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
Patients trust and respect the great majority of doctors and appreciate the skilful care they receive. We are tired of headlines exposing the few who let down the profession and shake our confidence. The measures in the government's white paper should ensure that doctors have an opportunity to show their expertise while patients can be assured that any doctor they consult is competent and deserving of their trust.
Self regulation has produced some spectacular failures: Harold Shipman, Bristol, Rodney Ledward, Richard Neale, William Kerr etc. Probably no one believes that another Shipman is lurking, but as Lesley Southgate, past president of the Royal College of General Practitioners, told the Shipman inquiry: “There are doctors out there who are harming patients.” It is time for change.
Patients have long believed that the General Medical Council looked after its own. Doctors finance it and therefore they expect its support. Up to now the GMC has acted as investigator, prosecutor, judge, and jury in fitness to practise cases. It is only right and just that these functions should be split and that an independent organisation will adjudicate.
GMC council members will no longer be elected but appointed, so that they are not chosen on a particular manifesto. The professional majority will go. This will be an improvement only if lay members are genuinely lay. Objectivity is questionable for those who spend their lives working in the health service.
The most contentious measure is the change in the standard of proof in fitness to practise cases from beyond reasonable doubt (criminal standard) to the balance of probabilities (civil standard). This is about patient safety. The Family Court can take children away from their parents permanently on the civil standard of proof. In both cases the objective is prevention.
In the past, the tendency to give doctors the benefit of the doubt has ended in tragedy. Now it will be possible to act earlier on patients' concerns—well before the point where a string of patients are dead or damaged and a doctor is struck off. The aim is protective, not punitive. No one wants to see doctors struck off. What is needed is intervention—support, supervision, retraining—before conduct can reach this level.
The BMA believes that doctors will now begin to practise defensively rather than looking after the interests of their patients. We have more faith in doctors than that.
Most patients marvel that it has taken a string of scandals before the obvious necessity of medical colleges defining the skills and standard of performance needed for continuing membership has been recognised. The tightening up of appraisal to include a summative element is essential. The aim must be to gain an objective assurance that a doctor continues to meet the required standards. But we hope we can avoid a bureaucratic exercise with doctors wasting endless time ticking boxes.
If the changes are received in the right spirit by the profession and made to work effectively, then we can all move on, confident that the lessons of the past have been learnt. This will benefit doctors and patients alike.
Competing interests: None declared.