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

The "test of insight" - para 34, Indicative Sanctions Guidance

At para 34 of its Indicative Sanctions Guidance (ISG) the GMC FTP rules require a doctor to show "insight" into the consequences of his behaviour at first instance (or suffer more punitive sanctions). The practical effect of this provision is that the doctor cannot contest often-fabricated evidence from an NHS Trust or senior doctor without risking worse sanctions. In effect his hands are tied before he enters the hearing room. A doctor may show evidence of "remediation" at first instance but the punitive "test of insight" should be reserved for review hearings.

Many panellists continue to investigate for Royal Colleges while sitting as adjudicators. This is a clear breach of the doctrine of "separation of powers" and makes the jurisdiction wholly vulnerable to sectional interests. Why is this question not on the panellists declaration of interests ?

Unaudited GMC Performance tests have been found to be "unreliable" (GMC v Chakravarti,2014) though have cost the careers of hundreds of doctors. Comparing clinical performance in these tests with self-selecting, paid, doctors about to sit higher professional examinations is, and was, untested and unreliable. This year there has been 34 cases of "unlawful" guidance to panellists yet nothing has been done for the outcomes of those doctors subject to this unlawful guidance.

The culture and effectiveness of the GMC Investigations unit has been dramatically diminished in recent years resulting in a dramatic increase in the numbers of doctors out through Interim Orders hearing - in effect short, "emergency" hearings where facts are not found but sanctions are applied for up to 18 months though it may take several years before this Investigations unit gets around to arranging an FTP hearing. "Justice delayed is justice denied ?"

And the we have the small matter of over 100 deaths of doctors (2005-15) without a fact being proven against them. Much talk about a report but none has emerged - just more consultations about what the GMC should do next ! And one of those suggestions is to merge the MPTs back into the GMC - because the GMC cannot achieve its prosecutorial targets !!

Successive generations of leaders at the GMC (since Irvine) have inherited the jurisdiction without understanding the origins of its rules and particularly it's flaws and dysfunctions. It is now in a precarious state. It cannot command public or professional confidence in this condition. I suggest a clean sheet of paper and a searching review of its performance by someone with some experience.

Mr Justice Collins springs to mind.

Competing interests: No competing interests

31 October 2014
MJ Quinn
Doctor
London