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. 2001 Jun 30;322(7302):1599.

GMC: approaching the abyss

Preservation is well worth the effort

Brian Keighley 1,2,3,4,5,6,7,8,9, George Alberti 1,2,3,4,5,6,7,8,9, John Chisholm 1,2,3,4,5,6,7,8,9, Simon Fradd 1,2,3,4,5,6,7,8,9, Barry Jackson 1,2,3,4,5,6,7,8,9, Roderick MacSween 1,2,3,4,5,6,7,8,9, Hamish Meldrum 1,2,3,4,5,6,7,8,9, David Pickersgill 1,2,3,4,5,6,7,8,9, Mike Pringle 1,2,3,4,5,6,7,8,9
PMCID: PMC1120633  PMID: 11458891

Editor—In his editorial on the General Medical Council, Smith asks a question that is in danger of becoming a self fulfilling prophecy.1 He fairly describes differences of view in the British medical profession about governance and the introduction of revalidation. He then asks whether it is worth expending the effort required to ensure the GMC's survival on the grounds of its being dysfunctional, even suggesting that it might be better to scrap it and start again.

We write as a disparate group of senior doctors who have been intimately involved in the debate on the future of the GMC. We have held differing views about the solutions that might be offered but are united on the over-riding importance of professionally led regulation in partnership with the public. In this, we concur with Smith that most doctors wish to practise to the highest possible standards and that the model of the intrusive regulatory scrutiny practised by casino operators is totally inappropriate to the medical profession.

We believe, from very different perspectives, that the GMC should be allowed to develop into a better organisation for doctors and, more importantly, for patients. Smith's implication that we should start looking at fresh alternatives begs the question as to who would be entrusted do this work and whether the result would be any better equipped for the challenges faced by a 21st century regulator in an increasingly complicated society. Any “fresh start” would still have to deal with governance and revalidation, which have been firmly placed on the current agenda by the present GMC.

The abyss Smith describes is certainly there, and the GMC may be at its edge. Despite its current problems, however, the GMC is the crucible of our professionalism and without it doctors in this country would become mere technicians.

Any alternative to professionally led regulation is unthinkable.

Footnotes

Dr Keighley receives an honorarium as a medical screener.

References

BMJ. 2001 Jun 30;322(7302):1599.

People should be wary of the alternative

Graham Forbes 1,2, Sue Leggate 1,2, Bob Nicholls 1,2, Chris Robinson 1,2, John Shaw 1,2

Editor—As lay members of the General Medical Council, we know that we have a particular responsibility to discharge properly the GMC's first duty: the protection of the public. We are in no doubt that all members of the council—medical and lay, elected and appointed—strive hard to ensure that patient wellbeing is at the forefront of their work in standard setting, education, and registration, as well as in the fitness to practise procedures. Equally, we support the major reforms now under way to ensure that the GMC's processes and values remain in tune both with rapidly changing medical knowledge and practice and with society's expectations in a new century.

Radical change is uncomfortable, and the present debate reflects this, but it is essentially about means, not ends. Smith asked whether the GMC is worth saving or should be replaced by some other form of regulation altogether.1-1 The only other alternative to professionally led regulation seems to be a licensing and inspection system run by government. Experience in other professions and in other countries suggests that this would be demotivating for doctors and much more expensive to operate. In addition, it could produce conflicts of interest as full determination of standards and quality and responsibility for the organisation and resourcing of health become vested in the same body.

As patients and carers, we want our doctors to be governed by their consciences as well as their contracts. As lay members of the public active in the GMC, we are well aware of the many hours put in by doctors on a largely unpaid basis. We are convinced that the active involvement of practising doctors in all the council's functions is crucial in keeping it up to date and maintaining the trust and support of both the public and the profession.

The key requirement is to make the GMC fit for a purpose so that it retains professional support while meeting the legitimate expectations of the public. We think that the changes currently in train, while capable of some adjustment, must be carried through to ensure that the GMC provides an environment in which doctors continue to enjoy the trust of the public.1-2 Medical regulation through the GMC with its growing partnership of medical and lay members remains the best way of “protecting patients and guiding doctors”; any other mechanism really could be a step into the abyss.

References

  • 1-1.Smith R. GMC: approaching the abyss. BMJ. 2001;322:1196. doi: 10.1136/bmj.322.7296.1196. . (19 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Ferriman A. Poll shows public still has trust in doctors. BMJ. 2001;322:694. . (24 March.) [Google Scholar]
BMJ. 2001 Jun 30;322(7302):1599.

GMC: keeping feet on firm ground

Denis Pereira Gray 1

Editor—Smith queries the functions of the General Medical Council in the new heavily regulated era for medicine.2-1 Coordinating the medical schools, constructing the profession's ethical code, and setting baseline professional standards, are three of them and would not be done more appropriately by the state or its agencies. Professional regulation (not self regulation) to protect the public requires a strong partnership between lay and medical representatives. Many doctors still think that choosing, through elections, the doctors on the regulatory body is better than any alternative.

Smith concludes that the GMC is failing. Before seeking fresh alternatives, as he suggests, many members of the Academy of Medical Royal Colleges are currently working hard to seek agreements to the two main issues of governance and revalidation.

Looking over an abyss can be one way of learning how important it is to keep your feet on firm ground.

References

BMJ. 2001 Jun 30;322(7302):1599.

Time to go

Gareth Lloyd 1

Editor—It is time for the General Medical Council to go.3-1 With the possible exception of its health committee, it has a long history of being draconian, of incompetence, and of poor leadership. Its slogan, “Protecting patients, guiding doctors,” reflects typically muddled bifocal thinking.

There is no future in revalidation. There is no instrument that will effectively detect a dysfunctional doctor with any degree of reliability until the doctor makes a mistake, when it becomes too late. It has to be ultimate folly to believe that doctors, apparently unlike any other professional, will willingly report failures and faults themselves. It is equal folly to assume that fellow workers will have the time, energy, or motivation to be watchdog and reporter.

The only solution for the GMC is disbandment. The work of the health committee has been of sufficient quality and standard as to be replaced by an equal.

References

BMJ. 2001 Jun 30;322(7302):1599.

Australia may show way foward for the United Kingdom

Peter Arnold 1

Editor—It seems to be common ground that regulation of the profession by the General Medical Council is better than an alternative, state run, system.4-1 Ultimately, the argument concerns the power of the GMC or some other body to suspend or strike off a practitioner. Perhaps this is a false choice.

No doctor should be deprived of the ability to earn a livelihood other than as a consequence of due process when an alleged, serious misdemeanour has been investigated and proved. If that belief is shared by all, then the question is whether or not a body, constituted as is the GMC, in its present or any alternative form, is an appropriate body to execute such justice. There is always a risk of its being perceived as biased, either towards a favoured son or against a thorn in the side of the establishment.

One of the former British colonies resolved this problem many years ago. In New South Wales the powers of the medical board do not include suspension or deregistration. The Medical Practice Act gives this power to the medical tribunal. This comprises a judge of the district court; two medical practitioners appointed by the Medical Board from panels nominated by the colleges, the universities, the Department of Health, and the Australian Medical Association; and a lay person chosen from a panel nominated by the Minister for Health.

The medical board itself makes no adverse decisions about any doctor, other than about eligibility for initial registration. All inquiries that might have an adverse outcome for a doctor's right to practise are conducted by committees that are independent of the board but governed by the Medical Practice Act.

Might this help the debate in the United Kingdom?

References

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