THE General Medical Council (GMC) was set up in 1858 to register genuine medical practitioners and make a distinction between them and pretenders. This was in order to protect the public from quacks without proper medical knowledge mistreating patients. It was also to protect the reputation of the medical profession.
‘An Act, which whatever its shortcoming, will collect the scattered sheep of the profession into one fold, and put on them – as far as law can do so – a mark by which they may be known from pretenders.’ BMJ 1858.
It was to define a group with a special training and knowledge who were differentiated from others and would have their names placed on a special list.
The public recognises that being registered as a doctor meant that the person in front of them had a certain standard of training and qualifications, has been to medical school and passed examinations.
This engenders trust. The GMC has responsibility for seeing that those on the register are fit to be there.
What is in a name. Everything. A pilot is not a flight assistant, an air steward, or a baggage handler. The name should correctly demarcate one type of training from another. This protects the patient and the public.
Since the advent of the NHS plan, the government has embarked on a conscious policy of blurring professional boundaries and confusing names called ‘workforce re-design’.
In particular the Department of Health (DoH) has openly stated that all the tasks of a doctor can be performed by a nurse, e.g community matrons can take a history, examine, carry out blood tests, make a diagnosis, prescribe, insist on hospital referral or not, give end-of-life advice and care for the patient in their home.
How anyone who has not been 5 years in medical school and studied anatomy, physiology, biochemistry, and pathology and then watched and learned about all the aspects of medicine (and sometimes spent further years in specialist training), can proficiently do this, has not been answered.
The GMC and the Chief Medical Officer have kept silent and looked the other way. They have been leaned on by the government and capitulated. What an outrage!
If the government maintains that nurses can do what a doctor can do, then let the nurses sit the same final medical examinations as doctors and achieve the same qualifications.
You cannot have a nurse masquerading as a doctor and taking on a doctor’s responsibilities without being registered with the GMC.
If he or she cannot perform those duties to the same standard then he or she should not be doing them and cannot have the ‘mark’.
That is what the GMC was initially set up to insist upon. To protect the public from pretenders.
Last month, the enormity of this state of affairs was catapulted into the public domain, by a conscientious whistleblower.
Dr Anila Reddy, who outlined the unsafe state of affairs in one of the new four private, nurse led walk in centres and resigned his post.
He wrote to Patricia Hewitt, the GMC, the Health Commission, the company, and the BMA .
He started: ‘I am writing this letter in accordance with the GMC guidelines which make it clear it is expected of me in my duties as a doctor to bring to the attention of my superiors a situation where patient safety is being put at risk.’
He noted that the private company did not stipulate that there should always be a doctor present; that nurses could decide on their own competency to see patients; that any type of nurse from a district nurse to a nursing home nurse could see new patients.
The casemix included children and the acutely unwell.
He writes: ‘In training to be a doctor one is continually on a daily basis being assessed on our history taking and examination skills. These are further tested in rigorous undergraduate and postgraduate examinations . . . The nurses are now seeing the same patients as we do.’
Further: ‘It should be obvious that managing minor illness well by its very nature, means being able to detect more serious illness masquerading as minor illness. I ask you all to consider what is being meant by being qualified to see a patient?’
Referring to nurses seeing sick children, he asks: ‘How after a few days training are you letting these same patients be seen in such an unregulated fashion?’
The abstention of the GMC from carrying out its statutory duties, has allowed the the DoH to get away with this blurring of boundaries where less well qualified staff are given the responsibilities of more qualified staff.
Because the main arena of work is the NHS, a highly regulated environment, where senior colleagues are around to give ‘cover’, the results of this policy have been hidden.
But in the corporate private sector this is not the case. There, care is production-line for profit with low skill mix, and unit costs.
The plan for the staffing of the new private corporate ‘specialist community hospitals’ is with nurse and other ‘practitioners’.
There, the terrible consequences of this policy of deregulation, will be reaped.
Already, the BOA (British Orthopaedic Association, Channel Four and the BMA’s CCSC (Central Consultants and Specialists Committee) have exposed the lack of clinical governance, lack of properly qualified surgeons and poor outcomes in the ISTCs (Independent Sector Treatment Centres).
When asked for information the DoH claims commercially confidentiality.
The government is proceeding, to outsource 100 per cent of clinical services to the private sector. How dangerous is this?
Donaldson states that the best ‘business plan’ is the best ‘quality plan’. That is not the view of the private companies as evidenced by the new walk in centres. It will be nurses instead of doctors because they’re cheaper and Donaldson knows it.
Where is the GMC and the Chief Medical Officer ? How have they responded to the exposures of the ISTCs? How have they responded to Dr Reddy? By keeping their mouths shut.
While these outrages continue in the commercial private sector where nurses and other non doctors are left to see new patients outside their sphere of competence, putting patient safety at risk, the Chief Medical Officer, decides to recommend the end of professional self regulation for qualified doctors and proposes the most draconian government regulation ever, to be instituted in 2006.
If the Chief Medical Officer and Dame Janet are so concerned about patient safety, let them stop nurses doing doctors’ jobs, and audit the private sector like they do the NHS.
One can only conclude that the abolition of the GMC as we have known it, has nothing to do with improving patient safety, but everything to do with instituting a ‘big brother’ medical regulation system to end the professional independence of the medical profession, at a politically sensitive time for New Labour, as the government tries to break up and destroy the NHS.
