A DEPARTMENT of Health (DoH) report from the Chief Medical Officer (CMO) Sir Liam Donaldson, 202 pages long was published this July called ‘Good doctors, safer patients. Proposals to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients’.
This document proposes fundamental changes to the structure and the functions of the General Medical Council (GMC), making it unrecognisable, constituting the end of professional self-regulation.
It proposes the GMC becomes a board consisting of members appointed by the Public Appointment Commission. It would no longer contain doctors elected by the medical profession which comprise over half of the 35 members at present. In essence the new body would be government appointed.
There is to be a vast increase in government regulation of doctors.
The new body would have a hugely expanding regulatory role, in terms of investigating cases and preparing cases like a crown prosecution service. Its adjudicating role would be lost.
At present the GMC:
– produces standards in the form of a written code of good practice.
– supervises the education of medical students.
– keeps and manages the register and specialist register and PLAB (Professional and Linguistic Assessment Board)
– investigates and adjudicates in fitness to practice cases.
The new body would:
a) lose its educational role in the supervision of medical school education and organisation of PLAB, which would be taken over by PMETB (the Postgraduate Medical Education and Training Board).
b) Still produce its code of good practice, and keep the medical register.
c) Investigate fitness-to-practice cases.
d) Lose its adjudication role which would pass to an ‘independent’ tribunal, consisting of a lawyer, a doctor and a lay person.
The burden of proof used would be that used in civil cases not criminal, and therefore doctors could be struck off the medical register losing their livelihoods on the balance of probabilities, rather than the criminal standard of beyond reasonable doubt, by a tribunal essentially government appointed.
e) The investigatory role of the new body would mushroom to include a massive network of ‘GMC affiliates’ in every work place.
These senior doctors would have special training and be financially rewarded, would work with the local employer and be informed and involved with complaints.
They would keep a log of ‘recorded concerns’, which they would pass on the GMC centrally and these would collect on each doctor’s record.
To get one removed from the Medical Register, the doctor would have to appeal to the central GMC.
In this way, the government would have a network of medical agents watching other doctors at work.
Also, medical students would be ‘regulated’ by a GMC affiliate while at medical school to check on conduct even before starting practice.
f) The culture and viewpoint of the new body would be totally different.
Up till now, the prevailing concept has been that the vast majority of doctors are competent and the occasional few have fitness-to-practice problems.
Referrals to the GMC were only resorted to if the problem could not be sorted out locally or with the help of the NCAS (National Clinical Assessment Service).
The culture we had was that doctors were competent unless there was evidence to prove otherwise.
Moreover, the GMC and the medical profession had accepted in the last five years, that in order to make this transparent, that doctors should engage in annual Appraisals and five-yearly revalidations.
Donaldson’s document proposes the complete opposite view of medical practice – that doctors are incompetent until proved otherwise.
This is the view of Dame Janet Smith, which he uncritically endorses. He constantly reports how Dame Janet regards appraisals as a whitewash. No evidence is given for this and he repeats this allegation so many times that he represents it as an established fact.
Instead he proposes
1. Re-licensure. Medical registration and licence to practice should terminate annually. Re-licensing would involve a revised assessment scheme including 360 degree appraisal commissioned from an independent organisation and include input from the GMC affiliate.
2. Re-certification. Specialist registration would terminate up to every five years. In order to be maintained on the specialist register, the doctor must reach standards set by the college, measured by knowledge tests, simulator tests, CPD, observations of practice, or audit data. In this way, the Royal Colleges would be drawn into the centre of medical regulation, by policing their trained colleagues.
This is all being done in a big rush.
The consultation period lasts till just November. According to Donaldson, the last big review of the GMC was in 1972, when the Merrison committee deliberated until 1975.
It is being done in the context of a huge attack on the NHS.
This week, Patricia Hewitt Health Secretary proposed unlimited privatisation of clinical services, adding that the that the District general Hospital (DGH) is outdated and that there must be care for patients in their homes.
Last week, David Nicholson, NHS Chief Executive, demanded 60 hospital reconfigurations, in which DGHs will lose their A&Es, paediatric or maternity units, or disappear entirely.
This is at a time when Consultants are trying to maintain high quality care under the most difficult circumstances – hospitals with turnaround teams making drastic cuts in numbers of consultants PAs (Programmed Activities), surgeons’ operating times being cut, staff who leave not being replaced, clinics without receptionists, fewer trained nurses on the wards, reduced secretarial support, constant job-planning meetings. There are uncertainties as to whether the department or hospital will remain intact.
There are dermatology and rheumatology colleagues under threat of redundancy.
In the middle of all this, the Chief Medical Officer comes along and alleges that we are all basically incompetent and should be re-examined every year, that we should be policed by GMC affiliates in the work place who will log ‘recorded concerns’ about us on centrally held records; that we are not fit to regulate our profession ourselves and that the government must do it; that we can no longer supervise the education of undergraduates via the GMC as was.
This document is a total and dangerous diversion from the main issues affecting the medical profession and patients.
It is designed to lay the blame for all the problems in the health service at the door of bad doctors at a time when our National Health Service is being dismantled and sold off.
The real big threats to patient safety are scarcely mentioned.
These threats are massive funding cuts to NHS hospitals with the withdrawal of high quality consultant-led services, reduction in nursing and support services, and reduction in beds.
– The introduction of demand management, with GP referrals diverted from consultants.
– The transfer of hospital services into substandard ‘community care’.
– The introduction of privatised clinical services, where there is no clinical governance, and the blurring of boundaries between professions.
It constitutes a vicious attack on the independence of the medical profession.
Why is the government so determined to bring in draconian government regulation of doctors and medical students at this point of time after 150 years of self regulation?
Not because the medical profession is suddenly full of bad doctors.
No, it is because we are independent professionals.
We do have pride in our work and we are conscientious in wanting to provide for our patients.
We do stand up for services and we do not want our hospitals closed down or privatised.
They aim to use a new style ‘GMC’ as a government policeman to threaten us with ‘recorded concerns’ if we step out of line.
The new contract means we have to collaborate and promote trust objectives. This may mean increasing productivity to meet targets and tariffs, and sacrificing teaching and training, or keeping quiet about deteriorations in care to satisfy commercial confidentiality of business foundation trusts etc.
The medical profession has to totally reject this document.
