Further difficult reforms are essential

The General Medical Council (GMC) has been submitted to a highly detailed forensic examination and found severely wanting. It has broken its contract with the public—to protect patients in exchange for the privilege of self regulation—and if it wants to survive it must now launch into a further round of reforms, even while those of the last few years are still being implemented.

The forensic examination has been conducted by Dame Janet Smith as part of her inquiry into the issues arising from the case of Harold Shipman, a general practitioner who murdered over 200 of his patients. Her fifth and final report, which is over 1000 pages long and makes 109 recommendations, examines the performance of bodies responsible for monitoring primary care and makes recommendations on how better to protect patients in the future.1 I want to concentrate here on what Dame Janet said about the GMC.

Dame Janet's examination of the GMC has been complicated by her prey being on the move. But if the leaders of the council ever hoped that they could reassure her that she need not worry because reforms were under way they must have been seriously disappointed. She finds deficiencies not only in the “old” fitness to practise procedures but also in …