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Rapid Responses: Rapid Responses published:
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"Downward spiral of...confidence in the profession"
- Jay Ilangaratne (29 July 2005)
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A very welcome editorial
- Peter Gooderham (29 July 2005)
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GMC was correct in the Roy Meadow case
- Malcolm E Kendrick (29 July 2005)
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The quality of mercy
- John Stone (29 July 2005)
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GMC Leadership
- Brian D Keighley (29 July 2005)
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GMC is trying hard
- John A Garner (29 July 2005)
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GMC Responds
- Finlay Scott (29 July 2005)
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Out of its depth and totally submerged
- Philip G Griffiths (30 July 2005)
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Guilty until proven innocent.
- Kayvan Shokrollahi (30 July 2005)
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Re: "Downward spiral of...confidence in the profession":postscript
- Jay Ilangaratne (30 July 2005)
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Sorry for the GMC
- Mark Struthers (30 July 2005)
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Re: Out of its depth and totally submerged
- C Frank Lockyer (31 July 2005)
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Re: A very welcome editorial
- Finlay Scott (2 August 2005)
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overinvestigation and overacting
- Peter Bruggen (2 August 2005)
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If it's raining cats and dogs there, here it never stops raining
- Dr. Emilio Polo Ledezma (4 August 2005)
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Does the GMC act justly?
- Anne F Travers, LS8 4AD (15 August 2005)
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Re: Does the GMC act justly?
- Jay Ilangaratne (17 August 2005)
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Oh dear, and then we get to revalidation
- Oliver R Dearlove (19 August 2005)
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Re: Oh dear, and then we get to revalidation
- Jay Ilangaratne (20 August 2005)
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Jay Ilangaratne, Founder medical-journals.com
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The editor says "likely to continue the downward spiral of loss of public confidence in the profession"[1]. I thought the last poll commissioned by the BMA (via ?Mori) following the The Shipman Inquiry, confirmed that the doctors were still held in high position by the public. Perhaps,things have changed since, thus the editor's remarks[1]. References [1]Fiona Godlee. The GMC: out of its depth? BMJ 2005; 331: 0-g. Competing interests: None declared |
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Peter Gooderham, Teaching Assistant Cardiff Law School
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Interestingly, it was in the context of research fraud that Wilmshurst agued that the GMC was too lenient(1). On other occasions it has appeared harsh, and decisions about a doctors' fitness to practise have been overturned on appeal. Examples include Silver (2), and Rao(3). An extreme example is the case of Cream (4) in which a doctor had been found guilty of serious professional misconduct, having taken medico- legal advice and followed it. Mr. Justice Turner stated, "the decision of the PCC must be quashed since it fails the test of rationality." In some respects, he found that it "achieves the status of perversity." I wonder what the response of the relevant GMC panellists was to Mr Justice Turner's judgment. Courts and quasi-judicial bodies do make mistakes, some bad. If they did not, we would not need appeal courts. It does seem, however, that the GMC gets it wrong too often, and attention to this would be welcome. It might help to restore public confidence in medical regulation and remove any actual or perceived need to treat doctors harshly in order to satisfy public desires. (1)Wilmshurst, P. The GMC is too lenient. BMJ 2002;325:397 ( 17 August ) (2)Silver v General Medical Council, PRIVY COUNCIL, [2003] UKPC 33 (3) Rao v General Medical Council [2002] UKPC 65 (4) R(Cream) v General Medical Council [2002] EWHC 436 (Admin) Competing interests: None declared |
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Malcolm E Kendrick, Salaried GP Benchill Medical Centre Wythenshawe Manchester M22 9wp
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It seems that no doctor believes that the GMC got it right in the Roy Meadow case. The feeling appears to be that the GMC scapegoated Professor Meadow to save its own skin. Whilst I do not know the full details of the case, my understanding is that a number of juries convicted several mothers of murdering their children primarily on the unequivocal opinions provided by Professor Meadow. Including his infamous 'one in seventy two million against' odds of two children dying in the same family. With no hard evidence to go on, the juries were highly influenced by the supposedly objective 'judgement' of a highly regarded international opinion leader, and he should have known that his word would have carried massive weight. As such, he must have been aware of power that he wielded in that situation, and had a duty to ensure that his 'facts' were certain. His public excuses that (sic) he didn't know much about statistics, and that he had never been properly trained in how to act as an expert witness ring hollow. As he acted many, many, times in this role (and was no doubt paid handsomely for doing so) it would surely not be asking too much that he found out for himself how an expert witness should behave. Nor to check his figures with some care, prior to annoucing them in a court of law. The simple fact is that several women have spent many years in jail, in large part as a result of the testimony of Professor Meadow. Perhaps the punishement seemed harsh, but the GMC applied the only sanction it could. Professor Meadow has retired, so he could hardly be offered retraining. To have done nothing would have passed a message to the public that, so long as a doctor thinks he is acting in good faith, that's okay. Even if the doctor got their facts horribly wrong, and caused huge suffering. I beleive that the GMC got the judgement right. A person who places themselves in an extraordinary position of public trust, and influence, such as Professor Roy Meadow, is required to act to extraordinary standards. Competing interests: None declared |
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John Stone, none London N22
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I wonder whether Fiona Godlee thinks that what happened to Sally Clark was proportionate and appropriate? It is disturbing how far out of touch the medical profession's concerns are with those of ordinary ordinary people, at least as expressed by the editors of the Lancet and the BMJ. So far the media fall out has been relatively slight. But the medical profession will have to face something far worse than public opinion: it will have to face the lawyers. Welcome to tomorrow. Competing interests: None declared |
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Brian D Keighley, General practitioner Balfron, Stirlingshire, G63 0TS
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Editor Your Editor’s Choice (BMJ, 30 July) accurately, in my view, reports much criticism of the GMC on the part of increasing numbers of UK doctors. The perception that the Council is over-investigating doctors cannot be divorced from the fact that complaints against doctors have quadrupled in the last decade, a matter completely outwith the control of the GMC. Professor Wendy Savage states that the number of hearings have gone from about 35 cases a year to several hundred, but perhaps fails to recognise that the proportion of cases taken forward has remained relatively constant. Savage is correct in asserting that the threshold for complaining to the GMC has been seriously eroded and, in the light of recent high profile cases, this is hardly surprising. Editor's Choice ignores the fact that the GMC has indeed decided to refer back to employing and contracting authorities the vast majority of less serious complaints for investigation believing that local procedures are more likely to bring speedy resolution for both complainants and respondent doctors while maintaining safety for patients. It has also abandoned its controversial decision to remove doctors’ names from its on- line search facility for less serious complaints and has promised to re- visit the tone of the letters it sends to doctors. These two recent decisions will remove much of the cause of criticism but will take some months to work through. The GMC is not oblivious to criticism but as the UK medical regulator it has to operate within the tension produced by three, sometimes conflicting, imperatives – Government policy, patient interests and fairness to the profession it regulates. The UK medical profession is still licking the wounds inflicted by high profile inquiries and searing public criticism; this is also reflected in the body that is the custodian of that very professionalism that operates primarily in the interests of patients and society. Critics also disregard the signal failures of local systems to protect patients as compellingly described in the inquiries into the cases of Ledward, Ayling, Neale, Kerr, Haslam, or Siddall. What is unacceptable, however, is to single out the GMC president for individual mention. Leadership, of course, carries the ultimate responsibility, but the current president should not have to answer for the perceived failings of his predecessors. Sir Graeme has shown those very qualities that will be necessary for professional self-regulation to survive or, indeed, for British medicine to survive as a learned profession and I see few applicants standing ready to inherit what must currently be its most difficult position of responsibility. Dr Brian Keighley Competing interests: Elected Medical Member of the GMC for Scotland |
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John A Garner, GP Edinburgh
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Dear Editor I am concerned that your article 'The GMC: out of its depth' doesn't truely reflect the views of the profession. The GMC has rightly come in for considerable critism over the last decade. However I, and many other doctors, recognise the calm, competent and professional manner in which Sir Graeme Catto has tried to steer the organisation over the last four years. He has espoused the value of self regulation and yet brought the GMC closer to the public. This is a difficult line to walk and is an invitation to critism from all sides. Whilst the GMC continues to be under seige from Government, public and the Council for Healthcare Regulatory Excellence I would hope that the profession could rally around with constructive critism rather than calls for resignations. After all we, the profession, elected the medical members of the GMC. Competing interests: GMC Team leader for performance assessment |
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Finlay Scott, Chief Executive General Medical Council, NW1 3JN
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Ten years ago the GMC received about 1,200 complaints annually. By 2000, the number had risen to 4,500 and this year will be around 5,000. The reasons for the increase are uncertain but they undoubtedly include greater public awareness of the GMC following high profile cases such as the Professional Conduct Committee's Bristol hearing, frustration with the perceived ineffectiveness of local procedures, and a greater readiness on the part of some complainants to try to use the GMC's procedures to overturn decisions taken elsewhere. We have long argued for a more rational approach, which is why the President proposed what has come to be called a single portal, which would help patients and the public to direct their complaint to the most appropriate body. This proposal was helpfully picked up by Dame Janet Smith in her Fifth Report and is being taken forward within Sir Liam Donaldson's review. Meanwhile, we have to deal with the complaints that come to us. Our approach was devised partly in response to past criticisms, from Dame Janet Smith and others, that, too often, complaints were closed on the basis of allegations considered, in isolation, without an adequate picture of the doctor. For about one third of complaints, It is clear from initial evaluation that they could not conceivably engage our fitness to practise procedures. The remaining two thirds are placed in one of two streams. Stream 1 covers cases where the complaint, in and of itself, would, if proved, be likely to require action on registration. Stream 2 covers cases where the complaint, in and of itself, would not normally require action on registration, even if proved. A Stream 2 complaint could be significant if part of a wider picture and not an isolated incident. The challenge is how best to determine whether it is significant. With Stream 1 cases we disclose the complaint to the doctor and to the doctor's employers (or contracting authorities). We also devise an investigation plan that reflects the nature of the concerns as presented. This may include, for example, requesting medical records, commissioning an expert report or inviting the doctor to undertake a performance or health assessment. Of course, a proportion of Stream 1 cases 'are subsequently found to have no grounds'. But it is difficult to see how that could be established without investigation. With Stream 2 cases, hitherto we have disclosed the complaint to the doctor and to the doctor's employers. We have invited the doctor's employers to help us to put the complaint in context, to establish whether there is a broader picture that needs to be taken into account. The great majority of Stream 2 cases have been concluded, without investigation, because the employer's response is reassuring. A proportion of Stream 2 cases have been re-categorised as Stream 1, because information from employers highlighted further concerns. Doctors' concerns and criticisms have largely been about our handling of Stream 2 complaints. And many of those concerns and criticisms have been justified. That is why the GMC's Council, earlier this month, concluded that Stream 2 complaints should be passed to the appropriate local system for action. Provided that we receive reassurance from the employer or other authority, no further GMC action will be required. We are also overhauling our standard letters to make them less officious and more obviously even-handed; and we are taking vigorous steps to try to reduce the inappropriate use of our procedures as a form of appeal against decisions taken elsewhere. We do recognise the understandable anger being expressed by doctors, many of whom are frustrated that we are becoming involved before local procedures have been exhausted or even engaged. In our response to Sir Liam Donaldson's Call for Ideas, we restated that all complaints, which we currently place in Stream 2, should be handled locally in the first instance and only passed to us if that becomes justified. Putting the point more generally, there should be a presumption that local procedures should first be engaged unless the nature of the alleged act or omission makes our involvement appropriate from the outset. We will continue to keep how we handle complaints under review and are prepared to make further changes to enable us to concentrate resources where they will do most good. Meanwhile, it is ironic that Editor's Choice should focus on criticism of the GMC on the day immediately following the Court of Appeal's total vindication of the GMC's guidance on withdrawing and withholding treatment. Regulation is complex and it is all too easy to overlook that the GMC's role as regulator is about much more than its fitness to practise procedures and that the GMC's reputation in relation to standards and ethics, education and registration is justifiably high. Competing interests: Chief Executive of the GMC |
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Philip G Griffiths, Consultant Ophthalmologist Royal Victoria Infirmary NE1 4LP
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The GMC judges on fitness to practice medicine, though it does not even do this well and does not have the confidence of patients or doctors. It is not an appropriate body to investigate the conduct of an expert witness, operating within the wider judicial system. Sally Clark was wrongly convicted and just as importantly, the death of a baby was not properly investigated, because of multiple failings in the judicial system including those of Roy Meadow. These failings should have been systematically investigated and viewed in context by a body able to take a broad view of the conduct of lawyers, barristers, the judge as well as medical expert opinion and by a body that is less easily swayed by press opinion. Mary Clark-Glass, a former law lecturer, announced that she would not be swayed by the recent editorial in the Lancet, a minority circulation journal by any standards. Yet, she made no reciprocal commitment not to be swayed by the press campaign skillfully waged against Roy Meadow in large circulation newspapers. This does not reflect well on GMC. The verdict of the GMC is also at variance with that of the appeal court, which endorsed Roy Meadow as an expert witness in the case of Paul Martin. There should be an independent enquiry, which is not led by the vested interests of the legal profession. The GMC is manifestly out of it’s depth on this issue and its reputation is sinking fast. Competing interests: None declared |
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Kayvan Shokrollahi, SPR Burns and Plastic Surgery Welsh Centre for Burns and Plastic Surgery
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Editor - The problem with current methods of professional regulation for doctors is that accusations themselves can lead to a situation so unpleasant that it equates to many of the consequences of guilt. It also equates to “guilty until proven innocent”, which cannot be acceptable. The consequences that can arise simply as a result of an accusation include suspension, often for inordinate periods of time, which itself has considerable knock-on effects on a medical career in the medium and long- term. These are over and above any mental stress or even mental illness that may ensue, and any issues relating to professional and personal standing with colleagues and patients, let alone the general burden of putting life on hold. The real and important issue is that this system can be used maliciously. Allegations themselves can instigate a process that in itself severely damages the accused, even if eventually found innocent. Not all doctors have the strength of character, resources and ability to come out of such a situation with the upper hand like Wendy Savage. There need to be measures in place that acknowledge this possibility, reduce the impact that allegations themselves can have on an individual until the evidence is examined, and mechanisms in place that can have consequences for anyone making malicious allegations. There is no justice in a system where you are either guilty for a while or guilty forever. The system needs to afford some protection to doctors, who are gradually becoming more vulnerable, as well as to patients. Competing interests: Final Year Student, Master of Laws (Medical Law) |
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Jay Ilangaratne, Founder Medical-Journals.com
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I have now traced the relevant Mori poll which I referred to in my earlier posting.It is clearly reported on the BMA's website[1]: "March 2005 Trust in doctors is at its highest for over twenty years, a MORI poll has shown. In its annual poll of trust in the professions, MORI has found that more than nine in ten members of the public (91 per cent) trust doctors to tell the truth. This is higher than the rating for any other professional group included in the poll." Hence, the editor's remark suggesting the public's confidence in the profession is in a downward spiral, does not appear to be consistent at all with the BMA's annual public survey. Nor have I noticed any other public poll which supports the editor's said contention.It seems the editor's remark is based on a personal belief rather than 'evidence-based' material. References [1] Public confidence in doctors (Great Britain):March 2005. [http://www.bma.org.uk/ap.nsf/Content/DoctorsPublicPU] Competing interests: None declared |
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Mark Struthers, GP Bedfordshire
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Though the paediatric professors Sir Roy Meadow and David Southall have broken no rule of professional etiquette, it is saddening to see how extraordinarily difficult they have made life for the medical regulatory body in Britain. Consequently, I feel almost sorry for the GMC and the body of doctors they seek to regulate. In these sorrowful times, I am reminded of P.G. Wodehouse, an English writer (and American citizen for the last twenty years of his life) who wrote: “It is a good rule in life never to apologize. The right sort of people do not want apologies, and the wrong sort take a mean advantage of them.” Competing interests: None declared |
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C Frank Lockyer, Retired SP1 2SS
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Just for the record and particularly for Dr Philip Griffiths. Mary Clark-Glass did commit herself and cautioned her Panel not to be influenced by media reports. I was there when she did it. The GMC Panel considered only the Sally Clark case which was the only complaint before it. It specifically exluded itself from any other case including those similar which have been well publised. The verdict of the Appeal Court therefore does not affect the issues one way or the other. Come to that I am not aware that anyone has ever said that Professor Meadow is wrong every time. Or that some parents do not do terrible things to children. By the law of averages clearly he is not. Neither is he infallible. It is conviction by speculative theory or conviction by formulae, without regard for the facts that is being challenged. Plus by 'Meadow's Law' the reversal of the rule of law for mothers to have prove their innocence. Particularly in the Family Courts where there is some evidence that children have been removed from their parents forever to adoption. C Frank Lockyer QPM Competing interests: Complainant in the Meadow case |
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Finlay Scott, Chief Executive General Medical Council NW1 3JN
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Gooderham asserts 'It does seem, however, that the GMC gets it wrong too often'. That is not borne out by the facts. In 2003 and 2004, 166 doctors were found guilty of serious professional misconduct. 33 doctors lodged appeals against the GMC's decisions. Nine appeals were subsequently withdrawn. Only four appeals were upheld. From 1 April 2003, all relevant decisions have been reviewed by the Council for Healthcare Regulatory Excellence. As Camm pointed out in her response to Walshe (http://bmj.bmjjournals.com/cgi/eletters/330/7506/1504#111010), the GMC's fitness to practise committees and panels have since made around 440 reviewable decisions. CHRE referred 12 of those decisions to the High Court. One referral was subsequently withdrawn by CHRE; seven were resolved with the cooperation of the GMC; and one is pending. Of the remaining three, where CHRE and the GMC disagreed, the Court ruled in CHRE's favour on one occasion (Leeper); and in the GMC's favour on one occasion (Solanke). On one occasion the Court found undue leniency but CHRE failed to secure their desired outcome, namely erasure, although, by agreement, there was useful strengthening of conditions on registration (Southall). Successful appeals by doctors in four cases (under 3%) and modified outcomes in eight cases referred by CHRE (around 2%) do not paint a picture of a system that ‘gets it wrong too often’. Gooderham may have been misled by the legal authorities he cites: they are incomplete and out of date. For example, the Court of Appeal judgment in the case of Campbell (2005 2 All ER 970) concluded that, in the case of Silver, the Judicial Committee decision, to uphold the doctor’s appeal, was wrong. As Camm pointed out, error is inevitable in a large scale system in which human beings exercise judgment. Mistakes are made in all such processes – by juries, by fitness to practise panels, and even by judges. That is why there are appeal and referral procedures. It is also why the GMC carefully reviews all outcomes in the small number of cases where the original decision is subsequently overturned. But the facts do not support Gooderham’s assertion that there is significant or systemic failure. Competing interests: Chief Executive, General Medical Council |
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Peter Bruggen, retired psychiatrist I have no work place because I have retired
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When I last attended a GMC disciplinary hearing, the Chairperson summarised the panel’s responsibility: not to ensure that there was little risk of re-offending, but that there was no risk at all. Therefore the doctor was struck off the register. I still feel regret that I had not shouted out ‘I too am a risk.’ I would, of course, have been ignored. I hope you will be listened to. Peter Bruggen pbruggen@blueyonder.co.uk 2 August 2005 Competing interests: None declared |
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Dr. Emilio Polo Ledezma, Ph.D. in Biochemistry Health's Faculty of the Surcolombiana University
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Each semester when I begin my regular Biochemistry course, and in order to place it in context for a physician's life, I talk to my first level medical students about the true dynamics of Colombian processes related to the health situation in our country. In some words I want to share with you the contents of this presentation. Together with the main social situations, which we have to live daily, such as poverty, insufficient schooling, the big problems of social security, inoperative justice, rampant insecurity, the high index of leisure and unemployment, in Colombia there are two classes of graduate professionals in the health fields. To the first belong those who use their strong academic background and true scientific and technological progress to solve the health problems of their patients and to continue their personal formation as a competent physician. To the second belong those who use their diploma for their personal economical benefit, without considering the suffering and the horror of their clients. The so called false progress in medical research, the quackery supported by radio and TV advertisements, often guaranteed by legal medical associations, constitute a sinister supermarket of bad procedures that take advantage of the pain, the suffering, and mainly the ignorance of clients. We should ever be against the existence, permanence or nature of these bad medical practices, which have left the medical profession discredited and on the floor. In the face of these absurd facts we cannot forget the ethical basis of the medical scientific knowledge directed to the practical activity of our professionals. Our efforts should be directed to maintaining a well–formed professional, honest, noble group conforming to medical standards of ethics, marked by moral integrity, kindness, and goodwill. The medical class of our country should be effectively organized with compulsory affiliation to academic groups, with total responsibility in cases of malpractice and total acceptance that private and public money are sacred and nobody must make illegal use of it. How is it possible that we continue allowing the bad professionals to fix the attitudes and procedures in practice!? Competing interests: None declared |
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Anne F Travers, retired Leeds, LS8 4AD
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Finlay Scott is sure that the GMC does not get it wrong too often. He tells us that 166 doctors were found guilty of serious professional misconduct in 2003 and 2004. 24 of these appealed, of whom four won their appeals. To judge whether the GMC gets it wrong too often, we need to know the comparable figures for criminal convictions in 2003 and 2004, the number of those convictions that were appealed, and the number of those appeals that were successful. Four definite miscarriages of justice out of 166 seems rather too many. Would a judge be happy to see one innocent person convicted wrongly for every 40 guilty people convicted rightly? If 1 in 6 appeals are successful, it is highly unlikely that every single one of the 142 non-appealed cases had been justly decided. I think that many unjustly "convicted" doctors would not have appealed. Maybe they were too exhausted; maybe the strain on their families was too great; maybe their employer pressed them not to appeal: maybe, not having been struck off, they decided to soldier on under the burden of a lesser unjust punishment. Or maybe their lawyers advised them not to, for a variety of reasons, including media frenzy. Scott also states that "error is inevitable" in a system where people exercise judgement, and "that is why there are appeal and referral procedures". The GMC believed that Professor Sir Roy Meadow exercised judgement erroneously as an expert witness; as the body which decides his fitness to practise as a medical practitioner, it brought him to book. The GMC saw his practice as an expert witness as an integral part of his medical practice. When a GMC Fitness to Practise Panel makes a decision which is found to be a miscarriage of justice when considered by a judge on appeal, how likely is it that the medical members of that Panel (whose position on the Panel clearly comes under the umbrella of their medical practice) will be brought before a Fitness to Practise Panel to answer for their errors? What is the mechanism by which the lay members of such a Panel answer for their erroneous actions in these same circumstances? Competing interests: None declared |
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Jay Ilangaratne, Founder medical-journals.com
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Travers says in order to judge the "GMC gets it wrong too often", we need to know the number of criminal convictions,appeals and their outcomes during the comparable period.I can well understand Travers' decision to compare GMC's decisions with criminal cases. However,it is not clear whether Travers' is attempting compare with criminal cases tried at Magistrate or Crown Court level, or on appeal to Court of Appeal or House of Lords. It would be helpful to know the exact criminal jurisdiction level with which she is comparing the GMC.It is important to know such information given quality of justice may differ depending on the level of the court. Trevers identifies GMC's decisions which have been overturned by an appeal court as "definite miscarriages of justice".If a decision has been overturned on first appeal to a higher authority/court, as has probably happened in the GMC-cases,perhaps 'miscarriage of justice' is a too heavier a term to apply.Incarceration of the innocent would certainly be a fitting example to justify using such a term. I can fully accept the proposition that some doctors who may have been wrongly found guilty by the GMC may not have appealed for a number of reasons.Nevertheless,Travers' suggestion that "If 1 in 6 appeals are successful, it is highly unlikely that every single one of the 142 non- appealed cases had been justly decided" is at best, a good guess;without further scrutiny via an appeal process it is unwise to blame the primary decision maker.Further,there is no proper evidence that all or even the majority of those who did not appeal--did not proceed--for the reasons suggested by Travers.It is of course possible,some did not appeal because they knew upon proper analysis,that chance of success was extremely low or hopeless. Travers' scrutiny as to accountability of those who make decisions which eventually turn out to be flawed,I think they are generally covered by 'judicial immunity'.Thus, most unlikely that a GMC panel member could be properly tried by PCC or any other organ of the GMC.Similarly,the lay members are immune from suit.A general argument against those who disapprove of such immunity is that the appellate process provides a remedy to those have faced an injustice at first instance.However, such arguments would not be entirely satisfactory or proper, if with evidence, one can reasonably contend that a decision maker/authority is continuing to make grossly disproportionate errors.In any event,whether it be the GMC or any other body--greater transparency as to methods of accountability when things go wrong--would be welcomed by many. Competing interests: None declared |
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Oliver R Dearlove, Consultant Anaesthetist Royal Manchester Children's Hospital M27 4HA
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I think that Dr Taylor has hit the nail on the head in terms of medical regulation – everyone is allowed to make mistakes bar doctors. Finlay Scott agrees that “error is inevitable in a large scale system in which human beings exercise judgment. Mistakes are made in all such processes….” See above. This understanding view of GMC errors by its chief executive (not a doctor so not subject to GMC procedures) is not reflected in the Fitness to Practise panels – see Bruggen’s letter above. And so we come to another very large scale process – revalidation. An error rate of 2% appears, from Finlay Scott’s answer, to be acceptable to the GMC,– and we agree that harm does result from an erroneous judgement [determination]. So in revalidation of between 100 000 and 200 000 registered doctors there will be an acceptable erroneous classification of 2% - that is between 2 000 and 4 000 practitioners will fail to revalidate, when in fact they should. I am certain that this number of good doctors being called bad doctors by mistake and being deprived of their licences is unacceptable to the whole of the medical profession, whether or not it is acceptable to their regulator. – you could even set up a separate branch of the High Court to hear the appeals. We could call it the Regulatory Excellence Division of the High Court. Revalidation – I can hardly wait ! Oliver Dearlove FRCA Conflicts of interest – Dr Dearlove has been nominated as a candidate in the GMC by-election. The closing date for candidates' nominations is next week. Competing interests: as script |
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Jay Ilangaratne, Founder Medical-Journals.com
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With reference to the GMC and BBC, Dr Dearlove once said "Both institutions have not aged well, are unfit for their purpose, and should be pensioned off"[1].Despite holding such grim view of the GMC[1],in particular, having suggested it should be pensioned off, it is somewhat ironic that Dearlove is seeking election to its council.Of course,this is not the first time he has sought election to GMC council. In his rapid response Dearlove says "everyone is allowed to make mistakes bar doctors". I disagree.In fact, no one is "allowed" to make mistakes;the reality is everyone is prone to mistake including Consultant Anaesthestists and Metropolitan Police Officers. So can we really expect the GMC to be error free? Based on some remarks that Mr Finaly Scott had made in relation to successful appeals from GMC's PCC decisions,Dearlove suggests a 2% error rate as to revalidation would be acceptable to the GMC. With respect,that is pure conjecture.Neither the GMC nor Finaly Scott had said that 2% error would be acceptable to the GMC in relation to PCC-decisions or otherwise; that is simply a percentage figure of successful appeals.Of course, error- free decision making will be the ideal scenario, but as practising clinician,Dearlove will know that it is not an easy target to meet. Despite Dearlove's cynicism as to renaming the High Court, I am confident that most logically-thinking people would be pleased that a transparent appellate process is in place to rectify any injustice that a doctor may have suffered at a GMC hearing.In one of the most recent cases[2],the GMC's decision had been upheld by the High Court, and perhaps that is further evidence suggesting the GMC has learnt from its previous mistakes. References [1]Oliver R Dearlove. Suspension of doctors: GMC may be ultimate sacrifice BMJ, Mar 2004; 328: 709. [2]Dr Phipps v GMC [2005] EWHC 1608 (Admin) [http://www.bailii.org/ew/cases/EWHC/Admin/2005/1608.html] Competing interests: None declared |
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