Editorials

Medical regulation: more reforms are needed

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5744 (Published 25 September 2014) Cite this as: BMJ 2014;349:g5744

Re: Medical regulation: more reforms are needed

Walshe and Archer argue convincingly that the 2014 Law Commission proposals for Healthcare regulation constitute an opportunity to overhaul the GMC. On one matter almost everyone is agreed: there is a need for change. That’s the easy part: the real contention is what that change should be.

The GMC’s curiously punitive consultation document launched on August 22nd includes proposals (paraphrased heavily; the parentheses and inverted commas are mine) to ‘require’ a doctor to apologize, guidance on what to do if a doctor ‘lacks insight’, the ability of the GMC to award costs against a doctor for ‘unreasonable behaviour’ (not defined), the GMC acquiring the power to consider a doctor’s personal conduct and directing that an MPTS panel should not take into account the consequences of its determination on a doctor.

There is a legitimate concern that some of the proposals could infringe Human Rights legislation. Further and quite separate, that an untestable standard of ‘maintaining public confidence’ applied more commonly to politicians in difficulty has for the first time made an appearance into the sphere of medical regulation. Whilst it would be entirely inappropriate to draw parallels, students of history may recall that in the Spanish Inquisition of the 12th -16th centuries (2) and Stalin’s show trials of 1936-1936 (3) a lack of insight was a prominent feature in defining guilt, a failure to confess or repent frequently led to sanction and the trials were justified in the name of public confidence in Church and State respectively.

How can we be assured that the current proposals will not put more pressure on doctors to show ‘insight’ and apologize or accept a warning even if there is no case to answer? Further, that an irregularity in a doctor’s personal life normally considered irrelevant will not unduly influence a decision to settle as the pressure will be enormous to do so given the potential cost-in financial, personal and career terms-of an ongoing investigation? A recent study has shown the deeply troubling effects of GMC investigation on sick doctors (4). In this light, that the GMC’s own investigation into 96 suicides of doctor whilst undergoing procedures and concluded many months ago has still not reported surely demands an immediate explanation, not just for the sake of those doctors who might currently be at risk.

We must be careful that ‘topsy turvy’ regulatory reform does not inadvertently create a culture of fear and thence a form of plea bargaining based on the nebulous concepts of insight and forced apology with a regulator able to use almost anything to justify concerns that may impact on ‘public confidence’.

Dr Christoph Lees
NHS Consultant Obstetrician
Founder, Doctors Policy Research Group
Civitas, London SW1

References:
1. Walshe K, Archer J. Medical regulation: more reforms are needed. BMJ. 2014 Sep 25;349:g5744.
2. http://history.howstuffworks.com/historical-figures/spanish-inquisition2...
3. http://www.historylearningsite.co.uk/ussr_show_trials.htm)
4. Brooks SK, Del Busso L, Chalder T, Harvey SB, Hatch SL, Hotopf M, Madan I,Henderson M. 'You feel you've been bad, not ill': Sick doctors' experiences of interactions with the General Medical Council. BMJ Open. 2014 Jul 17;4(7):e005537.

Competing interests: No competing interests

27 September 2014
Christoph Lees
NHS Consultant
London
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