A cry of pain and anger

It was the Times that broke the story. Under the headline “Struck off doctor elected to GMC” (1 May), it carried the first account of what, by any standards, was a major electoral upset. Just as Tony Blair was about to receive a bloody nose from London voters, and William Hague from those in the Romsey byelection, Britain's doctors were making their opinion felt of efforts by their leaders to reform the General Medical Council.

At first glance, the result seemed simply perverse. In a byelection for the GMC last month 50 candidates stood for one place on the disciplinary body, whose slogan is “Protecting patients, guiding doctors.” Over 45 000 doctors voted, 23% of the total on the medical register. The result suggested that many who completed their ballot papers would prefer to see the GMC's slogan reversed to read “Protecting doctors, guiding patients.”

Two of the three doctors who topped the poll had themselves been found guilty of serious professional misconduct by the GMC in the past. Jennifer Colman, who won with 5719 votes, was struck off the medical register in 1987 for neglect of a patient and racial abuse of a colleague. She was restored to the register two years later when the GMC accepted that her behaviour was linked with ill health caused by two head injuries for which she had been treated. She has since given up medicine and now works as a medically qualified barrister.

Not far behind in third place was John Studd, with 4653 votes, who was admonished by the GMC in 1997 for removing a woman's ovaries without her consent during a hysterectomy operation.

Both comprehensively beat Professor Michael Baum, the internationally respected breast surgeon, whom most outsiders would have selected as a certainty to win. He was hoping to take over the mantle from his brother, the equally distinguished Professor David Baum, president of the Royal College of Paediatrics, whose untimely death from a heart attack during a charity cycle ride caused the byelection. But it was not to be. He polled 3872 votes to take fourth place. And there were another 46 candidates behind him.

So what are we to make of this? Why do doctors select from among a field of 50 candidates the two with, how shall I put it, chequered pasts over the one with the international reputation? None of the newspaper reports—the Times' scoop was followed by the Guardian, Telegraph, Mirror, Express, and Independent—offered an explanation. But, as I wrote later in the Independent, a clue may be found in Dr Colman's election statement. “I am concerned,” she wrote, “that doctors should, regardless of alleged misconduct, be dealt with fairly and with courtesy … Patients must not needlessly be deprived of doctors trained at great expense.”

When I telephoned Dr Colman, she expanded on her views. “[The GMC] is a quasi-judicial body that has its own way of interpreting its own rules behind the scenes. This has upset a lot of people. It is no good getting hysterical about it, but we have got to address what is wrong and put it right,” she said.

John Studd is of a similar opinion. In a call to me after my piece appeared in the Independent, he confirmed that he had stood on an “anti-GMC platform.” He told reporters in March that he regarded the GMC as a “useless organisation” that had done a “great deal of harm” to the image of medicine by attacking “high profile internationally respected doctors.” He was incensed by the Bristol heart surgery case, which had destroyed “three good, hardworking doctors” who had been made scapegoats for a “rotten, underfunded health service.” Second place in the election was taken by a consultant in intensive care from Bristol Royal Infirmary, Sheila Willetts, who gave evidence on behalf of the GMC in the Bristol heart surgery inquiry and whose popularity appeared to buck the trend.

This, then, is the kickback—a cry of pain and anger from beleaguered doctors who feel betrayed. The outcome of the byelection is the clearest possible signal from a section of the profession that it is sick of being criticised and shoved around and has little appetite for Tony Blair's programme of modernisation and still less for that of the president of the GMC, Sir Donald Irvine.

I wrote in the Independent: “These are the ‘dark forces of conservatism’ to which the prime minister referred—a minority, maybe, but one significant enough to swing a vote at the GMC.” That remains, for me, the chief message of the vote. Medicine is a broad church, and medical organisations have difficulty representing all shades of opinion within their ranks—witness the fierce battles fought over general practitioner fundholding in the BMA in the early 1990s. But the stakes this time are at an all time high—the next four years could break the NHS. If the profession's leaders cannot carry the grassroots with them the battle is as good as lost.

An interesting question is whether voters knew of Dr Colman's and Mr Studd's past GMC convictions. GMC rules do not require them to be declared on the principle that once the sentence, if any, has been served, the offence is deemed expunged. Stories about their candidacy, and their past misdemeanours, did appear in the London Evening Standard and the Independent in March, so some doctors must have known. But now that the votes are counted it seems possible those stories increased their popularity, rather than reduced it.

The GMC is now reviewing its electoral procedure. But in the light of this vote, much more will require review. Ministers have been at pains to secure backing for their NHS modernisation programme—which includes revalidation of doctors and tougher monitoring of performance by the GMC—from the BMA, the royal medical colleges, and the GMC itself. Whether those organisations can swing their members behind the project now looks less certain than it did.