The old implicit compact between doctors, patients, and society has broken. Chris Ham and George Alberti want to write a new one

The world is changing rapidly—probably more so than at any time since the industrial revolution. This applies to the professions as much as any other sector of society. So how has the medical profession altered and how is it responding to these societal pressures?

In the 19th and early part of the 20th century British physicians were private practitioners and functioned independently. There was a strong moral and ethical background to medicine and a tradition of voluntary work in the poor law institutions as well as in the community. Self regulation began in the 16th century with the foundation of the Royal College of Physicians. This functioned both as a setter of standards and as a closed shop. The Royal College of Surgeons followed two centuries later.

Learning at that time was based on a few medical schools and an apprenticeship system. Self regulation and a more uniform educational approach were strengthened in the 19th century with the establishment of the General Medical Council (GMC) and the introduction of royal college examinations. Throughout this period, standards and quality were implicit rather than explicit, with government and society trusting the medical profession to protect the public and granting the profession considerable autonomy in the process.