GMC must nip rotten medics in the bud

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The General Medical Council has stood for high professionalism for 150 years but exposures of malpractice suggest it must push on with its modernisation to regain public and professional confidence

This month the General Medical Council celebrates its 150th anniversary. On 1 October 1858 the Medical Act became law and provided that "persons should be enabled to distinguish qualified from unqualified practitioners". There has been much water under the bridge since then.

Looking at the GMC today, how effective is it as a regulatory body? What reforms are presently taking place? And what are its plans for the future?

The council's purpose, as the regulator of the medical profession in the UK, is to protect, promote and maintain the health and safety of the public by ensuring proper standards of medicine. In August I asked its chief executive Finlay Scott whether he thought the body is an effective watchdog of the profession. His answer was that the great majority of doctors in the UK are good doctors delivering high-quality healthcare, often under demanding circumstances.

But this response detracts from controversies raging in the medical profession. The "consultant is king" mantra was seriously brought into question in the wake of the cases of gynaecologists Rodney Ledward and Richard Neale, both found to be grossly incompetent for botching operations over many years.

Mr Scott believes cases such as this and of the serial killer GP Harold Shipman misrepresent the sterling work of the 150,000 or so doctors who have acted in their patients' interests.

Values and ethics

There is powerful support for this view and there is evidence to show the council has embarked on pursuing a set of values, ethics and principles to nip in the bud the dreadful deeds of the tiny minority of doctors who seriously undermine their profession. The thinking behind this is that local clinical governance can ensure poor performance is picked up at an early stage.

The British Medical Association, the doctors' trade union, is less upbeat. It claims that while perceptions of the council have improved in recent years, it has failed to inspire the confidence of the profession or the public. Yet the GMC has clearly made a concerted effort to modernise and has taken many steps to address the criticisms that flowed from the Shipman inquiry and other reports.

At the heart of the reforms are the Health and Social Care Act 2008 and the February 2007 publication by the Department of Health of the white paper Trust, Assurance and Safety. The government's aim is to modernise professional regulation so all health professionals can win patients' trust. Other objectives are to encourage high quality healthcare and to demand higher standards. But is the government simply reacting to popular political concerns caused by the recent scandals? Mr Scott suggests you cannot transform a wide-ranging and complex regulatory system on the basis of reacting to a few untypical, albeit deviant, doctors.

At your service

The 2008 Act sanctioned the creation of the Office of the Health Professions Adjudicator, which takes away the function of adjudication from the council. For its part, the GMC argues that its inability to carry out adjudication was never stated by government. The channelling of adjudication to a different body must be seen as a loss of power at the council. But the government holds that as a matter of principle it is the right move, as this is more likely to command patient, public and professional confidence.

Over the next few years, the council will bring in licences to practise and all doctors will be required by law to hold one if they want to continue with their medical work. In addition to licensing, a new system, known as revalidation, will require doctors to renew their licence every five years.

The Royal Colleges themselves support licensing and revalidation. Royal College of Physicians president Ian Gilmore comments: "[The GMC] will continue to be fully involved in the development of the process of recertification and relicensing, both as a contributor to the process and to represent the views of our fellows and members in its development."

Individual doctors, though, do not necessarily welcome the reform, showing resentment to further scrutiny and accountability.

Abuse and vendettas

The BMA claims the measures will expose GPs to abuse and vendettas. But in order to assure patients that licensed doctors are up to date and fit to practise, revalidation and other checks can only be for the greater good.

GMC president Sir Graeme Catto is less appreciative of the reforms. Earlier this year he told The Times that chief medical officer Sir Liam Donaldson's proposals for disciplining the profession lack clarity. Sir Liam's proposal, out to consultation until next month, is for a revalidation system in which doctors will be required to demonstrate to the council that their training is up to date and that they are fit to practise medicine. Doctors who take part in revalidation will be granted a licence to practise and be reassessed every five years.

Sir Graeme concedes that the GMC should report directly to Parliament and there is every reason to believe he wants the best for doctors and the public, recognising that the council has a massive task in trying to appease its detractors.

So it is largely public outrage that has led to the call for changes. Justifiable shock at what has happened in the medical profession has paved the way to reform.

The council is also preparing to reconstitute its governing body, which will come into office in January 2009. Consisting of 12 doctors and 12 lay people, its emphasis, again, is to try to bring onside the confidence and support of patients, the professions, the NHS and other healthcare providers, the medical schools and the Royal Colleges.

The future of training

The government has also decided to merge the postgraduate medical education and training board into the GMC in April 2010. The advantage of this is that for the first time the council will be responsible for all phases of a doctor's career: undergraduate, postgraduate and continuing practice. This integrated approach is an important step forward and offers an improvement on the previous system of annual appraisals, which did not work effectively, with some trusts failing even to appraise their doctors annually and a lack of consistency about how rigorous they were when they were undertaken.

Mr Scott wants these changes to continue and advocates for the future a model whereby the council is seen as a significant contributor to improving the quality of healthcare.

There are grounds for believing that an intelligent and properly measured form of regulation can make a vital impact on quality, while at the same time taking early and effective action in relation to the minority of doctors whose work may be impaired. Swift and effective action on the malpractice of individual cases should be the norm to protect the public against dangerous doctors and the regulatory procedures and processes should be fair.

Striking a balance

Clearly a balance has to be established between making sure doctors are practising good standards of medical care and allowing them freedom to exercise their professional judgement without fear of witch hunts by any regulatory body or of government reprisals. It is evident that both government and the council are striving towards this goal; the next five years will be crucial in determining whether their efforts will be rewarded.

While there is concern that doctors will resist further regulatory intervention, they must appreciate that effective action to counter the scandals in recent years has only come about after the press and public have become involved.

That they should be willing to yield to more regulation is no longer in question.