The Medical Act of 1858 establishing the GMC was a major watershed in the history of the professions in Victorian Britain. This statute was passed in the knowledge that over 30% of those practising medicine were unqualified for the work they undertook. The Act laid the foundation on which the current regulatory systems are based.
The move to install a regulatory system was obviously welcome, but it is clear the pendulum has now swung too far the other way. For many years, the body of opinion was affected by a belief in the supremacy of doctors. Notions that the GP engendered a sense of infallibility took a considerable knock in the wake of the Shipman case.
Following this outrage, the 2004 enquiry chaired by Dame Janet Smith held that the interests of doctors took precedence over their patients. The backlash of Shipman’s iniquities led to a regulatory framework determined to put the patient first. The Shipman conviction brought about much public reaction culminating in pleas for sweeping reforms later enacted in legislation passed in 2008 to make way for what was perceived as improved quality and accountability. More than at any time doctors’ claims for autonomy were called into question. But have the shakeup and the overly draconian measures gone too far?
I think they have. Many GPs undergo much heart ache due to vexatious complaints under the GMC’s regime, compounded by their long working hours and harsh working conditions. Concerns that the GMC’s regulatory powers are all-pervasive cast doubts on whether the existing arrangements are fit for purpose. One think-tank conducted a detailed review and found that as early as 2000 over-regulation was excessive, well before the impact of the Shipman trial actually kicked in and before the GMC adopted increased regulatory powers.
Surely the gate should be open for a measured form of regulation to make a positive impact on quality of care
A significant number of doctors under investigation have died, and statistics show the extent of suicide remains a harrowing feature of the medical profession. Some comfort has been drawn from the reinstatement of Dr Hadiza Bawa-Garba, after she was struck off following a gross negligence manslaughter conviction. Fortunately, with support of GPs and the rest of the medical profession, she now has the potential to resume her career. In the wake of this case, we need assurances for GPs who risk burnout and fatigue in an environment which is both under-funded and prone to staff shortages.
The Bawa-Garba case could be a turning point. Surely the gate should be open for a measured form of regulation to make a positive impact on quality of care. Taking early and effective action is desirable so as to prevent doctors having a watchdog constantly looking over their shoulder. A useful model to observe is that of the Medical Board of Australia, inviting doctors to engage themselves to develop knowledge, skills and professional behaviour in medical practice. A survey conducted by an Australian regulatory authority and comparing the extent of regulation between Australia and the UK concluded that the Australian version gave more attention to the workforce, bestowing more focus on training and individual welfare.
By contrast, the GMC has not achieved this aim and has not relented in dishing out excessive regulatory measures at the expense of neglecting the kind of training and development doctors deserve. The GMC would be wise to learn lessons from other professions, such as the record of the General Teaching Council for Scotland, which since 1965 has gained praise for making substantial progress in advancing both professional growth and learning among teachers.
I am not advocating a system of sweeping malpractice under the carpet. But surely we can strike a healthy balance in ensuring doctors are empowered to use their own professional judgement without over-the-top scrutiny while carrying out proper standards of medical care.
Dr Richard Willis is a historian at the Institute of Historical Research, University of London who has published extensively on regulation in the teaching profession
