BMJ  2005;330 (1 January), doi:10.1136/bmj.330.7481.0-g

Editor's choice

An important debate on the GMC

The General Medical Council—the regulatory authority for UK doctors—begins this year in crisis. Dame Janet Smith's inquiry into failures of regulation that allowed Harold Shipman to murder over 200 patients delivered bad tidings to the GMC in the last days of 2004 (see p 10). Richard Smith, close observer of the GMC during his career on this journal, argues that the GMC's failing is that it has put expediency before principle, and that further difficult reforms are essential (see p 1).

Readers may have been under the impression that the GMC was already in the business of reforming itself by increasing lay representation and allowing people who are not members of the GMC to adjudicate on fitness to practise. That impression was a reasonable one, but Dame Janet's report condemns those reforms—I paraphrase here—as ill conceived, inadequate, and unlikely to regulate the medical profession to the satisfaction of the public and parliament.

Now the government has said that the GMC's introduction of revalidation for doctors—a key plank of its regulatory reforms—may be inadequate too, and ordered a review by Sir Liam Donaldson, England's chief medical officer. The GMC has agreed to put revalidation on hold pending the review. Revalidation was a process agreed after "intense battles," and the GMC retreating from an elaborate but rigorous assessment to one that the Smiths—Janet and Richard—argue will not do its job. Expediency created a method of revalidation that left many doctors baffled as to how it related to their clinical competence, and now leaves others concerned that it will fail to protect patients.

The culture of the GMC is once again under scrutiny. In 2005, a regulatory authority pontificating on the doctor-patient relationship must put protection of patients first, however much doctors may dislike this transfer—even betrayal—of loyalties. Inevitably, another lurch towards upholding patients' rights increases pressure on the vast majority of highly committed, competent doctors, who may see more reform of the GMC as a further intrusion into their clinical practice. But self regulation in all professions has become increasingly hard to justify.

Finding fault with the current system is not rocket science. Finding a solution is more complicated. Might there be lessons from other countries, such as board recertification in the United States of America? Might we learn from the way accountants, for example, are regulated? A quick fix is impossible, which is why we are inviting contributions to a BMJ debate on the future of the GMC and regulation of doctors in the UK and worldwide. Over the next few months we will publish invited articles, as well as the best of the contributions that are submitted to us. Regulation of doctors is the major challenge facing UK health care in the year ahead—and resonates elsewhere. BMJ readers must be at the heart of this important debate.