RCPsych should not publish the London Approval Panel: Section 12(2) Mental Health Act 1983 Approval Criteria and Procedures

Photo: Professor Dinesh Bhugra President of The Royal College of Psychiatrists

I have written to the President about Concerns regarding LONDON APPROVAL PANEL: SECTION 12 MENTALHEALTH ACT 1983 APPROVAL CRITERIA & PROCEDURES

I noted the Royal College of Psychiatrists has commitment to racial equality.

The College was named in the Race Relations (Amendment) Act 2000 as a public authority with a"General duty". The "General duty" requires specific organisations to "eliminate unlawful racial
discrimination, promote equality of opportunity, and promote good relations between persons of
different racial groups".

LONDON APPROVAL PANEL: SECTION 12 MENTAL HEALTH ACT 1983 APPROVAL CRITERIA & PROCEDURES are discriminatory. There has been a failure to monitor the ethnicity of the applicants for approval under Section 12(2) of the Mental Health Act 1983. This is contrary to the stipulations of the Race Relations Act 1976.

7. F1 ...contract workers.
— (1) This section applies to any work for a person ( “the principal") which is available for doing
by individuals ( “contract workers") who are employed not by the principal himself but by another person, who supplies them under a contract made with the principal.
(2) It is unlawful for the principal, in relation to work to which this section applies, to discriminate against a contract worker—
(a) in the terms on which he allows him to do that work; or
(b) by not allowing him to do it or continue to do it; or
(c) in the way he affords him access to any benefits, facilities or services or by refusing or deliberately omitting to afford him access to them; or
(d) by subjecting him to any other detriment.

The vast majority of locum doctors appear to be from ethnic group.

The current LONDON APPROVAL PANEL: SECTION 12 MENTAL HEALTH ACT 1983 APPROVAL CRITERIA & PROCEDURES are discriminatory against locum doctors and other groups too. It can be postulated that the vast majority of female doctors work part time due to
family commitments. As such the criteria would be discriminatory to both groups-locum doctors as well as female doctors.

Further issues are as follows:

London region approval panel Section 12 (2) 1983 published by the Royal College of Psychiatrists
states this:

CORE CRITERIA FOR APPROVAL from LONDON APPROVAL PANEL: SECTION 12 MENTAL HEALTH ACT 1983 APPROVAL CRITERIA & PROCEDURES in Paragraph 1:

1. Applicants must have a minimum of three years' post-registration experience, with full GMC
registration. Doctors with GMC restrictions on their practice are unlikely to be approved.

a) You would know of course, that there is racial/ethnic discrimination in medicine and that there is increased rate of referral of doctors who are of differnt racial and ethnic origin (British and non- British) to GMC (BMJ 2009)

5. Additional requirements apply for doctors not in permanent NHS employment (e.g. post- retirement or locums). These include: evidence of CPD registration & participation in continuing
education; contemporary reference from an NHS consultant; statement on reasons for seeking
approval. Approval may be time-limited to the duration of a locum post or for one or two years.

a) You will know that it is not necessary to provide reasons why a doctor wishes to be approved under Section 12(2). The same is not asked of doctors in substantive posts.
b) Contemporary reference From an NHS consultant is an example of restriction on professional practice and contrary to European Treaty.
c) Limiting approval for the duration of locum post is also discriminatory as the same is not applied to doctors
in substantive posts. This is again against Eurpean Treaty which allows professionals to work as self-employed.

8. All applicants will be expected to provide evidence of an Enhanced CRB check(a normal request on NHS employment). A confirmation from an NHS or other employer that one has been issued may be sufficient. Individuals will be expected to fund their CRB check if their employer is unwilling.

a) CRB applications can only be made by an employment business and does not apply to self-employed people. There is no provision made by the Approval Panel to apply for CRB. This is also discriminatory.

PROCEDURES from LONDON APPROVAL PANEL: SECTION 12 MENTAL HEALTH ACT 1983 APPROVAL CRITERIA & PROCEDURES

2 In accordance with amendments to Section 17 of the NHS Act 1977 applicants must declare criminal convictions or GMC Fitness to Practise proceedings including Interim Orders and restrictions. This is the Section 17 from NHS 1977 Act:[ F117 Secretary of State’s directions: exercise of functions

(1)The Secretary of State may give directions to any of the bodies mentioned in subsection (2)
below about their exercise of any functions.
(2)The bodies are—
[F2(za)Strategic Health Authorities;]]
(a)Health Authorities;
(b)Special Health Authorities;
(c)Primary Care Trusts;
(d)NHS trusts.

[F3(3)Nothing in any provision made by or under this or any other Act shall be read as affecting the generality of subsection (1) above.]

LONDON APPROVAL PANEL: SECTION 12 MENTAL HEALTH ACT 1983 APPROVAL CRITERIA & PROCEDURES does not state which amendment it refers to. RESTRICTIONS AND WARNINGS from LONDON APPROVAL PANEL: SECTION 12 MENTAL HEALTH
ACT 1983 APPROVAL CRITERIA & PROCEDURES

1 Approval by this process gives authority to act as an approved doctor throughout England and
Wales. However, an approved doctor must ‘Recognize and work within the limits of your competence’ [GMC Good Medical Practice 2006]. Doctors moving area are advised to notify their employer and make sure their names are transferred to the relevant Register of Approved Doctors.

a) Locum doctors move all the time and it is not necessary or even possible to inform the employer if there is not one.

b) It is not necessary to always transfer to the local Register of Approved Doctors. There is no National Register because of the lack of organisation.

3 Doctors must inform the Register Administrator if they become subject to GMC Fitness to Practise proceedings. Suspension of Registration automatically cancels S12 (2) Approval.

a) Suspension of registration is a temporary measure which does not demand erasure from Section 12(2).Again this cannot be justified in law.

4 Approval may be withdrawn on the recommendation of a special hearing, comprising three members of the Approval Panel (chaired by the vice-chairman), with the doctor able to respond to the relevant evidence. An independent appeal mechanism exists.

a) This does not say what the Appeal mechanism is or what representations could be made and
under what conditions or where or within what time limit. This appears to be contrary to Article 6 of Human Rights Act 1998. There is no definition what a special hearing is or what rules govern it, or what charges can be considered.

6 Renewal Reminders - Doctors will be reminded of impending expiry of approval with approximately three months notice. Retrospective approval cannot be given which means there is a risk of completing invalid recommendations if approval lapses. Informing this office of change of address reduce the risk.

a) Unfortunately, this is an empty promise as reminders do not happen in my experience.

b) The reminder should happen at least 13 months in advance to allow for a refresher course

c) It fails to state that there is a discretion in law for additional six months approval for necessary arrangements to be made. In other words the approval can be extended for doctor to complete Refresher course. It is unlikely, that many doctors would know that. The observations that I made make me think that the Royal College of Psychiatrists does not have to continue publication of a document so flawed.

Dr Helen Bright
Doctors4Justice.