Whose misconduct—doctors or the GMC?
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c3021 (Published 22 June 2010) Cite this as: BMJ 2010;340:c3021
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This is a very rose-tinted view of the General Medical Council's
(GMC) fitness to practise processes and procedures that may not match the
experiences of those who
have dealt with the GMC in person in recent years.
Failure to respond to correspondence in a reasonable time frame - if
at all - is a major fault of the organisation. There may be an apology for
a delay but it seems rather hollow when it comes. Failure to challenge
those who provide misleading information in a fitness to practise
investigation that is patently at odds with and contradicts that already
published in the public domain, followed by poor excuses from the GMC as
to why there will be no challenge, in my view does not sit easily with an
organisation that demands honesty and openness from doctors. To say that
at times the GMC appears spineless and hypocritical would be fair comment.
New leadership at both the Chief Executive and President level should
lead to a more open and challenging review of GMC practices rather than
simply relying on a couple of external reports [1,2] one of which was
commissioned by the GMC from King’s College, London (KCL). That
organisation was linked closely to the former President as Professor Sir
Graeme Catto was a Vice-Principal there from 2000 until 2005 when he
relinquished the post to spend more time on GMC work.[3] This association
leads to the possibility of subconscious bias in any assessment and
evaluation of the GMC's work, particularly a piece that was to be
completed in a relatively short time so as to “gain assurance that Council
policy was being applied”.[2] The GMC’s 2007 Council minutes on the KCL
report note that “the sample sizes in the KCL audit are relatively small
and that we therefore need to exercise an appropriate degree of caution in
drawing any firm conclusions from the results of that audit.”[2]
Under the circumstances, Niall Dickson’s response and reassurances
seem somewhat misleading especially when there was a recommendation from
the Council to commission a further audit so as to ensure that processes
and procedures are “fair, objective, transparent and free from
discrimination.”[2] A comprehensive audit of the GMC’s current fitness to
practice processes and procedures from a non-London based body would be
more reassuring given the limitations of the KCL work . Will the new
leadership rise to such a challenge and commission a piece of work that
seems long overdue? Not everything is as perfect as claimed by the GMC.
[1] Fitness to practice audit report Audit of health professional
regulatory bodies’ initial decisions, Council for Healthcare Regulatory
Excellence, February 2010.
www.chre.org.uk/_img/pics/library/100302_FTP_Audit_Report.pdf (accessed 7
July 2010)
[2] External audit of decisions in investigations of the GMC’s
fitness to practice cases, King’s College London, July 2007 ( report can
be accessed at GMC Council agenda and papers September 2007 www.gmc-
uk.org/about/council/2007_09.asp )
[3] London South Bank University. Honorary Awards Ceremony 19
November 2008. Citation - Sir Graeme Robertson Dawson Catto. Award of
Honorary Doctor of Science.
www1.lsbu.ac.uk/about/documents/citations/gcatto.pdf (accessed 7 July
2010)
Competing interests:
Referral made to the GMC in 2007 re FTP matter
Competing interests: No competing interests
"Peter Wilmshurst's posting ‘Whose misconduct - doctors or the GMC?’
paints a negative picture of our fitness to practise procedures. What it
does not say is that these procedures have been transformed in recent
years, that they are subject to both internal and external audit, or that
the latest Council for Healthcare Regulatory Excellence report on the
fitness to practise work of the GMC (1) was extremely positive. A King’s
College London report (2) commissioned by the GMC into the application of
its internal guidance for decision makers also gave the procedures a clean
bill of health.
For obvious reasons it is difficult for us to respond to specific
cases, but I believe the profession should be confident in the way we
undertake this often difficult work. The fact that a decision in every
serious case is made by a medical and a lay case examiner, both of whom
are trained specifically in this work represents a major change from the
past. Of course any organisation making as many decisions as we do will
make mistakes and we are constantly looking at ways to improve our
procedures.
1. Fitness to practise audit report Audit of health professional
regulatory bodies’ initial Decisions, Council for Healthcare Regulatory
Excellence, February 2010
2. External audit of decisions in the investigation of the GMC’s fitness
to practise cases, King’s College London, July 2007
Competing interests:
None declared
Competing interests: No competing interests
GMC – plus ça change
As evidence that the GMC has changed for the better Niall Dickson
states that “a decision in every serious case is made by a medical and a
lay case examiner, both of whom are trained specifically in this work
represents a major change from the past.” Previously a decision was made
by a medical and lay screener. I hope that they were trained. Apart from
altering the name “screener” to “case examiner”, what has changed? As I
have described elsewhere, I believe that the superficial changes at the
GMC are designed to produce an artificial impression of reform.[1]
Reference
1. Wilmshurst P. The General Medical Council – a personal view.
Cardiology News 2006;10(1);13-15.
Competing interests:
I am the author of the original letter in this series.
Competing interests: No competing interests