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Sliding scale standard of proof 'unworkable'

A 'sliding scale' standard of proof for judging fitness-to-practise cases will be unfair and unworkable, medicolegal experts are warning.

Their criticisms came despite Pulse's Justice for GPs campaign forcing some concessions from the Department of Health.

Under the reforms proposed in the regulation white paper, there will be scope to try doctors at different levels of proof according to the severity of the charge.

The white paper pulls back from the original proposals to judge all cases on the civil standard, citing Pulse's petition of 1,065 GPs as evidence of the strength of opposition from doctors (see below).

Chief medical officer Sir Liam Donaldson admitted his Good Doctors, Safer Patients document had gone too far in proposing the civil standard – usually taken to mean the 'balance of probabilities', rather than the criminal standard of 'beyond reasonable doubt'.

Speaking at a press conference last week, Sir Liam said: 'In our original document, we didn't explain standard of proof as well as we could have done.

'When we started to explain about the sliding scale, people who had serious reservations became much more comfortable. The General Dental Council already uses it so it's already used in the health field, and it's a well-established legal process.'

But a GDC spokesperson said its change to the civil standard had only taken place at the end of last July and that it was too early to judge the new rules. No professional conduct committee cases have yet been heard under them.

Medicolegal experts said they still had serious reservations about the plans.

Dr Hugh Stewart, a medicolegal adviser at the Medical Defence Union, said it was hard to see how a sliding scale could be applied: 'The facts are determined and then it's considered what sanction is appropriate, so how can you set a standard for facts when you haven't considered the sanctions?'

Dr Priya Singh, medical director at the Medical Protection Society, said: 'The stakes for the accused doctor in all instances are high and justify retention of the criminal standard.'

hcrump@cmpmedica.com

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