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Doctors are being punished by a regulator that lacks insight into its own processes

Christoph Lees, 22 August 2014

Christoph Lees is a consultant and researcher in Fetal-maternal medicine and Obstetrics at a London teaching hospital. He has an interest in wider medical affairs where they impact on public policy and in particular, professional regulation. He was an author of the recent Civitas report The General Medical Council: Fit to Practise?

The GMC’s consultation on guidance for sanctions is flawed in several respects. It claims that it is necessary to protect public confidence in doctors, but a recent poll has shown public confidence in doctors to be high (MORI) and there is no evidence to suggest a decline. The guidance sets out how the GMC expects its independent panels to impose sanctions. But if the panels are in fact independent, what place is it of the GMC to ‘guide’ the panels? The sanctions are de facto punitive, but a recent High Court ruling has established that the GMC has misunderstood its position: it is there to regulate, not to punish. Those few doctors in whom  fitness to practice is found to be impaired rarely require further punitive sanction as many are effectively unemployable and subject to civil and sometimes criminal sanction.

The GMC could do worse than consider the effect of its own processes. It disciplines a higher proportion of doctors than does any country in Europe or North America. The effect of its processes have been reported to make sick doctors more sick. Approximately 100 doctors have committed suicide whilst undergoing GMC processes in the last decade and the internal GMC investigation commissioned in 2013 is yet to report: contrast this with the Howard League reports on deaths in custody. There is some evidence that  disciplinary processes make doctors practise defensively and have an effect on their mental state.

Doctors face a regulator whose intent is to punish and punish more whilst having no apparent insight into its own processes. This does not bode well for an over-regulated profession, nor for patient care.

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