Intended for healthcare professionals


GMC independence is a great British compromise

BMJ 2016; 355 doi: (Published 02 November 2016) Cite this as: BMJ 2016;355:i5905
  1. Abi Rimmer, deputy editor
  1. BMJ Careers

Niall Dickson, chief executive and registrar of the General Medical Council, talks to Abi Rimmer about maintaining the GMC’s independence, his successor, and rebuilding the trust of doctors

Having spent seven years at the GMC, Niall Dickson has been in the post longer than he planned. “I originally thought I would do six years here, because that’s the same time I did at the King’s Fund,” he says, “and now it’s been seven so I think I’ve done my stint.”

After a brief spell as a history teacher, Dickson spent his early career as a journalist, and is described by colleagues from that time as both ambitious and highly respected. A true specialist in the field of health and social affairs, Dickson’s move to the King’s Fund in 2004 was not a surprise to those who knew him.

“Good fit” at GMC

In 2010 Dickson moved to the GMC and, although this was a further step away from journalism, former colleagues say that it was a good fit for someone who cared deeply about transparency and accountability in the NHS. For now, however, he is taking a break from the world of healthcare, though he hasn’t yet decided what shape the next chapter of his working life will take.

During his time at the GMC Dickson oversaw shifts in the regulator’s role; the introduction of revalidation; and an increase in the organisation’s responsibility for postgraduate medical training.

More recently the GMC has faced calls for it to be funded by taxpayers rather than doctors.1 Dickson is clear that the current funding system is key to preserving the regulator’s independence.

State funding would, he says, mean state control over the GMC. “I think our independence is one of those precious British compromises,” he says.

The regulator’s independence from government may occasionally be questioned by the profession, Dickson says, but in his experience it has never wavered. “Would I say that government ministers, from all parts of the UK, have tried to influence us in one form or another? Of course they have. But have they ever told us what to do and have we ever done it? The answer is no.”

Successor and controversy

When it was announced in July that Charlie Massey, a director general at the Department of Health in England, would be replacing Dickson as chief executive, the regulator’s independence was once again called into question. However, Dickson says that it would be wrong to confuse Massey’s previous roles with a professional affiliation to a political party or government.

“Charlie Massey has advised Labour ministers, Liberal Democrat ministers, and Conservative ministers. He cannot be held responsible for all of their decisions because actually they made different decisions,” Dickson says. “Charlie Massey needs to be judged on his record at the GMC, his record as a civil servant is what it is—as a civil servant. He has not been responsible, as a civil servant, for government policy, nor is he responsible for the ministers who make that policy.”

Dickson says that it was unfortunate timing for Massey to be appointed while tensions were still high between junior doctors and the government.

Like many other organisations, the GMC faced criticism from doctors over its behaviour during the contract dispute. The regulator issued guidance for junior doctors taking part in industrial action—something that the BMA said was inappropriate. The GMC also wrote to the BMA following the announcement of escalation of industrial action to five days, asking the association not to go ahead with the action.

“I think there’s no doubt that we’ve taken a hit from the industrial dispute. There are a lot of doctors who are angry and frustrated about that,” Dickson says.

Next steps for the GMC

One of the GMC’s key future roles will be to ensure standards for the education and training of junior doctors. “The new educational guidance is tougher on employers,” Dickson says. “The proof of the pudding will be if the GMC enforce the new guidance.”

In terms of tackling services that are struggling under rising demand, Dickson says that progress has been made in North Middlesex, where the GMC intervened after concerns were raised about its accident and emergency department. But he says that there are still hundreds of other hospitals that could potentially have problems that need investigating. “There’s a limit to what a regulator can do if the service is coming under more and more pressure. That’s the question for the whole system, as well as the GMC—how do you manage this?”

Protecting and supporting doctors in training is, Dickson says, a key part of the GMC’s role, because ultimately it means protecting patients. But, he says, providing that protection and support is more difficult now than it has been in the past. “I hope that doctors in training, despite the soreness that they currently feel, will come to see the GMC as an ally, in the sense that our job is to protect their education and training environment.”

Niall Dickson’s CV

  • 1976-78 Broughton High School, Edinburgh, teacher of history

  • National Corporation of the Care of Old People, publicity officer

  • 1979-80 Age Concern England, press office

  • 1980-81 Age Concern England, head of publishing

  • 1981-83 Macmillan Publishers, editor, Therapy Weekly

  • 1983-88 Macmillan Publishers, editor, Nursing Times

  • 1988-89 BBC, health correspondent, radio news

  • 1989-95 BBC, chief social affairs correspondent

  • 1995-2003 BBC, social affairs editor

  • 2004-09 King’s Fund, chief executive

  • 2010-16 General Medical Council, chief executive and registrar