Sir Donald Irvine was president of the General Medical Council between 1995 and 2002. The Doctors' Tale has been written “for anyone... who is interested in what may be seen as an important moment in the history of medicine in the UK.” Sir Donald aims to give the reader an insight into the medical profession, its culture, and what makes it tick. Consequently, he devotes the first few chapters to the origins of the “medical tribes,” the development of professional self regulation, and the introduction of the NHS.
Figure 1.
Donald Irvine
Radcliffe Medical Press, £21.95, pp 247 ISBN 1 85775 977 X
Rating: ★★★
Born the son of a progressive, singlehanded general practitioner in Ashington, Northumberland, Sir Donald studied medicine at Durham, qualifying in 1958. After house jobs and vocational training, he joined his father in general practice before teaming up with colleagues in two other practices to form the Lintonville Medical Group—a multidisciplinary teaching practice. Later he became regional adviser in general practice, was a member of the Merrison Committee of Inquiry into the Regulation of the Medical Profession in the 1970s, and in 1982 became chairman of council of the Royal College of General Practitioners.
Figure 2.
Donald Irvine: mature reflections on Bristol
Credit: NICK SINCLAIR
Before his election to the presidency of the GMC, he chaired its committee on professional standards and ethics. In my view he was an outstanding chairman of that committee, which produced seminal publications, the most important of which were Good Medical Practice and Duties of a Doctor.
Three themes emerge from his account. The first is the importance of role models in his professional development. The second is a concern for the (undue) influence of hospital consultants—especially those working in teaching hospitals. The third is his belief that the BMA was a reactionary body. These factors were to colour his period as president of the GMC.
Donald Irvine inherited from his predecessor the implementation of the performance procedures, a task in which he was ably assisted by the new chief executive, Finlay Scott, who had already set about modernising the workings of the GMC and its divisions. Both of them recognised deficiencies in the GMC's disciplinary procedures, including the fact that a doctor who had been found guilty of serious professional misconduct could apply for restoration to the register after only 10 months.
It was, therefore, natural that, when concerns surfaced about the record of paediatric cardiac surgery at Bristol Royal Infirmary, Sir Donald should choose to chair the GMC inquiry himself. (This hearing investigated the conduct of two surgeons, James Wisheart and Janardan Dhasmana, and the infirmary's chief executive, John Roylance. Wisheart and Roylance were struck off the register; Dhasmana was banned from performing cardiac surgery for three years, a ban that was later extended.) Sir Donald describes the events succinctly in a 15 page chapter but, given the centrality of this episode, it is strange that the determination is consigned to an appendix.
In the aftermath of the Bristol hearing, Sir Donald moved rapidly in an effort to restore public trust—well aware that there were other high profile cases in the offing (those of the serial killer Harold Shipman, and the disgraced gynaecologists Rodney Ledward and Richard Neale). He concluded that there was a need for doctors to demonstrate that they were keeping their knowledge and skills up to date if they wished their names to remain on the register. He envisaged that this would require a new process, for which he coined the term “revalidation.”
This concept was put to the GMC for the first time in November 1998, by which time the government's new proposals for clinical governance—including audit, continuing professional development, and annual appraisal—had already been launched.
Despite unanimity that “specialists and general practitioners must be able to demonstrate—on a regular basis—that they are keeping themselves up to date and remain fit to practise in their chosen field,” the principle of linking revalidation with registration was deferred to a subsequent meeting. Although this was a major disappointment for Sir Donald (and drew adverse comment from some commentators), the outcome was unsurprising because the proposals lacked detail. Nevertheless, the time for reflection and further discussion was well spent and led to acceptance of the link at the next meeting of council. These events were followed by a challenge to Sir Donald's presidency in 1999 (the year in which I completed my term as an appointed member).
For me, the most interesting section of Sir Donald's book relates to the year 2000, which he describes as the GMC's annus horribilis with its high profile conduct proceedings, tensions within and between the medical tribes, and significant pressures from the government. Despite this, much was achieved including the launch of consultation relating to the revalidation procedures and the early stages of reform of the GMC's constitution. I enjoyed this section and Sir Donald's mature reflections on Bristol. The overall result has been a slimmed down GMC with much greater lay representation and strengthened conduct procedures.
By contrast, I found the chapter covering the years 1980-90 disjointed and the section titled “The doctors' tale: the next chapter” self indulgent. They detract from what is otherwise a well written account.