An already punitive General Medical Council now demands even greater powers
Civitas, 28 August 2014
This is a guest blog by Hilarie Williams, who was Senior Medical Adviser to the Department for Education and Employment from 1994 to 2000, and works part-time as an NHS specialty doctor. She is a member of the Doctor’s Policy Research Group, and was an author of the recent Civitas report The General Medical Council: Fit to Practise?
”There is no event that a bureaucracy is incapable of misunderstanding or of using to extend its own powers”: Theodore Dalrymple wrote this about the fall-out from the Alder Hey affair but it neatly encapsulates the General Medical Council post-Shipman, and was in evidence yet again on the Friday before the August bank holiday. The BBC Breakfast programme’s second news item was “doctors could face tougher punishment for failures in patient care”. It seemed that the GMC had launched a new consultation on further extending its powers (although it hadn’t bothered to inform the registrants who are obliged to fund it and whose lives stand to be affected by it). Radio 4’s Today programme followed up by interviewing, among others, Niall Dickson, chief executive of the GMC. He confirmed his belief that merely being concerned with whether or not a doctor is currently unfit to practise, or may be so in future, is not enough. Dickson believes doctors need to be punished for past breaches of the guidance that has flooded the profession over the past few years.
Why is this? The GMC has admitted there is no evidence of any fall in medical standards. The courts have established that it is not the GMC’s role to punish and that it must focus on current and future rather than past impairment. The chair of the GMC’s own regulator, the Professional Standards Authority, has declared that increasing guidelines is not the way forward. Ipsos MORI polls have found a vast majority of those they survey trust doctors. So why is Niall Dickson trying to re-write the rules?
The answer he supplied in the Today interview was that all of this is required in order to instill public confidence and safeguard the reputation of the profession. But that merely opens the floodgates to more questions: who determines what will instill public confidence? How do they determine it? Which sections of the public get to have a say: how are they selected, or do they self-select? Most importantly, is it appropriate for a professional regulator, focused on safety, to be driven by broader notions of approval ratings rather than by professional appraisal of risk?
If the answer to the last question is “yes”, we will have a medical regulator that explicitly takes a political rather than a professional perspective. We may already be seeing effects of the GMC’s political ‘spin’ since, according to a report drawn up by Plymouth University, the regulator’s own media strategy may well be playing a part in fuelling increased demand for its services. ‘Public Safety’ has a sinister history as a justification for increasingly draconian measures. It has been used infamously to justify a culture of denunciation and public admission of guilt, and these other elements can be found in the current GMC consultation – albeit dressed up in the 21st century terminology of reporting concerns, and apologizing early and often. But what’s not to like? Much of the new consultation document looks superficially reasonable, especially as the cases given as examples before each consultation question are usually quite extreme – for instance, a doctor who has fractured his son’s skull, and another who has embezzled large sums from a sick children’s charity. Who can object to ‘whistleblowing’ and cracking down on bullying?
Unfortunately, ‘whistleblowing’ and bullying are activities that, extremes aside, owe a lot to individual perspectives, so ticking the box on a consultation may not get you quite what you think. In the absence of strict definitions and a thorough understanding of the healthcare environment, there is a serious danger of ‘creep’: one can recall that surveillance powers, intended to combat terrorism, came to be used to try to enforce school catchment areas. Those who have witnessed the GMC’s ideas of proportionality and their ability to understand what constitutes evidence will need more persuading.
For more by the Doctor’s Policy Research Group, click here.