CMO's proposals must be resisted
From Dr Nev Bradley
Chair, Wirral LMC
The CMO's proposals for continuing professional development and revalidation ('Crackdown', News, 20 July) clearly show him to be a creature of government, clearly clueless about the workings of general practice and about whom little confidence was expressed at the recent LMCs conference.
His draconian, unfair and impractical proposals would seem more to seek to mire the profession with a collective guilt for the behaviour of Shipman than to have anything to do with education. They will prove wholly unacceptable to the majority of GPs and must be robustly resisted.
The medical profession fully understands the public's right to quality of service; indeed some backlash from the Shipman affair within the profession was expected. But the CMO's post-Shipman response is neither fair, practical nor measured.
GPs themselves already willingly undertake continuing professional development and an annual appraisal.
Even revalidation itself is seen by many as a bridge too far, but doctors will find it quite simply unacceptable
if on top of all of this they
have to repeat every five
years what amounts to a
repeat of their final examination as proof of competence merely to continue to practise.
The CMO's proposals about continuing professional development are an utterly impractical, professionally restrictive and excessive knee-jerk response to Shipman.
We now look towards our senior representatives at the GPC and call upon them to provide a robust and reasoned rebuttal of these wholly inappropriate proposals.
• From Dr Ailsa Sheldon
I read with interest of the 'crackdown'. I found it outrageous that after paying more than £1,000 to complete my MRCGP I then received no certification from the college until rejoining following my registrar year.
I then get a certificate with an expiry date on it. I am no longer a member as I feel I gain nothing from the college and therefore am unable to use the qualifications I earned (though I would be interested to know the penalty if I did).
It is now implied that I will have to join the college again and pay more for the privilege in order to jump through ridiculous GMC hoops to prove I am not incompetent.
If the CMO and GMC want to change the rules I suggest they foot the bill. I already pay the GMC enough money to humiliate professional colleagues and to make my heart skip a beat in fear every time its correspondence lands on the doormat.
If the GMC is so strapped for cash that an increase is necessary, perhaps it should focus on becoming more cost-effective rather than changing the appraisal system yet again.
• From Dr F Griffiths
I find it difficult to find temperate words to describe the shameful Donaldson report. I consider it an outrage, perpetrated on our beleagured profession by a member of the profession!
It is nothing less than betrayal, all in the wake of an elderly lawyer who should put her own house in order – and worse, that of a murderous psychopath.
I would also refer the author of this pernicious document to the clause in Good Practice which states: 'You must not make any patient doubt a colleague's knowledge or skills by making unnecessary or unsustainable comments about them.'
I would urge the whole profession to ensure that this CMO be made to resign forthwith.
• From Dr David Hay
Having read about the crackdown on all medics' behaviour, I feel moved to inform you of the sudden deaths of two individuals in the surgery at 10.30 this morning.
I admit guilt in the passing of a large hairy gentleman (Mr M. Domestica) and his smaller spouse and companion, crushed to death in my consulting room.
I have kept and read the murder weapon but need your help as to whether I should inform the GMC of this most heinous act, or leave them in post-lunch slumbers.
• From Dr Adrian Rogers
Many GPs will surely welcome knowledge tests for recertification. The current system of appraisal with its emphasis on woolly things – such as participation in audit, educational plans, working with colleagues, teaching, training and management activity – are not really fundamental to the practise of good medicine.
This is not to say they are not valuable, but it is to say that when it comes to deciding who can practise and who cannot, they should never be the ultimate arbiter.
Knowledge probably is a fundamental requirement and this, along with assessments of consultation style, will sort out who needs help and who should be thinking of retiring.
As one who trained 30 years ago, I would welcome this change and be prepared to meet it fearlessly. But when it comes to the assessment of professional impairment, I have serious reservations about changing from the criminal standard (beyond reasonable doubt) to that used in the civil courts (balance of probabilities).
Having given evidence to the GMC on a number of occasions, it seems to me that it could in many cases be grossly unfair to deprive a person of their livelihood for a misdemeanour on which there is reasonable doubt. If fitness to practise is to be assessed on the balance of probabilities, the ultimate sanction must only be used in the most severe cases.
There are few of us who could withstand a trawl through our consultations and not be found occasionally wanting. Assessing standards on the balance of probability could end up disabling a large number of useful doctors.
• From Dr Kailash Chand
Ashton under Lyne
I am surprised and horrified by the proposals of the CMO. Most of them seem destructive and unnecessary.
He wants competency tests with proper examination of knowledge. No other profession undergoes this kind of microscopic examination, scrutiny and hammering by busybodies.
Sir Liam is not a clinician. He should be reminded that we enjoy the highest public support – a lot higher than judges, lawyers and politicians and all those other do-gooders – in spite of the fact that we get maligned by the media since the Shipman affair.
I do not deny there are a few doctors who may need help, but certainly they are not criminals like Shipman. My suspicion is there will be a lot of sacrificial lambs.
The recommendations by Sir Liam are nothing short of cracking a nut with a sledgehammer (44 recommendations). The danger is the pendulum could swing to the other extreme.
The fundamental change in the way cases are conducted, dropping the required level of proof from 'beyond reasonable doubt' to a mere balance of probabilities, appears equivalent to Mugabe/Saddam justice.
This could prove to be worse that existing rules for international graduates. Patient safety is paramount and no one wants to put people at risk by bad practice.
But it seems wrong to be able to take away a doctor's livelihood because of something found on a balance of probabilities rather than proving something beyond reasonable doubt.
It opens the door to miscarriages of justice which will devastate the lives of doctors and their families.
There are a number of proposals in the report which are welcoming.
For example, the recommendation that the majority of GMC members would still be doctors, that cases would be dealt with more quickly and locally and the increased focus on rehabilitation and retraining.
However, the CMO's report recommends that in future members of the GMC would no longer be elected but appointed.
The worrying part is that the proposals add up to an elimination of elected professional members and thus an erosion of professionally-led regulation – a move that will alienate most doctors.
I believe doctors will be seriously concerned at having no elected representatives on the GMC.
The GMC shall become another quango in a long list of wasteful creations of this administration.
Furthermore I have considerable reservations about the plan to take adjudication of cases away from the GMC and give it to another, as yet unnamed, body.