Will we be getting good doctors and safer patients?

Abstract

Last week, the Department of Health announced its plans for reforming regulation of doctors. The BMJ asked some of those affected for their opinions

I argued in November that the chief medical officer's proposals for reforming and restructuring the General Medical Council represented a major assault on the principle of professionally led regulation.¹ The white paper Trust, Assurance and Safety sweeps that principle aside completely and for all health professionals.²

Government has accepted Janet Smith's argument that being an elected member of a regulatory body, and by implication accountable to a constituency of fellow professionals, is not compatible with acting independently in the public interest. The white paper repeatedly refers to the risk that the standing of a regulator is impaired if the public perceives it to be in hock to the profession it regulates. However, there must be an equally substantial risk that public confidence in the independence of their doctors is undermined if patients believe them to be under state control. Government needs to face up to the reality that 25 years of independent opinion polling by MORI confirms that the public trusts doctors, not politicians, to tell them the truth.

Some progress has been made since the consultation.³ The GMC's role in governing undergraduate medical education has been secured with a solid, tripartite structure for undergraduate, postgraduate, and continuing education.

The proposals for GMC affiliates have been moderated and the vital responsibility of medical directors for clinical governance recognised. Proposals for relicensure and recertification still need much greater clarity, but the white paper explicitly recognises that the majority of doctors retain a lifelong enthusiasm for learning and for developing their practice.

The GMC has already separated the governance of regulation from the delivery of casework, but its good faith in so doing has not been rewarded. Instead, it further loses the right to adjudicate hearings, with its role confined to investigation and prosecution. I am unconvinced that this further separation of functions is necessary or proportionate. It does at least open up a route for the GMC, as the body that sets standards of conduct and competence, to appeal against the findings of disciplinary panels if they fail to uphold those standards appropriately.

However, if the GMC is now the prosecution service for medicine, and if a civil standard of proof is to be deployed, doctors are likely to feel that they are paying not for the privilege of professional regulation but to be policed. I understand and respect the decision of the GMC to embrace the white paper and to work with the grain of emerging public thinking on regulation. But I do have real concerns about how these changes will affect doctors' sense of ownership of their profession and their role in shaping its future.

Professionally led regulation was never a right, nor was it just a privilege. Fundamentally, it was a responsibility on doctors to act in the public interest. Its passing will serve the interests of neither patients nor the profession.