'The GMC last month took the historic step of abandoning the principle of self-regulation. It has yet to do so officially'
Winter is closing in and MPs and peers are back at work on the factory floor. The time approaches when ministers have to decide what to do about medical regulation. I doubt that they are looking forward to it. Nor are the professions.
The consultation period for the 44 recommendations made in chief medical officer Professor Sir Liam Donaldson's report, not to mention the parallel, less severe Foster report on non-medical healthcare professionals, ends on 10 November. Some 170 replies do not yet include some big boys, including the General Medical Council itself.
What is going on? There is general 'Groundhog Day' irritation that Sir Liam failed to recognise the scale of reform in recent years, before and after Dr Harold Shipman entered the Guinness Book of Records as Britain's most prolific serial killer, and did not always provide evidence to warrant some of his proposals.
Technical problems exist over 'revalidation' of doctors' competence and concerns about reducing the burden of proof from criminal standards to less stringent civil court rules. Apart from that, there seem to be two main bones of contention in the report, Good Doctors, Safer Patients.
One is the removal from the GMC of control over the medical undergraduate education and its transfer to the Postgraduate Medical Education and Training Board. Almost everyone, including the universities, seems to oppose Sir Liam on that one and puzzle as to why he wants it done. I suspect he will not get his way with health minister Andy Burnham, to whom the decision falls.
The other, as HSJreaders will suspect, is the one which will catch the eye of the public with the watchful assistance of our regulation-resistant newspapers: an update of traditional professionally-led regulation versus the kind of 'separate but independent tribunal' approach recommended in the Donaldson report.
Clucking sceptically about the cost and effectiveness of the tribunal option, the GMC is battling to stay ahead of the game. It has been holding private seminars and conferences, including a full meeting of the GMC council last month in Cardiff which took the historic step of abandoning the principle of self-regulation. It has yet to say so officially.
Naturally, this move has been influenced by the wish to head off what we might call The Full Donaldson. In keeping with the spirit of the times the world over, the GMC will tell the government that it accepts that doctors should no longer have a built-in majority on the GMC.
Instead the council would have what it calls 'a balanced composition' with four component elements: the profession itself; the medical schools; patients and the public; and, of course, the employers, NHS management and the private sector whose doctors would finally be brought within the system.
I am told that the British Medical Association is less keen to concede the 50:50 split between lay and medical membership, though I also hear that the GMC rarely divides along those lines anyway these days and lay people get committee chairmanships in ways once unimaginable.
For the GMC, as for ministers, the bottom line is public confidence: how best to provide safety, transparency and accountability, plus a stronger dash of localism (a buzz word) in ways that reflect realities on the ground. But the GMC is also concerned about genuine independence from government as well as from professional dominance.
Harold Shipmans are rare ('Dr Shipman would have supported professional autonomy,' someone dryly remarked as the idea was endorsed at the Tory party conference), but there are 4,000 complaints a year and 500 'alert letters' are sent out to the NHS about clinical malfunction, according to the Donaldson report.
In reality the GMC, slimmed down from 104 to 35 members in 2003, already leaves adjudication on professional cases to its fitness to practice panels and does not even have a right of appeal against lenient verdicts, although Sir Liam's plans will change that.
I suspect that the GMC will have to stop having council members elected by fellow medics instead of appointed by the NHS Appointments Commission as lay members now are. But what constitutes a lay member? NHS managers and pharmacology professors are not lay enough, say some.
Michael White is assistant editor (politics) ofThe Guardian.