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

It is sad, but unsurprising, to see the changes in medical regulation suggested in Good Doctors, Safer Patients¹ being railroaded through unchanged despite the almost universal agreement among working doctors that they are fundamentally flawed (doctors.net.uk discussion forum). To quote Liam Donaldson, “There is little disagreement with the assertion that in 2006 every patient is entitled to a good doctor. Yet, there is no universally agreed and widely understood definition of what a good doctor is. Nor are there standards in order to operationalise such a definition and allow it to be measured in a valid and reliable way.”¹

The white paper proposes annual inspection of doctors. If this were a proposal to screen for a medical problem, it would fail to meet almost all of the World Health Organization criteria required to justify its introduction.² We do not have a definition to measure the doctors against; nor do we have any valid and reliable test that will separate the good from the bad. It is far from clear how many doctors are expected to fail, and there is no real plan that deals with the needs of failing doctors. How can this system succeed in its purported aim of protecting patients?

The proposals will, however, meet the pressing political need to “do something.” It will bring large financial rewards to the royal colleges.

Most failing doctors are not malevolent but have the simple human weaknesses of physical or mental ill health. The chief medical officer recommended the provision of support services in 1999.³ The evidence that easy access to support and treatment protects the public has been clear for a quarter of a century, yet still no action has been taken.³

The chief medical officer believes 5% of doctors fail over five years. But he is choosing to re-invent medical regulation instead of proposing additional powers for the National Clinical Assessment Service, which is already referred this number of doctors but finds it cannot act effectively.⁴ It seems far simpler to give the assessment service the power (behind closed doors) to work to the civil standard of proof and to require appropriate remedial training.

The government, guided by the chief medical officer, could protect patients and support doctors by providing adequate occupational health support, giving the assessment service adequate powers to deal with failing doctors, and allowing the reformed GMC an opportunity to succeed—all of which could be done quickly, without new legislation, and at relatively low cost. Its preference for grand schemes over practical actions comes at the expense of both doctors and patients and will in due course be seen for the folly it is.