2009 - Judgment Year

The GMC recently released the following

"At the GMC Council meeting in April it was agreed that licences to practise will be introduced in the summer or autumn of 2009. Any doctor wishing to practise in the UK will need to hold a licence.The introduction of the licence to practise will be a critical step in the development and implementation of revalidation. Licensing and revalidation, once fully implemented, will greatly strengthen the system of regulation, providing patients and employers with the assurance that their doctor continues to practise in accordance with the standards set by the GMC.GMC President, Sir Graeme Catto, said:"We have long sought to implement a system of licensing and revalidation for UK doctors and this is an important step forward. The GMC has proven itself to be an effective and efficient regulator and I am confident that we can deliver this ambitious project. We will keep doctors up to date with progress via our website and GMCtoday."


Graeme Catto also writes in Advances in Psychiatry and states "Effective revalidation will provide affirmation of doctors’ entitlement to practise, and give the public the assurance that the doctors who treat them are up to date and fit to practise"

Criticisms of the then proposals led to a review and the publication of the White Paper (Trust Assurance and Safety, the Regulation of Health Professionals in the 21^st Century) in 2007. The key principles underpinning professional regulation are set out in the White Paper as follows:

• First, the overriding interest should be the safety and quality of the care that patients receive from health professionals.
• Second, professional regulation needs to sustain the confidence of both the public and the professions through demonstrable impartiality.
• Third, professional regulation should be as much about sustaining, improving and assuring the professional standards of the overwhelming majority of health professionals as it is about identifying and addressing poor practice or bad behaviour.
• Fourth, professional regulation should not create unnecessary burdens, but be proportionate to the risk it addresses and the benefits it brings.

Relicensing

• All doctors will need a licence to practise.
• Licences will be issued by GMC: based on Good Medical Practice.
• The licence to practise will be based on:

i. Satisfactory annual appraisal

ii. Participation in independent 360-degree feedback

iii. Any issues concerning the doctor’s conduct or practice have been resolved to the satisfaction of the medical director or responsible officer.

iv. Relicensure will be based on a positive affirmation of the doctor’s entitlement to practise, not simply on the absence of concerns.

Now lets examine this in more detail.

1. The Public Policy Institute and the Shipman Inquiry both severely criticised the workings of the General Medical Council. These public criticisms are still true today and we have seen no improvement in the general demeanor of the GMC.
2. The GMC regularly flouts Data Protection policies [ as seen in Pal v GMC and other cases]
3. If we for one second assume that the GMC is fit to practise, the above suggestions may well be legitimate and should not worry the population of doctors. The problem though is this, the General Medical Council is unable to cope with the current case load [ given the large numbers of appeals and challenges against it]. There has never been an assessment of the GMC's own Fitness to Practise. We have never had a independent study into the General Medical Council's functioning or ability to regulate the profession.
4. The GMC is facing a head on crisis in the Southall v GMC issues. There is a vote of no confidence by leading consultants involved in child protection [ http://www.paca.org.uk].

Relicencing and Revalidation will involve the GMC being in possession of far more personal data than it would otherwise have access to. This will make it broadly easier to victimise junior doctors, terminate their license due to a dislike and we must observe the fact that racial discrimination is said to be rife in the NHS. In 1994, the research showed some worrying problems " Doctors from ethnic minority groups in Britain are six times more likely than white colleagues to be brought before the conduct committee of the General Medical Council (GMC), according to research released last week by the Medical Practitioners' Union. Dr Sam Everington and Dr Aneez Esmail found that between 1982 and 1991 a total of 402 doctors had been brought before the committee, of whom nearly 60% were from ethnic minorities. Fewer than one in five doctors in Britain is from an ethnic minority". There was no independent inquiry into these issues.

The public should know that a 360 degree appraisal normally involves your colleagues and friends providing you with assessment and reference. If there is discord with one colleague who say may be a BNP member or one who develops a dislike for you, it is quite easy for the revalidation to be sabotaged. On the opposite side of the coin, a department that continues to conceal its bad doctors, will ensure that their colleagues are well supported. There is therefore a very limited option of ousting truly bad doctors. The system though tilts against the junior doctor who may be left vulnerable. The GMC makes no allowances for these local problems.

For those who have been astute will understand that the government is set on developing centralised databases. This has also been the aim regarding doctors. Do we trust the General Medical Council to be in possession of so much data which can be easily used against that doctor? Do we trust an organisation that sent the data of one doctor to another one accidentally? The data base the GMC has collects all prior complaints against doctors. For instance, if there is a vendetta by patient, the patient can repeatedly complain. The complaints may be dropped but the record of the complaints remain on the GMC database. The GMC has no vexatious complaints policy therefore in their view " the more complaints that exists against the doctor", the more acutely they will observe their fitness to practise and the more likely it is for the complaints to be passed to the next stage. The GMC's view is fairly narrow. Within their simple minds, the more complaints that exist against the doctor will mean the doctor may be a risk. It makes no allowances for the abuse of the GMC by those with a vendetta. Compensation seeking groups of patients may well use the GMC to bolster their cases.

In summary, this process partly suggested by the GMC runs roughshod over the doctor's rights and provides no protection for the patient. The result of the Shipman Inquiry is to tilt the balance against the doctor and against the patient and public. The only winners within these new procedures will be the vexatious complainants and those doctors who wish to use the GMC as a way of bullying their colleagues or juniors. Dame Janet's suggestions were extremely badly thought through without any concern for the doctor or the fact that the General Medical Council is itself prone to vendettas [GMC v Southall, GMC v Meadow]. The Shipman Inquiry never ordered a investigation and revalidation into the fitness to practise of the General Medical Council.

Dr Harold Shipman existed because the General Medical Council failed to prevent him from the outset. Everyone knows Dr Shipman's behaviour came to the attention of the GMC long before he was caught as a serial killer. The fault does not like with other doctors, it lies solely with the General Medical Council. We shall soon be examining the General Medical Council's role in Harold Shipman. This includes the fact that Harold Shipman was registered with the GMC as a convicted serial killer.

There is no reason why the medical profession particularly its junior doctors should pay a price for the incompetence of the General Medical Council.

2009 will see more doctors than ever facing the GMC. This is because the GMC will be streamlining the profession into those who they approve of. Those who they do not approve of and those who for instance write intemperate emails to the Royal Colleges about the MMC will either be given a warning or they will be caught within these draconian procedures. Given the vast majority of doctors are unhappy with the current structure of their training, any form of rebellion will be frowned upon. Using revalidation, the GMC will be able to effectively control the profession. An example of such control is this found within the transcripts of a GMC hearing "The Committee was very concerned by the contents of your e-mail to the GMC . This e-mail cast unjustified aspersions on the GMC's procedures and fairness".

The GMC seeks to achieve control of the profession in this way. At present, there is nothing to prevent this. The profession has to ask itself - is it right for a regulator who has been dubbed a "Totalitarian regime" to be in possession of vast quantities of data within its centralised system?