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Independents' Day

Just who sits in judgment on GPs at the GMC?

As concern grows over the number of GMC judgments being reversed, GMC member Dr Brian Keighley explains how the problem is being tackled

GMC disciplinary hearing, a quasi-judicial procedure that threatens one's reputation and livelihood, is any doctor's nightmare. Doctors rightly expect scrupulous fairness, and some recent Privy Council reversals of GMC judgments have raised quite a few questions. As a GMC member I shall attempt to put matters into context, but in doing so I must make it clear that I am not commenting on any individual case.

Only a small minority of about 4,000 annual complaints ever come to a hearing and a successful appeal against an adverse finding is extremely rare. Over the past five years the proportion of clinically related complaints has roughly doubled and the penalty imposed for serious professional misconduct (SPM) involving clinical offences has sometimes been thought to be too severe by the Privy Council.

Some have speculated that recent reversals are because of the employment of panellists who are not themselves GMC members. There has been a huge rise in the number of complaints and sitting days between 1995 and 2002 (1,503 to 3,943 and 83 to 651 respectively). This led to the council's 2000 decision that the regular pool of GMC members could not possibly service this commitment and thus maintain consistency. GMC associates were therefore recruited and appointed on a contractual basis.

For the first time associates were selected for specific qualities demanded by the role, receiving appropriate training and undergoing performance appraisal, rather than merely being appointed by a royal college or attracting votes in an election.

Another suspicion is that reversals have increased because of an increasing proportion of lay panellists. My experience of panels suggests it is the medical members who are more 'hawkish' and there is no evidence that reversals are related to the panels' relative composition.

Where there does seem to be some foundation to criticism, however, is the variability of penalty visited on those found guilty of SPM. This inconsistency is also echoed in the criminal courts, producing tension between the judiciary and the Executive. In their defence, panels have often heard many days of detailed evidence and also evidence in mitigation.

That mitigation receives varying weighting from panels and a committee decision, reflecting a consensus, is often more vulnerable to Privy Council review.

The introduction of fitness to practise reforms next year in response to the European Convention on Human Rights will change the situation radically. The GMC will adopt exclusively an investigative and prosecution function. Adjudication, while still under the 'GMC umbrella', will become separate with a renewed effort to produce continuity and consistency through training and performance review.

A separate adjudication branch will hear cases on evidence laid by the GMC and panel chairs and members, whether lay or medical, will not be drawn from the GMC itself. All who perform this function will by then be specially selected and trained for the role.

It is, of course, crucial the GMC gets it right and the council constantly strives to achieve just that. But the reassurance for doctors is that despite a cluster of reversals, there is an effective appeals mechanism at a time of change that indeed causes us to pause, reflect and refine our processes.

The medical panellists tend to be more 'hawkish' than the lay members~

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