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 believe that forward thinking doctors will welcome this white paper, which puts the uncertainties of recent years behind us. The emphasis on the independence of the General Medical Council—independent of government as the UK's dominant healthcare provider and of dominance by any single group—is surely right if we are to command the confidence of everyone who receives and provides health care. We all need a lasting settlement.
The white paper stems from the four major inquiries that tragically showed what can go wrong when a tiny number of doctors depart from the high standards that are rightly expected of them. Professional regulation, however, must primarily be concerned with supporting and embedding good practice; the majority of doctors are good doctors who strive to be better. Support for ill doctors is particularly welcome.
The central role of the medical register is recognised, together with the GMC's four main functions: setting standards, coordinating all stages of medical education, ensuring that only appropriately qualified doctors are registered, and dealing effectively and fairly with concerns about individual doctors. These interlocking functions remain the basis for independent professional regulation built on the GMC's accountability for the fitness for purpose of the register and fitness to practise of those on it.
The principle of revalidation, which we first suggested 10 years ago, is now accepted. We must begin relicensing and recertification as soon as practicable.
The composition of the council will be changing, with equal proportions of medical and lay members. Council members need to be there because of specific interests, competencies, and commitment to the public interest; democracy on its own will not give us the most appropriate mix. We have agreed to introduce the civil standard of proof, flexibly applied, to take account of the seriousness of the allegations and the possible consequences for the doctor. This will not result in more doctors being erased or suspended but will enable appropriate restrictions on practice when that is necessary to protect patients.
The white paper extends our role in coordinating all stages of medical education, in defining and assuring standards of practice, and in modified plans for GMC affiliates. The further separation of adjudication is an incremental change, since we already have independent panels. Many doctors, as well as patients, have questioned whether we should both investigate and adjudicate, however well we perform the tasks.
Regulation is a dynamic process. The GMC has already made important reforms—and there is always more to do. This white paper provides a secure foundation for the GMC and for the medical profession in the years ahead.
Competing interests: None declared.