This was supported by the internal stakeholders’ responses which suggested that the key purpose of the offices was to ‘promote standards’, ‘raise awareness’, ensure consideration of the political landscape and listen to key interest groups.

b Stakeholders have indicated that there has been limited reporting to Council on Devolved Office activities, one stakeholder commenting that reports appear as ‘one GMC operating in one health structure’. It is expected that appetite for four country information, ways of working and reporting will continue to increase as a direct result of our work on SoMEP, Data Strategy, National Training Survey,


3

discussions driven by Council, the success of the UK Advisory Forums and the divergence of the health and political systems across the UK.

c More work is being devolved to be managed/supported locally by the Devolved Offices. While positive and in line with an increasingly devolved health system, this raises questions about the sustainability of current ways of working, the associated resource model and the need for improved succession planning.

d Each office should introduce its own risk register in line with the new GMC risk management framework.

Strategic questions arising

5 The Review highlights operational issues that the Devolved Offices will take forward with the support of the Director and Assistant Director for Strategy and Communication.

6 However, it also raises key strategic questions for consideration by the wider GMC:

a Does the GMC sufficiently understand what it means to be ‘relevant’ in each country and is it clear on the accountability, responsibility and authority of the devolved offices and how this aligns to stakeholder expectations or perceptions? Is the GMC sufficiently mitigating the risk of being perceived as ‘London-centric’?

b Are the Devolved Office goals clear and are they linked to purpose and desired impact? What will be the impact of moving to a four-country regulation model, on existing structures and how would the Devolved Office strategy and plans fit within this approach? (This linked to the observation of a lack of ‘England’ office/function).

c Is there sufficient reporting on the four-country dimension internally and to Council?

d What is the GMC’s operational model for supporting its activities in each country? Does meaningful information exist to understand the risk of not being joined up, in fact as well as appearance, in each devolved country?

e Is there an opportunity for Devolved Offices to be involved in new projects and initiatives from an early stage in order to provide relevant country specific input and to enable their anticipation of work and resource planning?

f What opportunities exist to provide country specific information and data for public consumption?


4

Next steps

7 Subject to the Board’s approval, the proposed next steps include:

a To share the final Review Report with Council.

b To instigate an evening seminar with Council in advance of devolved country elections in 2016.


3 – Devolved Office Review

3 – Annex A

Devolved Office Review report

GMC DO Review 2015Final reportOctober 2015

ConfidentialGovernance, Risk & Assurance PREC ISE . PROVEN . PERFORMANCE .

Confidential 1 GMC DO Review 2015

Contents

Page

1. Executive Summary 2

2. Key questions arising 6

3. Methodology 7

4. Main findings 8

5. Highlights from the internal stakeholders responses 23

6. Appendices 26

General Disclaimer The content of this report is confidential and not for distribution to anyone other than the GOC. Disclosure to third

parties cannot be made without the written consent of Moore Stephens LLP.


1. Executive Summary

Introduction

This engagement was commissioned by the GMC to better understand how each of the devolved offices was aligned

to GMC strategy and business plans. This was achieved by:

ascertaining how each devolved office operates on a day to day basis through a series of semi-structured

interviews and visits to each office

current work and operating procedures in the context of the GMC corporate strategy and business plans

the purpose which underpins activities

an internal and external stakeholder survey to understand current experiences and future needs/ expectations

of each office.

In the intervening period since this work was commissioned there have been a number of internal discussions and a

paper submitted to the Council away day recognising the ongoing debate about devolution across the UK, and the

integration of health and care as well as devolution powers to English cities following the example of Greater

Manchester1. In the context of the findings of this review, where appropriate, this report acknowledges and in some

places refers to these discussions.

Internally the offices are referred to as the devolved offices (DO), although in practice they are very much part of the

whole. The offices are not in fact devolved or decentralised as the term perhaps suggests, but are satellite offices of

the GMC that are strategically located in each devolved country. For this report the term ‘DOs’ is used

interchangeably with ‘offices’.

It is not the intention of this report to recommend changes to the DOs or question whether they should exist at all. The

results of this review indicate there is a significant degree of support for and value gained from the offices. Where

observations have arisen, these have been framed as key questions for the GMC to consider and are summarised in

section 2. Main findings are reported in section 4, and the questions arising are also embedded within the narrative

report. Highlights from the survey completed by internal stakeholders have been provided in section 5. Section 3

outlines the approach taken to the review.

This report is supported by a separate pack for each DO which draws together key themes from the interviews held

with various stakeholders and summary highlights from the external stakeholder and DO staff surveys.

“Background to the genesis of GMC in Northern Ireland, Scotland and Wales”2

In 1999 the rollout of devolution began in Northern Ireland, Scotland and Wales. Healthcare policy was devolved to

each country with healthcare professional regulation also fully devolved to Northern Ireland. As a result, the GMC

commenced operations in a Scottish Office in late 2003. The Welsh and Northern Ireland offices followed in early and

late 2005 respectively. This made the GMC the first, and still only, UK wide healthcare regulator with a physical office

and staff in each UK country.

Since establishment the offices have largely grown organically. The scope of the offices has expanded to support a

much wider portfolio of colleagues and teams as the GMC’s role and size has expanded and diverging policy issues

emerged in each country. This included the addition of postgraduate education and training, the introduction of

revalidation, reform of the fitness to practise procedures and greater use of GMC data as new areas to support.

Increased focus on direct engagement with doctors and patients has also placed additional demands on the offices.

Apart from a small internal review in 2008, there has not been a strategic review of the offices to date. The offices are widely credited as paving the way for the establishment of the Employer Liaison Service across the

UK and more particularly the Regional Liaison Service in England. Unlike these services the Devolved Offices did not

have significant support in advance to design models, processes and systems.”

1 Agenda Item 2, Council Away day, 1 - 2 July 2015 2 This quoted section was provided by the Heads of DOs as a summary of the office journey


.

Sitting within the Strategy and Communication Directorate, the offices have grown from one or two people in each

location to a total of 14 staff across the three locations. Their activities have been described as ‘multi-dimensional’

and the political systems that they monitor are complex. Table A indicates the relative size of the register across the

devolved countries, data relating to the public purse and local offices3.

Table A

Northern Ireland Scotland Wales

Number of doctors based on registered

address (licensed) 7,216 (6,781) 21,200 (19,714) 11,045 (10,361)

Number of licensed doctors with a

connection to an organisation 5,395 17,412 8,587

Number of designated bodies 24 31 20

Total number of medical students 1,308 4,890 1,833

Total population 1,800,000 5,300,000 3,100,000

2014 local government health and social

care budgets (approximate) £4.7bn £12bn £11.7bn

Number of staff in DO office in Country

(at time of the review) 3.5 FTE*

4 FTE

1 temp L5 to 09/15

Clinical adviser to

08/15

4 FTE

2015 Budget of DO office in Country £263,612 £405,300 £262,677

*(a clinical advisor has joined the team since the review)

Survey results

The GMC in each country is close to key stakeholders, and this was largely evident from the survey results as well as

interviews. The value of relationships ‘in country’ were an important but consistent message from the offices and

stakeholders, giving a real sense of loyalty to the GMC as well as to the DOs.

External stakeholders were invited to respond to questions about the success of the offices. Of the 32 responses

received, the majority agree that the DOs have achieved their purpose (as they perceive the purpose to be), and are,

overall, successful in each country (see Charts 1 and 2).

Internal stakeholders were also invited to respond to a set of questions exploring their knowledge and engagement

with the DOs, and the feedback was positive. It was clear from the survey that the offices provide significant value to

individuals from across the organisation, having an important role in developing local knowledge and driving local

relationships which would not be achieved from England only. The survey also highlights that more could be done to

share information about their objectives and activities, and there was recognition of the demand on their time. These

themes are explored further in this report.

Overall the survey results show a positive outcome for the DOs.

3 England data has not been included here as this review was focused on the three devolved countries.


Chart 1 Chart 2

Key observations

The review identifies important questions for consideration, some of these may have strategic implications while

others relate to operational effectiveness. The most important question relates to how clear the GMC is on its

approach to the four countries. While England was not included within the scope of this review (the country does not

have a representative GMC office), it is relevant in a four-country context – processes and oversight are absorbed

within the existing functions of the London and Manchester offices. If the GMC moves to a four-country approach,

what will be the impact on existing structures and the DOs?

With an increasing level of activity within each country stemming from different teams, the risk of not appearing joined

up increases. An operational model that underpins activity in each country would help mitigate this risk; greater clarity

here would support all teams that operate within each country, and in particular the DOs development of clearer and

aligned purpose, strategy, goals and objectives.

The following points summarise the observations made in this report and are split between the GMC corporate and

the DOs. We consider that there is responsibility on both parties to recognise the part that they can play in addressing

the review findings.

GMC Devolved offices

Provide greater clarity around the positioning of the DOs in

GMCs business so that there are clear boundaries for

them to operate within, taking account of the different

activities within each country that are driven by different

teams.

Take ownership of their contribution by defining their goals

(these need to be consistent with their Directorate),

aligning their purpose with the organisation’s expectations,

more effective planning, and engaging in the development

of formal structures that come with working with

colleagues in each country.

Recognise the value of support that the DOs can provide

with earlier involvement or notification of the planning of

initiatives. This will also help the DOs plan their own

workloads maximising the efficiency of their limited

capacity.

Clarify expectations on workload requirements early on

with internal stakeholders, and use hard data on time

spent on activities to give greater credence to

conversations about doing too much and the requirement

for further resource – these conversations should be risk

led with supporting evidence.

Consider and manage the risks associated with single

points of failure and succession planning for each office.

Introduce more structure around risk management and

bring visibility to the complexities of the three countries

multi-dimensional perspective and their inherent risks such

as planning, significant reliance placed on key individuals

and succession planning.

Do you think the devolved offices have been successful in fulfilling their

purpose?

Successful

Unsuccessful

Neutral

Are the devolved offices perceived as successful overall?

Yes

No

Neutral


GMC Devolved offices

Be aware of the risk of the DO heads ‘going native’ (and

the extent to which this applies to other teams), and

provide the necessary support and acknowledgement to

help mitigate inherent risks.

Hold up a mirror periodically and ensure they remain

objective. At times this may be a fine line as inevitably the

DO role is about standing up for the individual countries

but testing their personal objectivity from time to time will

ensure objectivity remains proportionate and appropriate.


2. Key questions arising

Below is a summary of the key questions (KQ) raised by this review.

Question To be led by: Page

number

1. Are the Devolved Office goals clear and are they linked to purpose and desired

impact?

GMC and DOs 12

2. Does the GMC sufficiently understand what it means to be ‘relevant’ in each country

and is it clear on the accountability, responsibility and authority of the devolved offices

and how this aligns to stakeholder expectations or perceptions?

GMC and DOs 12

3. What will be the impact if moving to a four-country regulation model, on existing

structures and how would the DO strategy and plans fit within this approach?

GMC and DOs 13

4. Do internal stakeholders have sufficient sight of the DOs plans (and vice versa) to

enable a robust conversation about workload priorities and enable more effective

planning?

DOs 13

5. Is the current workload and way of working sustainable for each office? DOs 14

6. Is there visibility and understanding of the (internal and external) risks to achieving

the DO plans?

DOs 14

7. Is there an opportunity to further streamline some of the systems and processes that

underpin and are common to each office?

DOs 16

8. Is there an opportunity for DOs to be involved in new projects and initiatives from an

early stage in order to provide relevant country specific input and to enable their

anticipation of work and resource planning?

GMC and DOs 16

9. How effective are the DOs in identifying and managing their (internal and external)

risks?

DOs 17

10. What is the GMC’s operational model for supporting its activities in each country? GMC 17

11. Does meaningful information exist to understand the risk of not being joined up, in

fact as well as appearance, in each devolved country?

GMC 18

12. Is the GMC sufficiently mitigating the risk of being perceived as ‘London-centric’? GMC 19

13. What opportunities exist to provide country specific information and data for public

consumption?

GMC and DOs 19

14. Is there an opportunity for the DOs to engage in monitoring of impact that is driven by

central activity, or monitoring their own impact?

DOs 19

15. Do the DO reports provide sufficient information over the quality and added value of

engagements or activities, and/or the achievement (or progress towards

achievement) of DO objectives per their approved plans?

DOs 21

16. Is there sufficient reporting on the four-country dimension internally and to Council? GMC 21

17. Do the DOs have clarity over resource planning that is driven by their annual planning

and planned work programme?

DOs 22

18. Is there sufficient information available to understand whether the DOs can sustain

the current level of, or an increase in, work activities?

GMC and DOs 22

19. Is there sufficient thinking around succession planning for each office? GMC and DOs 22


3. Methodology

GMC’s offices in Northern Ireland, Scotland and Wales were visited. A series of semi-structured interviews were held

with office staff, and internal and external stakeholders who were invited to meet us during the visit. A series of

interviews were also conducted by phone with a number of internal staff and external stakeholders. A pre-defined list

of internal and external stakeholders were invited to complete an online survey which explored their perceptions

about the GMC in each country and the work of the DOs.

In order to gain an understanding of the devolved offices day to day business and alignment with GMC strategy and

business plans, the areas outlined in Table B were reviewed. Documentation was also reviewed, including strategy

and plans, reports, and engagement logs.

Table B

Area Scope

Purpose To understand the context in which the devolved office operates and the purpose that

drives their activities.

Operational activities

To ascertain the day to day activities of the office and whether these are underpinned

by local strategy, and/or action plan(s).

To understand how the office engages with stakeholders and the kind of events

organised.

Processes To establish:

the stakeholder relationship management processes that exist and the processes in

place for capturing engagement;

the type of communications and marketing activities with which the office is

engaged;

the points of contact the office has with GMC functions and how these are used;

and

how performance is captured and measured.

Stakeholders To identify the internal and external stakeholders with which the office is engaged.

To ascertain how stakeholders perceive the GMC in the local country context, and

what they consider the GMC should be doing through the devolved office.

Financial management To review the devolved office’s operating budget and the type of expenditure

recorded in order to understand how the budget is used, and how it supports the day

to day activities.

Staffing To establish what the operating structure is and the roles and responsibilities within

the devolved office.

Procedures To establish what procedures are documented and implemented.

We would like to take this opportunity to thank the Heads of the Devolved Offices, and the members of the team from

each office for their support and assistance during the review, the internal and external stakeholders who agreed to

be interviewed by Moore Stephens, and to all stakeholders who set aside time to complete the individual surveys.

Finally we also extend our thanks to the Assistant Director of Audit and Risk Assurance for her part in supporting

Moore Stephens in this review.


4. Main findings

Introduction

There are a number of factors to consider by a satellite office that is remotely located and run by a small number of

staff. These relate to ensuring that the satellite office:

is clear as to why it exists - it has a purpose.

has an agreed strategy or at the very least a plan supported by a budget.

day to day activity supports the achievement of said purpose / strategy / plan.

(in the case of a charity) captures and monitors engagement and impact.

reports back to headquarters on achievement of said purpose / strategy / plan.

is staffed appropriately for the size and expected level of activity.

Following public endorsement of devolution in Scotland and Wales (devolution to Northern Ireland was already part of

the ‘Good Friday Agreement’), Parliament passed 3 devolution Acts: the Scotland Act 1998; the Northern Ireland Act

1998; and the Government of Wales Act 1998 (which was later effectively superseded by the Government of Wales

Act 2006)4. The GMC opened its offices in Northern Ireland, Scotland and Wales in 2005, 2003 and 2005

respectively.

This report assesses the extent to which the considerations (as listed above) are relevant to the GMC devolved

offices. While it is not the intention of this report to present the offices as ‘homogenous’ – the above assumptions

have been used as a guide to structure the review and this report; the findings reported are common to all three

offices. We have also included within the report references to interviews and survey results arising from our

engagement with internal and external stakeholders. At the end of this report a summary of the internal stakeholder

survey is provided.

An important contextual point is that the GMC does not have an ‘England office’ per se. The existing offices within

London and Manchester service the requirements of England through existing structures. Since this review was

commissioned, the GMC reported to Council that ‘devolution has changed the face of healthcare design and further

devolution legislation is planned in each country and to English cities/ regions’, the GMC ‘must continue to consider

the future shape of its regulatory model’. The paper provided four models of regulation along with benefits and risks

of each option for Council to discuss – it is clear that there is an appetite to consider a four-country approach to

regulation which in itself has a number of implications. This is important context for the findings of this review.

The GMC in each devolved country is uniquely positioned to monitor, listen and report on local politics as well as

engage with the local main client group, doctors, as well as other key stakeholders.

4 https://www.gov.uk/guidance/devolution-of-powers-to-scotland-wales-and-northern-ireland


Purpose

Purpose can be defined as ‘the reason for which something is done or created or for which something exists’.

By setting up satellite offices in each devolved country the GMC made a statement of commitment to those who

engage with the GMC directly or indirectly in those locations. However, when each was launched their purpose was

not clearly established or documented. It could be said that their remit was to ‘make themselves and the GMC

known’, and in the intervening period the offices have done exactly that in each country. An ongoing criticism has

been that they have not had the necessary direction provided to them, nonetheless the absence of a historically

agreed purpose has not hindered the ability of each office to develop relationships, contacts and networks and this is

evident through the feedback received.

In 2015 the outlook is vastly different, a common and agreed purpose has been developed and provides the starting

point for each office’s strategy and plan for the year ahead:

‘The devolved offices ensure that the GMC continues to be a relevant and physical presence in Scotland, Wales, and

NI. We enable the GMC to fulfil its statutory role as a UK wide regulator by managing reputational, political, financial,

operational and legal risks; an efficient and effective provider of intelligence and advice to colleagues. Our

engagement with key interest groups and promotion of GMC guidance supports patient safety and good medical

practice across the devolved nations’.

It is widely acknowledged that the offices do not replicate the functions of the GMC, but provide crucial support on the

ground. Many stakeholders, both internal and external, described the offices as the ’human’ face of the GMC, which

personifies the GMC, suggesting that the organisation has a softer touch than just the hard edged regulator from

which it tends to get its reputation.

What stakeholders said

External and internal stakeholders of the offices were invited to respond to a survey about the GMC Office in each

country. The external stakeholders were asked what do you see as having been the key purpose of the devolved

office to date? The internal stakeholders were asked about the role of the devolved offices. Some of the

responses are set out in Table C and are provided as highlights in section 5.

Table C

Internal stakeholder feedback External Stakeholder feedback

“Promotion of GMC standards and position, raising

awareness of the role and functions of the GMC, ensuring

the views of key interest groups figure in the development

of policy and guidance.”

“To reflect local issues, by having a credible link between

the stakeholder (usually senior colleagues and decision

makers) and the GMC. Being in country sends an important

signal."

“Picking up local intelligence from an operational and

political point of view.”

“Build effective relationships with key stakeholders [in each

country].”

“Ensure consideration of full political landscape of the UK

taking into account specific sensitivities.”

“To be a local point of contact, to act as a listening point.”

“Ensuring a consistent UK message/ voice and that

views/different experiences across the UK are fed into our

decision making and policy thinking.”

“Being the ‘human face’ of the GMC, a communication

conduit.”

“Ensuring good relationships with key interest groups.” “Without a local presence would run the risk of being too

Westminster focused.”


External affairs and risk management

Engaging with the profession,

patients, medical students and educators

Operational support of all

GMC directorates in country

Overall, the responses to the surveys were positive about the value that each office brings internally to the GMC and

to external stakeholders. Internal stakeholder responses include the value of having strong relationships, strong

communication skills, and helping avert potentially difficult situations.

Chart 3

We asked external stakeholders How

successful did they see the devolved

office being in having fulfilled its

purpose? Out of 32 responses only one

individual answered ‘not successful’ and this

was in the context that the individual

interacted directly with the GMC in London

and not the local office.

Overall external stakeholders reported that

the devolved offices were successful in

achieving their purpose(s). This suggests

that external stakeholders are (in the main)

satisfied that there is harmony between what

they perceive to be the purpose of each

office and what the office is achieving, for

example, “having a credible link between the stakeholder and the GMC”, and for “building relationships”. This is

supported by the internal stakeholders responses which centre on “promotion of standards”, “raising awareness”,

ensuring consideration of the political landscape and listening to key interest groups.

Purpose and priorities

Purpose should also be linked to the activities needed to achieve desired impact, and for the offices this appears to

relate to ‘supporting patient safety and good medical practice’ as a result of having a relevant and physical presence,

helping the GMC fulfil its statutory role, and providing intelligence and advice internally.

Their purpose translates in to three broad categories or work streams as per the annual plans (see Figure 1).

Elsewhere (GMC website) presents ‘our’ priorities for being in each country (see Table D).

Figure 1 Table D

Do you think the devolved offices have been successful in fulfilling their purpose?

Successful

Unsuccessful

Neutral

Raising awareness of the role and functions of the

GMC

Ensuring the views of all key interest groups are

considered in the development of our policy and

guidance

Monitoring developments in health policy, legislation

and structures in each country

Liaising with the Scottish Parliament, Northern Ireland

and Welsh Assemblies regarding changes in medical

regulation

Providing a point of contact for all interest groups

The roll out of the GMC’s Welcome to UK Practice

Programme


The GMC’s priorities for being present in each country appear activity focused, while the purpose (see above) and

work streams per the annual plans (Figure 1) which drive day to day office activity appear quite broad. The purpose

and workstreams are a reflection of the offices activities today, which have expanded organically and reactively (this

point is discussed in the next section).

While there is likely to be synergy, there is merit in conducting an exercise which aligns the priorities as published on

the website to the offices work streams per the annual plans; it may provide insight into whether or not the offices are

doing more or less than what was originally intended.

Purpose and goals

The strategy and plan for each office appear to follow the following thought process (see Figure 2):

Figure 2

What is not clear is the reflection of the directorate’s goals, the goals5 for each office, and risk identification. Goals, by

their very nature, can be of longer term, and should link to purpose and desired impact.

We have worked on the assumption that there is proper cascading of the GMC’s strategic aims to the directorate

goals and in turn, the goals of the DOs, which supports objective-led activities. Such an approach helps mitigate the

risk of the offices becoming ‘orphan offices’ or ‘going native’ (identified by some internal stakeholders as a risk). This

leads to the following key question:

KQ1. Are the Devolved Office goals clear and are they linked to purpose and desired impact?

Purpose and relevance

The purpose of the devolved offices clearly states that they ‘ensure that the GMC continues to be a relevant and

physical presence in Scotland, Wales and Northern Ireland’.

A small number of stakeholders commented on being relevant in each country. The risk of being perceived as

London-centric is a real one (this point is discussed elsewhere in this report) - some external stakeholders observed

that accountability, responsibility and authority of the offices was not clear, that there is perhaps a perception of

reliance on the centre to agree GMC’s position on important matters. This last point relates to the degree of

(perceived and actual) autonomy that the offices have in relation to decision making on a day to day basis which is

also linked to relevance. The implication is that relevance in each country is undermined as decisions are controlled

via the centre. This raises the following question:

KQ2. Does the GMC sufficiently understand what it means to be ‘relevant’ in each country and is it clear

on the accountability, responsibility and authority of the devolved offices and how this aligns to

stakeholder expectations or perceptions?

5 Goals are, by definition, observable and measurable with an end result and supported by having one or more objectives to be achieved within an agreed timeframe.

Purpose WorkstreamsGMC

Strategic aims

Priority projects Objectives

Projects/ Business as

usual


Strategy, planning and risk assessment

Healthcare professional regulation model

The GMC’s strategy is underpinned by the purpose that it exists to help protect patients and improve medical practice

across the UK. This is set out in its Corporate Strategy (2014-17) and provides the starting point for developing the

individual DOs plans which are discussed below. The Corporate Strategy is UK wide and does not reflect a four

country approach.

There is recognition and understanding internally that because of increased divergence in the health and care

systems between the four nations within the UK, there are impacts on GMC’s ability to demonstrate a UK wide

approach to regulation. There is also increasing recognition internally for the need to be nuanced, and GMC’s

response to divergence to be nuanced.

During Council’s away day (July 2015) members were invited to consider a paper on the ‘future shape of regulation’

and in particular asked to consider ‘healthcare professional regulation in the devolved context’. There is a likelihood

of Scotland asking for healthcare professional regulation to be devolved, and the paper reflects that Wales could

follow. Internal debate confirms that there is an appetite to move to a four-country healthcare professional regulation

model, and this is supported by Council driving the expectation that information reported to them should have a four-

country dimension, which includes impact and data analytics by country.

As part of the move to a four-country regulation model the GMC will need to consider the impact on its current

organisational structure and the positioning of England within this model alongside Northern Ireland, Scotland, and

Wales. While the devolved nations each have GMC representation via the offices, in contrast England does not. The

‘England response’ is absorbed within the GMC’s current set-up, primarily through the teams within London and

Manchester. A move to four-country regulation raises the following questions:

KQ3. What will be the impact, if moving to a four-country regulation model, on existing structures and how

would the DO strategy and plans fit within this approach?

Devolved office strategy and plans

Each office has, through an annual office strategy and plan that is underpinned by the directorate plan, made a

commitment to contributing to the achievement of all 5 strategic aims, though it could be challenged as to whether or

not this needs to be the case and is appropriate. While there is no requirement to share plans outside the directorate,

one internal stakeholder indicated that they did not have sufficient sight of DO plans to enable them to understand

their planned workload and others have commented that they recognise that there is increasing demands on the

offices. Sharing the DO plans (and in our opinion vice versa) with key internal stakeholders would enable early and

useful conversations with colleagues about planned activities. It would also enable each party to understand the

reasons for pursuing initiatives that have impact in each country. The GMC should consider the following question:

KQ4. Do internal stakeholders have sufficient sight of the DOs plans (and vice versa) to enable a robust

conversation about workload priorities and enable more effective planning?

How the existing annual plans are broken down

Within the plans the offices have set out a number of objectives against priority projects (these are not the same as

the GMC priorities for being present in each country as mentioned above). The priority projects are a reflection of

wider GMC activities for which each office provides local support and the objectives are a reflection of planned

activities. Table E illustrates the high number of priority projects and objectives the offices are working with in 2015.


Table E


Number of priority projects 13 12 13

Number of objectives 34 32 35

Objectives should be a reflection of what needs to be achieved and the timescale in which it should be achieved. This

is broadly clear within the plans for each office, although could be better defined in terms of how objectives will be

measured and by when.

Each plan also contains an overview of ‘business as usual and project support’ activities which are mapped across

the GMC directorates. From the manner in which they are outlined it is not clear which activity is business as usual

and which is project support, nor in their present layout are they linked to objectives or priority projects. However, it is

clear that these activities form part of the workstream ‘operational support of all directorates in country’ (as outlined in

Figure 1). Table F shows the scale of business as usual and project support activity (as outlined in the annual plans)

across the GMC.

Table F


Strategy and

Communications

29 28 26

Education and Standards 22 22 23

Fitness to Practise 9 9 9

Registration and

Revalidation

5 5 5

Operations 9 7 8

OCCE 4 3 4

Internal stakeholders recognise the demand on the DOs time and both stakeholders and the offices themselves gave

a sense of them ‘doing too much’. This is supported by the number of objectives committed to by each office, in total

101, while still supporting business as usual and project support activities that may be driven by teams across the

GMC. It is not clear whether this approach or the scale of business as usual and project support provided

operationally is sustainable for the offices.

KQ5. Is the current workload and way of working sustainable for each office? Risk assessment in planning

The 2015 DO plans do not identify risks to their achievement. It is evident that the DOs are increasingly working in

complex environments, with multidimensional perspectives, and risks are included within the Directorate risk register.

However, risk assessment should begin when plans and objectives are agreed at all levels within an organisation,

without this formal step in the process there is a risk that the offices are not fully considering the impact and likelihood

of risks materialising. This highlights the need to consider:

KQ6. Is there visibility and understanding of the (internal and external) risks to achieving the DO plans?


Future planning

Adopting a different approach to developing the annual plan could provide a more effective platform for operational

activity. This would involve using the existing alignment of the GMC’s strategic aims to the DOs priority projects, but

introducing the directorate’s goals, and the development of the DOs goals. This would support the alignment of the

GMC’s priorities with the DOs for being in country, and provide a clear foundation for the development of ‘work

streams’ and activity-led objectives, risk identification and management, and a reflection of the performance

indicators or measurements the office will use to determine success in achieving objectives and ultimately goals. This

model is outlined in Figure 3.

Figure 3

Priorities (per GMC intention)

Office goals

Work stream 1

Work stream 2

Work stream 3

Activity led-objectives and

risk identification

KPIs/ measurements

GMC Strategic Aims and Directorate Goals

Devolved office purpose

GMC projects/ Business as usual

Risk management


Operational activity

Day to day activities

The DO teams have perceived a lack of understanding by the rest of the organisation of what they actually do rather

than what they think they do - this is not borne out by the survey results or the interviews. Generally there is a good

understanding of the value that the teams bring internally, but there may be additional benefit to gain by increasing

internal engagement with others across the GMC.

Examples of the offices’ day to day activities include:

monitoring external affairs and political healthcare landscape,

maintaining relationships with key external stakeholders,

engagement with doctors and patient groups,

helping the GMC manage risks around consistency and relevance of its communications and policies,

arranging and hosting GMC events,

providing operational and facilities support to visiting GMC staff, and

dealing with or redirecting enquiries.

Day to day operations are managed through regular DO meetings, activity planning and monitored regularly through

dashboards. Various logs are in place to capture engagement, communications and activities. There are monthly

communication meetings, meetings with directors and key staff from around the organisation are invited to attend

meetings with the DOs. Each office has developed their own office manual for administration and day to day office

maintenance, although have common processes or procedures.

The offices have agreed a portfolio approach to ensure coverage of the different directorate activities. This means

that on a monthly basis, the DO Heads and officers engage in regular meetings with relevant directorates. This

approach helps the DOs with sharing workloads while maximising efficiency. It also provides an opportunity to share

the work of the DOs and ensure their role and activity is understood.

As there are a number of common activities across the offices there may be further opportunities to gain efficiencies.

The DOs should consider:

KQ7. Is there an opportunity to further streamline some of the systems and processes that underpin and are

common to each office?

Internal drivers of activity

Some of the offices day to day operational activity is driven from the centre. For example, there are initiatives to

improve the GMC’s communication with its stakeholders, so there is an increase in the number of communications

that are driven by the Strategy and Communications Directorate’s priorities and cross directorate policy initiatives. For

the devolved countries the offices are pivotal to ensuring that all of these are targeted and handled appropriately.

It is important therefore that the DOs are engaged early enough in conversations on policy and communications that

may have an impact on each country. Criticism was raised that the DOs often arrive to the table when decisions have

already been made and equal frustration on the part of the DOs that they are an ‘after thought’ in policy and

communication development. This supports the view (highlighted through interviews with a small number of external

stakeholders) that policy is possibly driven by England’s priorities and do not necessarily take into consideration the

political systems of the other three countries until it is time to be implemented. A four-country dimension would mean

that divergent health and care systems would be considered at the start of planning initiatives. The GMC and the DOs

should consider:


KQ8. Is there an opportunity for DOs to be involved in new projects and initiatives from an early stage in order

to provide relevant country specific input and to enable their anticipation of work and resource planning?

Risk management implemented

Some risk management activity is evident through the weekly monitoring mechanism and there is consideration of

risk through the use of RAG ratings for different activities (e.g. risk areas raised as part of weekly reporting versus

stating the health of a stakeholder relationship), but the offices do not maintain individual risk registers.

GMC’s Risk Management Framework endorses the position that visibility of risks (including inherent risks which are

discussed elsewhere in this report) should be at all levels of operational activity. Without risk registers:

KQ9. How effective are the DOs in identifying and managing their (internal and external) risks?

Non DO activities within each country

External stakeholders also interact with other key GMC services. Interviews and survey results confirm the value of

these interactions.

Central teams have assigned country leads, and activities in each of the devolved nations may stem from different

drivers, e.g. FTP, Revalidation, Education and Standards. While these activities are not the responsibility of the DOs,

they may be involved or partake in some activities that are priorities for the regulatory directorates. The DOs

engagement has also changed with the introduction of the clinical fellows and more recently liaison advisors.

The offices work with each of the directorates and provide operational support where necessary, although some

activities will be independent of the DOs involvement. The offices are keen to be kept updated of GMC activities and

meetings occurring in their relevant countries of responsibility. Some of these activities will be instigated by the DOs

or by London or Manchester staff. Whilst less frequent now, in the past there have been criticisms that the DOs were

not sighted on key meetings within the devolved countries.

A lack of coordinated approach in each country increases the risk of not being joined up and emphasises directorates

working in silos.

Introducing an operational model for each country (including England) will support a four-country approach – and may

be a matter of formalising ‘joined-up’ operational delivery in each country. Practically, this may involve formal

structures around how services work with each other, and at country level, extending the use of the intranet for

internal stakeholders (another survey comment), and using the GMC website for relevant signposting for external

stakeholders (for example the Memorandum of Understanding with the Care Quality Commission has a long list of

‘whom to contact’ and ‘for what’, something similar for the DOs could be useful). It would help the GMC to identify:

KQ10. What is the GMC’s operational model for supporting its activities in each country?


Engagement

How external stakeholders are engaged with

External stakeholders have indicated that they may engage with the GMC in a variety of ways; informal and formal

meetings with members of staff in the DOs, finding out who to contact within the GMC via the offices, through the

Quality Improvement Framework, regular face to face engagement with the ELAs, sharing of information and

involvement at the UK Advisory Forums (UKAF) are a few of the examples given. Many external stakeholders

commented positively on the accessibility of the Chair and Chief Executive at the UKAF events.

Stakeholders commented on the GMC in each country as well the GMC as an organisation. A few stakeholders

indicated engagement was also directly with the GMC in London or Manchester which was in addition to contacts with

the DOs. One stakeholder indicated very little or no engagement with the DO due to direct links with the GMC office

in London. A small number of stakeholders indicated their preference to go directly to the DOs, which supports the

value they place on the relationships established.

With the addition of the new post of liaison advisors (LA) in each office, which will replicate the Regional Liaison

Service (RLS) in England, direct engagement with customer groups will grow. The addition of the LAs will enable the

model of engagement to align with the RLS in England. A perceived criticism from one stakeholder was that the roll

out of the LA arrangements was 3 years behind the RLS model, and implied a lack of investment in the devolved

countries.

This review highlights the importance of understanding the relationships that each office has with its external

stakeholders. Each office has identified its stakeholders and indicated the ‘health status’ of the relationship. However,

the wider strategy behind these relationships is not clear. For example, what is the risk behind a relationship that is

assessed as ‘red’? How should this be managed? By whom and how will it be monitored during the year?

The importance of understanding the strategies behind relationship management becomes increasingly important

when engagement with the same stakeholder may occur through different teams across the GMC (which is discussed

above). Different engagements raise the risk of not appearing joined up in terms of messages and consistency (as

raised above) – this was commented on by a small number of internal stakeholders, and raises the following

question, which should be considered alongside question 11:

KQ11. Does meaningful information exist to understand the risk of not being joined up, in fact as well as

appearance, in each devolved country?

How engagement is captured

The offices have developed processes around capturing engagement, and also use the GMC’s Relationship

Management System (RMS) to capture contact. At least one office mentioned that detailed contact notes are not

maintained, while another office, in comparison, does maintain more detailed notes. Additionally, RMS has been

described as ‘clunky’ and not user friendly, it is therefore unlikely to be used to its full potential.

Different spreadsheets have been developed for different projects or purposes although are underpinned by a

common principal, to capture engagement. Each office maintains a number of different spreadsheets for capturing

different types of activities. This is discussed above, under the operational activity (see question 8).


Impact

When external stakeholders were asked what the offices do well, words such as engagement, networking,

relationships, supporting the introduction of revalidation, liaison, and communication were used. However, in contrast

one stakeholder indicated that while the GMC sends an important ‘signal of wishing to be a UK body, there is a risk of

perceived tokenism [with the office in country] while the organisational centre of gravity remains in [London]’.

Discussions with a small number of external stakeholders supports this view, particularly that there is a sense of

some policy decisions being driven by England priorities. This has been raised elsewhere in the report, and requires

the following consideration:

KQ12. Is the GMC sufficiently mitigating the risk of being perceived as ‘London-centric’?

Demonstrating impact

During the visits the question of whether the GMC via the offices was achieving impact, and how this was captured

was tested. The GMC gathers meaningful data and intelligence, and is putting in place systems to allow better

sharing of information internally. However, there is a view that this still needs to be filtered at country level. For

example, the State of Medical Education in Practice (SoMEP) report was commented on as being useful by external

stakeholders, but only when it was broken down by the office for the specific country. There is an appetite for

information that is relevant for each country – there was an overarching comment that ‘more local information would

be better, and would help bodies inform their own strategies’.

KQ13. What opportunities exist to provide country specific information and data for public consumption?

The level of engagement achieved across all key groups during 2014 are outlined in Table G.

Table G

England Northern Ireland Scotland Wales

Doctors and trainees 15,536

(7.8%)

524

(7.8%*)

21

(0.1%)

323

(3.1%)

Medical students 11,005

(34.1%)

938

(69.2%)

2,428

(48.9%)

1,437

(78.2%)

Patients and public 821

(0.00%)

73

(0.004%)

239

(0.004%)

550

(0.02%) *percentage engagement within each country

There is very little information available on outcomes and impact in each country as a result of DO activity. While

engagements are key (and this is confirmed through the survey results and interviews), the quality of the outcomes

and the resulting impacts of these are not captured. A proportion of the offices’ engagement with stakeholders is

driven by GMC central activities in developing policy, guidance and communications so there is no requirement for

DOs to monitor impact. However, the offices are in a good position to understand outcomes and impacts and we

would encourage this to be explored:

KQ14. Is there an opportunity for the DOs to engage in monitoring of impact that is driven by central activity, or

monitoring their own impact?

At the office level there is an appetite for understanding impact across the different stakeholder groups. This could be

achieved by using logic frameworks for planning programmes of engagement. See Figure 4 for a simple logic

framework as an example.


Figure 46

6 Taken and adapted from BOND, Networking for International Development: Logical Framework Analysis

Purpose

What is the project [engagement] going to achieve?

Activities

What activities will be carried out to achieve [the engagement's]outputs and purpose?

Resources

What inputs are required (e.g. finance, people, time etc.)

Risks

What are the potential problems which could affect the success of the [engagement]?

Success

How progress and ultimate success of the [engagement]will be measured and verified?


Reporting

The offices report in a consistent manner, and provide periodic updates on engagement and communication, on an

individual basis as well as collectively.

The content of weekly reporting includes a retrospective look at activities completed, and a forward look at expected

activities. The content centres around projects, business as usual and ‘core functions’. There is also a section for

‘current hot topics’ and risks or issues to note which include a ‘red-amber-green’ rating. The weekly reports feed into

the Directorate’s business plan reporting.

For 2014, the content of the updates was around engagement summary (doctors and trainees, medical students, and

patients and public), feedback summary from doctors and students, top 5 requested sessions and issues affecting

doctors in [country]. These are mostly output driven activities.

The updates in 2015 have changed to Headlines for [period], Engagement including promoting professionalism,

Public and external affairs engagements, and Operational support. The 2015 content is aligned to the three ‘work

streams’ that stem from the DO’s purpose, and outline activity and outputs completed. However, these are not linked

to the objectives of each office.

While the reports show the degree of office activity, these do not provide the added value and quality of the

engagements held and activities completed by the DOs. This observation also links to reporting of impact which is

discussed in the previous section. There is perhaps a question over meaningfulness of the information reported.

KQ15. Do the DO reports provide sufficient information over the quality and added value of engagements or

activities, and/or the achievement (or progress towards achievement) of DO objectives per their approved

plans?

Stakeholders have indicated that there has been limited reporting to Council on DO activities, one stakeholder

commenting that reports appear as ‘one GMC operating in one health structure’. It is expected that appetite for four-

country information is increasing as a direct result of discussions driven by Council, and the potential to move in the

direction of a four-country approach.

KQ16. Is there sufficient reporting on the four-country dimension internally and to Council?


Staffing

The offices have experienced momentum, they have evolved organically from one or two persons in each office, and

are now better resourced in terms of office space, staff numbers, IT support etc. They represent less than 1% of the

GMC budget, and have grown in size and depth of activities.

Resource planning

The DOs have a coordination role which interfaces and performs as a point of contact internally. The role is presently

embedded as part of an existing staff role and will rotate between the offices. There is a ‘wish list’ for a dedicated

resource to take on the coordination role. However, there is not sufficient information available about time required for

and spent on different activities that would warrant an additional role. This raises the question of whether resource

planning is underpinned by work planning, and if there is sufficient clarity over time spent on different activities.

KQ17. Do the DOs have clarity over resource planning that is driven by their annual planning and planned work

programme?

Capacity

There is an emerging question to ask about the capacity of the DOs to manage an increasing number of projects, the

time required and tools available to monitor effective use of resources. It may be helpful for the offices to undertake

an exercise which compares ‘person hours available’ to ‘person hours needed’ to cover all expected activities and to

introduce a simple time recording tool to help understand how much time is spent on different activities, to support

annual and quarterly forward planning. This could also inform discussions on resource planning when considering

workload.

KQ18. Is there sufficient information available to understand whether the DOs can sustain the current level of or

an increase in work activities?

Small offices come with inherent risks, and this includes having single points of failure where significant reliance is

placed on key individuals, or where key individuals possess knowledge and experience which cannot be easily

replicated, or a combination of these factors. The risk of single points of failure increases when there is insufficient

consideration of succession planning.

Additionally, as a satellite office, which by fact is remote from the centre, there is a risk of ‘going native’ – this was

commented on by a small number of stakeholders.

The DOs are exposed to these risks and therefore the following key question arises:

KQ19. Is there sufficient thinking around succession planning for each office?


[BLANK PAGE]


5. Highlights from the internal stakeholders responses

Total number of respondents: 23 Overall response: positive

Themes from the responses: The feedback was positive. It is clear that the DOs provide significant value to individuals that are engaged

but their objectives could be more clearly communicated to the wider organisation.

The DOs have a lot of demands on their time and can be limited by resource in their small teams.

As a UK wide regulator the DOs have an important role in developing local knowledge and driving important

local relationships that may not have been achieved from England only.

Highlights from the feedback include:

The role of the DOs: They promote the GMCs standards and position. They also pick up local intelligence from an operational

and political point of view.

To ensure we consider the full political landscape of the UK and ensure we have taken into account

legislation in all four countries and specific sensitivities.

Providing a two way link between the GMC and the devolved legislatures.

Raising awareness of the role and functions of the GMC, ensuring the views of key interest groups figure

in the development of our policy and guidance.

Ensuring we have a consistent UK message/voice and that views/different experiences across the UK are

fed into our decision making and policy thinking.

Ensure that we have good relationships with our key interest groups.

Contribution to the GMC achieving its objectives: Increased our influence and impact with key stakeholders, their presence is in itself a manifestation of our

commitment to our role as a UK wide regulator.

Ensuring the organisation is compliant with local standards.

Allowing us to effectively respond to the wider devolution agenda.

Championing the GMC’s UK-wide objectives and profile.

Promoting professionalism and working to influence policy.

At a practical level they have provided meeting facilities and support.

Discharging their objectives: Instrumental in supporting and embedding political change.

The DOs provide a means of engaging with both senior members of the healthcare system and politicians.



The development and roll out of Revalidation is a good example, as it had to reflect the differences in

healthcare structures and political supervision in each of the four countries.

Through developing strong relationships with key stakeholders that we would be unable to maintain from

London.

Very effective, and will become more so with the additional resources allocated.

Really effective and seem to work effectively with the Employer Liaison Service which also works in the

devolved country.

Priorities going forward: Two way stakeholder engagement.

Developing important networks and managing who takes the lead, whether from London or the relevant

DO.

Ensuring greater collaboration and joint working across the four countries.

Informing the organisation's response to greater devolution.

Deepen our knowledge of the national/regional landscape.

Promoting the GMCs standards and being champions for patient safety.

Engagement / interaction with the DOs: This can be difficult as the DOs appear to have their own set agenda/objectives and therefore resources

are allocated to these objectives and not, at times, available for other work or support.

I really value my involvement with them. We enjoy a very positive, open and mutually supportive working

relationship.

My personal relationships with my DO are excellent and I am made extremely welcome whenever I visit

the office or telephone colleagues there.

On the whole positive. This can depend on DO capacity which is influenced by the sheer range of GMC

matters which the offices have to cover and to some extent the strength of the staff's relationships with the

people and knowledge of the issues that Standards may want to engage with.

I’ve always found the teams in the devolved offices to be very approachable and keen to work with us on

delivering facilities services.

We are working on a framework to provide guidance on how we work together and on what.

Added value to internal stakeholders:

Strong local knowledge, perspective and sound advice.

Strong communication skills.

Close personal relationships.

Dealing with potentially difficult situations which has adverted more serious issues.

Challenges in working with DOs: Resource: time / capacity.

Lack of input into DO year plan.

Clarity of local stakeholder management activities- right person for right subject matter.

Ability to see the bigger picture.

Sometimes lack of clarity or disagreement about distribution of work between two teams.

What would you like to see the offices do differently? Have a stronger voice in our communications and engagement planning activity.

Possibility of carrying out more operational activities (with appropriate staffing levels).

The January training course was excellent – could we mainstream this into induction as an e-learning

module?

Share more information, and in a timely manner with the ELS and other individuals across the

organisation.

Be more cost focused and commercial.



Is the role of the devolved offices sufficiently understood? There are colleagues who just don’t know about the DOs work and it is everyone’s responsibility to see

that we are a UK wide regulator.

The roles are not sufficiently clear.

We're all too busy working in our own areas to understand fully what others do. But once you engage with

the team there is no doubt as to the value they add.

The DO's are often seen simply as satellite offices and their impact on key statutory functions is unclear.

The Employer Liaison Service is well aware of the role and the benefits of the DOs.

Probably only with those members of staff who come into direct contact with the devolved offices as part of

their work.

What could be done differently to improve internal engagement with the DOs:

The AD responsible for the devolved offices and the offices are very good at championing their work. I

would like to see the teams having more opportunities to do so in both the London and Manchester Office.

This needs to be driven largely by the teams in Manchester and London, rather than the staff at the DO’s

having the sole responsibility to “make themselves known”.

More regular updates on topical issues – e.g. through policy network.

Presentations at the corporate induction or a roadshow to Manchester / London.

Effective use of the intranet.


6. Appendices

The following stakeholders invited to participate in the survey

External Stakeholders

Name Organisation

Regulation and Quality Improvement Authority

BMA Northern Ireland

NI Confederation of Health & Social Care

NI Medical and Dental Training Agency (NIMDTA)

Pharmaceutical Society of NI

DCMO

RCGP (NI)

RCPCH (NI)

Queen’s University Belfast

Patient and Client Council

NI Social Care Council

Healthcare Improvement Scotland

BMA Scotland

NHS Education Scotland

NSS

GpHC Scotland

Scottish Government

RCPE

Dundee

Board of Academic Medicine

PASS

The Alliance

Glasgow Medical School

MDDUS

General Dental Council

Healthcare Inspectorate Wales


Name Organisation

BMA Cymru

NHS Confed

Wales Deanery

GPhC

Welsh Government

Royal College Physicians

Cardiff University

Academy of Royal Colleges Wales

Swansea University

Welsh Community Health Councils

Royal College of GPs

Internal Stakeholders

Name Directorate

Chair

Council Member

Council Member

Council Member

Chief Executive

Chief Operating Officer

OCCE/OCCO

OCCE/OCCO

OCCE/OCCO

Strategy and Communications








Standards and Education





Name Directorate






Registration and Revalidation




Fitness to Practise

Fitness to Practise

Fitness to Practise

Fitness to Practise

Fitness to Practise

Resources and Quality Assurance



Moore Stephens LLP, 150 Aldersgate Street, London EC1A 4AB T +44 (0)20 7334 9191www.moorestephens.co.uk

DPS29853


3 – Devolved Office Review

3 - Annex B

Devolved Office Review action plan


B2

Report Question

Action Owner Timescale Notes

Risk training undertaken and logs created for each office DO Under way Training delivered by Moore Stephens 3/9/15 Risk logs underway

Improved analysis of DO dependencies by Directorate for 2016 Business Plan - DOs approaching directorates for confirmation of requirements

DO/Directorates Under way Some directorates originally noted no DO dependencies, DOs checking this

DOs developing updated operating model (one for three nations)

DOs Under way

Updated to include new Promoting Professionalism provision, risk logs and soft intelligence sharing

DO representation on Data Strategy working group, commitment to 4 country thinking across Data Strategy work-streams

DOs/S&C Under way Noting DO Head time commitment of 23.5 days in 2016

Update DO section of Corporate Induction to demonstrate integral part of S&C and overall corporate strategy/commitment to 4 country working

DOs/S&C Under way New version of corporate induction session introduced in October 2015

Regular briefings by DO Head for DO country Council Members

DOs/Governance Under way Meetings re-introduced in 2015

Review Governance templates/guidance for more prominent prompts for 4 country thinking on all policy or project board documents

DOs/Governance Under way Meeting scheduled with Governance Team to discuss


B3

Report Question

Action Owner Timescale Notes

Council evening seminar/informal session on DO Review and devolved political/regulatory context. Consideration of what parts of our business need to be a. UK only b. tailored to country and c. country specific.

DOs

Short term* To be agreed

Audit of DO representation on key policy making/project groups and boards with AD and Director of S&C to ensure appropriate cover/representation

Short term

Consider establishing regular DO link and update to Directorate leaderships teams as per R&R and Education & Standards

S&C and Directorates

Short term

DO representation (via Assistant Director – Strategy and Communication) on 2016 SOMEP editorial Board to assure 4 country commitment

Short term

CI review of DO office manuals and operational processes DOs (and CI Team)

Short term DOs already undertaken CI training – early 2015

New template to be used for DO 2016 business strategy and plan summary pack to ensure clear link between strategic purpose, priorities and desired impact

DOs Short term

2016 business strategy and plans shared with key contacts across directorates once finalised

DOs

Short term

DO input to 2016 Impact Report to assure 4 country proofed

DOs

Short term

Ongoing tracking/monitoring of demands on DOs linked to resourcing

DOs

Short term

• Short term = End of 2015 – first 6 months of 2016


B4

Report

Question Action Owner Timescale Notes

HR led review of succession planning risks/issues/options for DOs

HR

DOs

Medium/ long term*

Review of “England” question/issue as a commissioned review with the Audit and Risk Assurance function and Moore Stephens

COO

Medium/ long term

Possible combined review with A&RA function with MS leading as per DO Review

Review of how all GMC work organised across countries for effectiveness and efficiency

CE/COO/Directors/Internal Audit

Medium / long term

• Medium/long term = by Q4 2016

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