This article appears in the August 2000 edition of the Catholic Medical Quarterly

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In an atmosphere in which ‘Elitism’, regarded as the authority of self regulating bodies, is being widely questioned by the government, it is not surprising that the General Medical Council has come under extensive scrutiny. But what is unprecedented is when doctors themselves at the BMA’s annual representative meeting overwhelmingly declared their lack of confidence in the GMC as presently constituted and functioning. Very few wanted to abolish the council; the vast majority reaffirmed support for professional self regulation and for the principle of revalidation, although there was criticism of the GMC’s revalidation proposals. The discontent appears to centre on the state of the GMC and its current leadership. In a BBC television interview Sir Donald Irvine was asked abruptly ‘When are you going to resign, then?’ Such hype from the media illustrates the difficulties of the GMC, for, as a judicial body, it is restricted by law in what it can say and do.

But Sir Donald is a reforming President. In 1995 a programme was started to modernise procedures and ensure ready access to good quality services. By 1999 the traditional approach to medical education was ended: an approach which had been virtually unchanged since 1858.

Professional standards have been raised, bringing the public and the profession together on the essential attributes of a doctor. A new curriculum has been implemented in medical schools, laying the foundation for graduating doctors with the desired attributes. The pre_registration year and the senior house officer period have been reformed. A decision has been made to introduce regular revalidation of doctors registration. There have been substantial changes in the fitness to practise procedures which handle complaints against doctors. The pace of reform is accelerating, but it must be remembered there is always danger of going too fast.

The main target is the Professional Conduct Committee: on its behaviour the media is now weighing the survival of the GMC as an independent body. Perhaps the most immediate complaint is about the long delays in hearing cases. Delay makes the complainant more aggrieved and the doctor more anxious. It has been announced that a new triple track method is to be introduced to speed things up. However, if more cases are proved against doctors, the image will correspondingly deteriorate. Last year the Professional Conduct Committee (PCC) sat on 129 days considering new cases relating to 68 doctors. Medical members of this committee may be required to spend up to seven days every quarter on it, for which they receive only their expenses.

Meanwhile complaints are reaching record levels, 1534 in the first 6 months last year whereas the figure rose to 2047 in the corresponding period this year. There is a preliminary screening process by medical and lay screeners before a case is presented to the PCC. Then the scene becomes an open court with a lawyer for the prosecution and defence. Little imagination is required to understand why the delays occur, as each case has to be explored at length.

Sanctions range from admonition with further registration conditional on certain requirements for up to 12 months, to three years suspension or indefinite strike off the Register.

A bone of contention is that doctors erased from the Register are not given any indication of when if ever, they might have a chance of restoration. This raises problems, as a definite signal might fore shadow restoration after a suitable interval. But a recently introduced sanction of 5 years seems to many ridiculously severe, for it is quite impossible for a doctor who is not allowed to carry out any ‘hands on’ tasks to keep up to date for more than a year or two.

A disturbing feature of the resolution at the ARM was that it was mostly GPs who voted against the motion, leaving the consultants voting largely in its favour. Such a split in the profession leaves those sounding the death knell of the GMC rather smug.

Most doctors accept that there will have to be a mechanism to guarantee to the public they are competent, professionally, and up to date. Revalidation is the answer from the GMC. A summary of its proposals has been sent to every doctor for comment, but it has not received widespread acclamation from the profession. What is presented is a comprehensive audit of the standards of medical care and, it would seem, as most work in teams nowadays. their ability to liaise with colleagues. Doctors like other professionals are independent spirits, and the practice of medicine has many windows. The proposals envisage an annual appraisal with a five yearly assessment by a revalidation group. But an appraisal of professional competence must envisage conformity with a representative body of medical opinion: something on the lines of the Bolam test. Many representative bodies can be recruited in the profession. It should not, as a recent editorial in the BMJ pointed out, consist of attendance at many educational sessions and scoring well on tests of knowledge, for the doctor may still remain incompetent in practice. Dangers abound in such a solution.

What if the doctor’s treatments fail to correspond to what is now known as ‘evidence based medicine?’ Will managerial competence rank equally with clinical expertise? What if the doctor’s conscience refuses to allow referral for an abortion procedure? Obviously an amendment will be necessary to cover ethical decisions.

There are many grave dangers in acting hastily in the face of current misdemeanours. It has been demonstrated that the GMC has acted and continues to act in a severe manner when it is deemed necessary. The alternative is probably a committee with a large body of appointed persons and a smaller body of elected doctors without the power of veto.

Perhaps a better solution would be to support the reforming President with a larger body of elected doctors to enable the work, which has admittedly been slow in the past, to be completed more expeditiously.

The cry for abolishment should be transformed to a plea for improvement.

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