Intended for healthcare professionals


Repositioning self regulation

BMJ 1998; 317 doi: (Published 10 October 1998) Cite this as: BMJ 1998;317:964

The influence of the GMC may be leaking away

  1. Richard Smith, Editor
  1. BMJ

    The British government is to take the power to change in one parliamentary move the legislation governing professional regulatory bodies, including the General Medical Council. At the moment changes require modification of the governing acts by a new act of parliament on each occasion, which involves the full parliamentary procedure of multiple readings and committee stages. Is this proposal to make future changes through an order in parliament simply a tidying up exercise or is it an ominous signal on self regulation?

    The government insists that its proposals are benign. Parliamentary time is at a premium. It is thus hard to find time to modify the acts governing the professional councils that regulate the healthcare professions. As a result many are left with archaic procedures. Even a council with the political clout of the GMC had difficulty getting parliamentary time to modify the Medical Act to introduce performance procedures. The council wants now to make changes to training registration for overseas doctors, But time is unlikely to be available during the lifetime of the current parliament.

    In a letter to the president of the GMC announcing the government's intentions, Alan Milburn, minister of health, insists that “the government has made a clear commitment to work with the professions to strengthen the existing systems of professional self regulation by ensuring that they are open, responsive, and fully accountable.” So can the GMC president sleep easily in his bed, confident that the influence of his illustrious council is not being weakened? Many will think not. The timing is suspicious.

    Although such a change will itself require legislation, the announcement, which appears after little or no consultation with the profession, comes soon after the end of the Bristol case, in which three doctors were found guilty of serious professional misconduct for misleading patients and for allowing paediatric cardiac surgery to continue in the face of high death rates.1 At the time the secretary of state for health declared publicly that the GMC had done the wrong thing in not erasing from the register all three of the accused doctors.2 It comes too as the government is constructing its elaborate systems of clinical governance, standard setting, and a trouble shooting commission. These are command and control systems.3 The announcement also precedes the public inquiry into the Bristol case, which will run for more than a year and feature more washing of dirty linen than British health care has ever experienced before. The government will strengthen its ability to respond to any public outrage if it can quickly change legislation governing the GMC.

    The GMC has always been only one part of the machinery regulating the work of doctors. 4 5 The medical schools, the royal colleges, the postgraduate deans, the NHS, the government, the media, and others have all had a role, but the GMC has been the centrepiece. In future it may not be. It has been too slow to change, and the balance of regulatory power is shifting. The government may have entirely benign intentions for making the primary legislation governing self regulation easier to change, but the temptation to use this machinery to reduce the power of the GMC may one day prove irresistible.


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