Intended for healthcare professionals

Education And Debate

The medical profession, the public, and the government

BMJ 2002; 324 doi: (Published 06 April 2002) Cite this as: BMJ 2002;324:838
  1. Chris Ham, directora (⇑,
  2. K G M M Alberti, presidentb
  1. a Strategy Unit, Department of Health, London SW1A 2NS
  2. b Royal College of Physicians, London NW1 4LE
  1. Correspondence to: Chris Ham

The old implicit compact between doctors, patients, and society has broken. Chris Ham and George Alberti want to write a new one

The world is changing rapidly—probably more so than at any time since the industrial revolution. This applies to the professions as much as any other sector of society. So how has the medical profession altered and how is it responding to these societal pressures?

In the 19th and early part of the 20th century British physicians were private practitioners and functioned independently. There was a strong moral and ethical background to medicine and a tradition of voluntary work in the poor law institutions as well as in the community. Self regulation began in the 16th century with the foundation of the Royal College of Physicians. This functioned both as a setter of standards and as a closed shop. The Royal College of Surgeons followed two centuries later.

Learning at that time was based on a few medical schools and an apprenticeship system. Self regulation and a more uniform educational approach were strengthened in the 19th century with the establishment of the General Medical Council (GMC) and the introduction of royal college examinations. Throughout this period, standards and quality were implicit rather than explicit, with government and society trusting the medical profession to protect the public and granting the profession considerable autonomy in the process.

Summary points

The NHS was established on the basis of an implicit compact between the government, the medical profession, and the public

This implicit compact has been undermined over the years and needs to be updated

A new compact is needed spelling out the rights and responsibilities of the government, the medical profession, and the public

This will not be easy to agree but is essential to enable the different partners to make an effective contribution …

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