'We can make the system work'
In recent months, the GMC has resembled a swan, gliding serenely across the water, the casual observer unaware of the frantic paddling taking place under the surface.
When the Chief Medical Officer's proposals on regulation appeared last July, the regulator, presided over by Professor Sir Graeme Catto, remained publicly muted while conducting a furious behind-the-scenes campaign to influence the plans.
The CMO's Good Doctors, Safer Patients report divided opinion and caused controversy even among the GMC's own council members.
But as the GMC steers its course through the new regulatory landscape, it can claim to have achieved many of the concessions it sought.
There is relief that the uncertainty of the recent past is now over and Sir Graeme defends the white paper's proposed regulatory system, which he says provides 'a very firm platform from which to face the future'.
Reforms such as the losses of adjudication, the professional majority and elected council members have led some commentators to talk of the end of self-regulation and of a weakened 'GMC-lite', but Sir Graeme dismisses these criticisms,
saying the remit is unchanged.
He does not feel there is a
legal need to separate out adjudication, which is already carried out by a separate group within the GMC: 'It's a matter of perception – although it's an important issue for many in the profession, it's a very small shift in what we're currently doing.'
Sir Graeme views the fact that the GMC will now be able to appeal against the decisions of the future adjudication body,
something which it has been demanding for years, as a more significant victory.
He also sees a continuation of current GMC thinking in the changes to the structure of council. 'It can't just be the great and the good. It needs to be representative of the profession at large,' he says.
But with victory comes
irritation at the 18-month hiatus caused by the wait for the white paper.
Sir Graeme admits: 'Of course there's a feeling of frustration – we put forward the concept of revalidation 10 years ago and it seemed like a good idea then. It would be good to be able to get on with it.'
This frustration extends to the lack of detail in the white paper and how it will translate into legislation.
He says: 'There's always a gap between what's proposed and what goes forward in legislation, and we would like to keep that gap as small as possible.'
Sir Graeme hopes the proposals will allow the regulator to move away from simply being
a bogeyman figure whose postmark on a letter is capable of
ruining any doctor's breakfast.
He feels the GMC should be setting the standards for doctors, taking responsibility for education throughout a doctor's career, as well as dealing with those whose fitness to practise is called into question.
One of the GMC's future responsibilities is relicensing, which will see doctors being assessed on appraisals.
Some appraisers are concerned changing this process will place them in a difficult position. But Sir Graeme believes most understand the information required from appraisal can be used in a formative and summative way.
The new era of regulation is unsettling for doctors, as medicine becomes ever more complex, and Sir Graeme admits that the move to a civil standard of proof in fitness-to-practise hearings is untested.
He says he hopes to introduce the GMC's own version of the standard in consultation with the profession: 'We need to get the principle established, sit down and see what the way forward is, then go out to consultation and end up with a set of rules to put into practice.
'I'm absolutely confident any system can be made to work.'
But he acknowledges: 'At the present time, the criticism's
absolutely right. It needs to be worked through.' He says the point is not to erase more doctors, but to help doctors with problems at an early stage before they get into serious difficulties.
He proposes a system that applies a civil 'balance of probabilities' test to performance matters and a criminal 'beyond reasonable doubt' proof for removal. However he recognises the fear among many doctors that they could be forced to practise more defensively.
'You need to be very careful any change doesn't create adverse consequences.
'I'm not sure doctors will act in that way but if they do, we have to address it and see how we can help.'
But Sir Graeme's mood is upbeat. He feels a palpable sense of 'enthusiasm uniting the profession'.
'We need to build on that, not lose it,' he says, 'and not carp about small problems.'
Sir Graeme Catto
• President of the GMC and clinical chair in medicine and therapeutics at the University of Aberdeen
• Knighted in 2002 for services to medicine and medical education
• Until 2005, vice-principal at King's College London; dean of the Guy's, King's College and St Thomas' Hospitals' Medical and Dental School; and pro-vice chancellor, University of London
Sir graeme on...
'It was a good idea 10 years ago – it would be good to get on with it'
Loss of GMC's adjudication role
'It's a very small shift in what we're currently doing'
Weaker standard of proof
'You need to be very careful any change doesn't have adverse consequences'