Intended for healthcare professionals


The GMC: expediency before principle

BMJ 2005; 330 doi: (Published 27 January 2005) Cite this as: BMJ 2005;330:252

A former BMA chairman responds

  1. Alexander W Macara (nhf-post{at}, chairman
  1. National Heart Forum, London WC1H 9LG

EDITOR—Inexplicable omissions in Smith's intemperate editorial on the GMC prompt me to break an unhappy silence.1

Late in 1994 the British Medical Association organised a core values conference for the whole profession (BMA, royal colleges, deans, GMC). It addressed the challenges facing the profession as outlined by an eminent lay member of the GMC, which, led by its then president, Lord Kilpatrick, had already formulated performance review procedures and called for action by us all.

During the following turbulent years—and intensively during 1997 and early 1998—discussions in each part of the profession culminated in a historic commitment, “self-regulation and clinical governance at local and national levels,” co-signed by the chairmen of all the leading medical organisations, which was sent to the Secretary of State for Health, Frank Dobson, and others on 2 July 1998. In a covering letter Sir Norman Browse, chairman of the Joint Consultants Committee, on behalf of the whole profession, expressed the belief that the document complemented the government's contemporaneous clinical governance proposals and that they would “together solve problems at an early stage and at local level.” The italics are mine to emphasise that the profession's united commitment was to deliver accountability through acting proactively at the earliest possible stage in identifying any problem with a colleague through its various mechanisms. The culture change to which the whole profession thereby committed itself was early prevention at source, rather than leaving problems to the GMC to resolve when it was too late.

What happened to this initiative? I believe that, had it been vigorously pursued, much if not all the trauma of the past six years could have been avoided. What I do know is that within days of its release a number of the co-signatories, myself included, had demitted office and Sir Donald Irvine, as president of the GMC, had produced his revalidation proposals. It is difficult to resist concluding that shifting the focus to these proposals (now seen to be flawed) distracted the profession as a whole from the more promising combined operation on which it had embarked.


  • Competing interests None declared.

  • AWM was chairman of BMA Council, 1993-8.


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