Editor—Esmail is looking at things from the wrong end of the telescope when claiming that the General Medical Council has failed to grasp the issue of scrutinising doctors' performance.1 Surely the main lesson that has emerged from the various recent inquiries is that employers of doctors (including primary care trusts) need to ensure that they have in place local systems that can deal quickly, effectively, and fairly with poor or dangerous practice.
That approach has—rightly—underpinned the government's quality agenda since 1997, and it was reaffirmed by Lord Warner at the conference of the Council for Healthcare Regulatory Excellence in March this year, when he said that the responsibilities of employers must be properly exploited before we load more on to regulators. We need proper clarity on the respective roles of each. What is needed is a proper understanding of the role of clinical governance in improving the quality of care and protecting patients from harm, and of the relation between clinical governance and GMC procedures, including revalidation. How curious, then, that Esmail does not even mention clinical governance once. By contrast, Dame Janet Smith devoted an entire chapter of the fifth report to it.2
The GMC is determined to look forwards, rather than backwards. As our contribution to Sir Liam Donaldson's review, established after the fifth report, we have set out a vision for the development of medical regulation over the next few years, which includes creating a robust system for revalidating doctors' licences to practise. As the regulator we want local systems to be subject to robust quality assurance so that evidence such as patient surveys, complaints records, professional development, clinical audits, and prescribing records provide the basis for confirming that doctors are up to date and fit to continue practising. We are certainly not “burying our head in the sand” but preparing to deliver the most significant improvements in professional regulation for 150 years.
Competing interests: None declared.
References
- 1.Esmail A. Failure to act on good intentions. BMJ 2005;330: 1144-7. (14 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.The Shipman Inquiry. Reports. Fifth report—Safeguarding patients: lessons from the past—proposals for the future. www.the-shipman-inquiry.org.uk/fifthreport.asp (accessed 7 Jun 2005).