Reviews

All gloss and noise

On 29 June the BMA conference passed a historic motion of no confidence in the General Medical Council, the regulatory authority of its own profession. The GMC had been "shamed," said the Times, and the Guardian suggested that the government had been handed a "trump card" to abolish the GMC altogether (30 June).

This may well be the mortal blow to an organisation already reeling from a sustained attack from both the media and the broader public. How is the GMC fighting back?

Its latest effort to do so is a sorry dumbing down of its newsletter, GMC News, out this month. Glossier and noisier than its predecessor, it proclaims its key messages in letters up to 4 cm high. On the front page an attractive white doctor oozes empathy from under his white coat to an attractive white mother and child. The large headline screams: "HELP SHAPE THE NEW STANDARDS." Inside, the bold typeface ingratiates,as it yells the key words "TACKLES," "TOUGHER," and "LESSONS." The newsletter trumpets the GMC's "BID TO STRIKE A FAIR BALANCE." Smiling faces reassure and cartoons amuse.

We are informed that the aim of this "more attractive design" is to stop the newsletter from hitting the bin unread. It is paid for largely by advertising, and the advertisements themselves tell a story. Many of them offer mock antique furniture for your surgery, dark leather and authoritarian in style, that will take you back to a bygone Oslerian era before the public revolted. Others offer escape to hotels around the country. The newsletter looks like a knee jerk response born of panic, at a time when the GMC should remain calm and level headed.

The determinants of the GMC's demise are easy to list. There is the growing demand from "consumers" of healthcare "commodities" and the reluctance on the part of doctors to respond to the partnership approach increasingly demanded by the public. Successive governments are increasingly distrustful of self regulating professions, suspicious of their elitism and of career structures where patronage predicts advancement. The GMC's selection procedures, and its racism, arrogance, and fear, are other factors in its downfall. The GMC has been so wrongfooted by the confluence of these forces that it now looks very much out of touch.

If the GMC is to survive, and right now that must be a huge 4 cm "IF," then it needs to understand what it is to be a profession in the 21st century. Sociologists describe a process of professionalisation that characterises the steps taken from the margins to the establishment. Medicine is a wonderful example of this process.

The profession itself controls entry and enforces legislation that enshrines the right to self regulation. The GMC needs to ask what are the next steps for our firmly rooted profession to advance. If self regulation is here to stay, then the GMC must regulate not only performance but also openness and accountability.

The government, the media, and the public are watching closely. The BMA, by its no confidence motion, is distancing itself from this wounded body.

GMC News reflects an organisation anxious and fearful. But we must be careful not to scapegoat the organisation and so avoid the root and branch reform and cultural change that are needed.

The GMC has launched its long awaited consultation document Revalidating Doctors. It is trying hard to listen above the din. They say that hearing is the last sense to go before you die. (See also pp 61, 69, and 123)

Gregory Battle, general practitioner. 

London