Should GMC leaders be put to the sword?

The growing dissatisfaction among doctors with the General Medical Council (the regulatory authority for doctors in the United Kingdom), which I wrote about just six weeks ago, has now boiled over.¹ The British Medical Association's annual representative meeting last week passed by a substantial majority a vote of no confidence in the council (p 69).² Despite intense battles in the past between council leaders and rank and file doctors, this is a historic first. The meeting voted in favour of self regulation and revalidation and only one or two representatives spoke in favour of scrapping the GMC. The discontent is with the state of the GMC and its current leadership. Could everything be solved if the leadership resigned? When football teams lose repeatedly, their managers go. Should medicine follow football? As always, it's easier to moan about the problems than identify the solutions.

The doctors' dissatisfaction has many causes and some are longstanding. The most immediate complaint is about the long delay in hearing cases. These delays are miserable for those making the complaints and for the doctors being complained about. This problem is in hand, and the GMC is about to introduce a triple track for hearing cases. One unfortunate side effect will be the increase in the number of “bad” doctors paraded in front of the public and the media.

A further anxiety is about the decision making processes of the council. The president and his close associates seem to decide policy. This is how it has always been with the GMC, but this concentration of power is increasingly unacceptable in a world where—rightly—medical students, junior doctors, and general practitioners are as important as deans of medical schools. The GMC needs to become more democratic, although it is challenging to both lead from the front and be inclusive in decision making.

The biggest—but least well defined—complaint is to do with public relations. Doctors are fed up with their bad press. Ordinary doctors who work long hours managing complex, emotionally draining problems for less money than their equals in other professions find it intolerable that doctors are depicted as villains rather than heroes. The media were as unpopular as the GMC at the BMA's meeting, but doctors know they cannot control the media. The GMC thus comes into the firing line, probably unfairly. In its dealings with the media the GMC has a more difficult time than most medical bodies both because it is restricted by law in what it can say and do and because it is in the position of the judiciary. GMC leaders are aware of the public relations problems and are trying to fight back, although their relaunched GMC News seems to be more style than substance (p 122).³ Most medical bodies—apart from the BMA—are underresourced and naive when it comes to public relations.

The most important battleground for the GMC might be revalidation, and this seems to be sparking the most dissatisfaction with the council among doctors. Most doctors recognise that there will have to be some mechanism to guarantee to the public that their doctors are competent, professional, and up to date. This is a worldwide phenomenon, and doctors are under attack from the media in many countries. The public might think that it should be simple to show that doctors are competent and professional and that their knowledge is up to date. In fact there is no well validated method for doing so. For instance, recording a doctor's activity in continuing medical education is almost useless because it is possible to attend many educational sessions, score well on tests of knowledge, and be incompetent. Recognising the difficulties, the GMC has gone for a process of revalidation that is way beyond anything expected elsewhere.⁴ It may be ahead of other countries, but it may also be ahead of what British doctors are willing to accept.⁵

The GMC's problems are in many ways the problems of British medicine. There are no simple solutions, and getting rid of the council's president and other leaders will not help. The government probably does not want the job of regulating the profession, but all politicians would be happy to see the political power of doctors reduced. It would make it easier for them to implement their policies, no matter how ill considered.

The motion of no confidence could be helpful because it signals strongly the unhappiness of ordinary doctors. But the most disturbing feature of the BMA debate may be that it was mostly general practitioners who spoke against the motion of no confidence and other doctors who spoke in favour. Doctors must work and speak together to solve the profession's problems. Blaming each other for them will take us nowhere.

News p 69, Reviews pp 122, 123