The New GMC – The Spanish Inquisition?

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The GMC was set up by an act of the Parliament in 1858. Since then there have been several modifications and changes to its role. The Medical Act 1983 (amended) notes that, “The main objective of the General Council in exercising their functions is to protect, promote and maintain the health and safety of the public”.
The GMC website states that it is concerned with ensuring that doctors are safe to practise. Its role is not, for example, to fine doctors or to compensate patients following problems.

What the GMC can’t do
The GMC cannot:
deal with concerns or complaints about nurses, pharmacists, dentists, opticians, hospital or practice managers or administrative staff, or anyone who is not a registered doctor;
normally give you a detailed explanation of what happened to you. This can only come from the doctor or health provider;
order a doctor to provide the treatment you want;
pay you compensation;
fine a doctor;
order a doctor to give you access to your records;
make a doctor apologise to you.

An independent report cleared the GMC of racial bias in 2000 despite finding 50% of doctors struck off in 1999 were from overseas qualification whereas only 38% were UK qualified.  While the overall number of complaints received about overseas-qualified doctors was roughly representative of the group as a proportion of the medical profession (about 27%-29%), the number of cases, which were then referred up to the Fitness to Practice Panel, was extremely disproportionate. The study found this bias “impossible to explain”.  Several excuses were put forward for this anomaly – doctors working in pressure areas, locums, high-risk specialties and even the influx of doctors from the commonwealth in the fifties and sixties when the regulation was not as strict as it is now.  Concern has also resulted from several studies, which have shown that GMC handling of complaints appear to differ depending on race or “overseas qualification”.

Mortality among doctors referred to FTP:

In a response to a request for information using the Freedom of Information Act, the GMC revealed that 68 doctors had died during FTP proceedings.  The mortality and morbidity amongst doctors going through these procedures is one of the highest of any profession going through similar investigation.  In 2003/4 between 4 and 5% of doctors undergoing fitness to practice scrutiny died.

Dr Clare Gerada, chairperson of the Royal College of General Practitioners warned of over-regulation in 2011 (http://www.pulsetoday.co.uk/gerada-warning-on-over-regulation-after-documentary-secretly-films-gp-consultations/12822006.article#.VGjJGfmsWX8):

We already spend up to £1bn regulating doctors. We are one of the most over-regulated professions around and there will always be people who fall through. If we pile on more and more regulation, we will never win.

Sir Liam Donaldson, the then Chief Medical Officer, echoed concerns about the FTP procedures in his report “Good Doctors, Safer patients” in 2006 – In his view, complaints were dealt with in a haphazard manner; the GMC caused distress to doctors over trivial complaints while tolerating poor practice in other cases. In his report, which was broad ranging, he accused the GMC of being “secretive, tolerant of sub-standard practice and dominated by the professional interest, rather than that of the patient”.  (http://webarchive.nationalarchives.gov.uk/20130107105354/http://dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_4137232).

The GMC has now released this new guide to sanctions, which goes a long way to make it draconian to say the least.  There is nothing in the document to safe guard doctors against incompetent assessment.  We have seen that any doctor referred to the FTP is more often than not treated as guilty unless proven otherwise.  In a court of law, the accused is treated as innocent until proven guilty.  I would not be surprised if the statistics of deaths and morbidity among doctors referred to the FTP will increase due to the new sanctions guide.

Changes to our sanctions guidance

Reviewing how we deal with concerns about doctors:

A public consultation on changes to our sanctions guidance and on the role of apologies and warnings

 

Our proposed changes guide panels to:

  1. Take appropriate action to protect the public interest without being influenced by the personal consequences for the doctor.
  2. Take action in all cases where a doctor’s fitness to practise is impaired, unless there are exceptional circumstances which meet a specific definition.
  3. Take appropriate action to maintain public confidence in doctors even when a doctor has remediated.
  4. Consider more serious action where cases involve a failure to raise concerns, failure to work collaboratively, discrimination or abuse of professional position involving predatory behaviour.
  5. Consider the factors that may lead to more serious action where specific issues arise in a doctor’s personal life, which undermine confidence in doctors (e.g. criminal or civil proceedings).
  6. Consider specific aggravating and mitigating factors when deciding on the action to take in cases involving addiction or misuse of alcohol or drugs.
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