The GMC: expediency before principle
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《英国医生杂志》
EDITOR—The BMJ's rigorously exercised editorial independence is well shown, but lest Editor's choice and Smith's editorial on the General Medical Council are mistaken for BMA policy, I emphasise that these were not the BMA's views in the wake of the fifth report of the Shipman inquiry.1 2
Richard Smith, a long-term critic of the GMC, says that Dame Janet Smith finds deficiencies in the GMC's new fitness to practise procedures introduced in November 2004. Would it not be sensible to allow the new system a chance to prove itself before condemning its existence? In chapter 27 of her latest report Dame Janet says that broadly speaking the changes are an improvement, stating: "I do not know how well they will operate in the interests of patient protection." She believes it would be sensible to allow the new procedures "to develop and settle down before their adequacy and fitness for purpose is judged." The editorial does not reflect this.
The inquiry set out to ensure that another Shipman would be detected very quickly. The BMA supports the suggested reform of the coronial system, death certification procedures, and drug monitoring that will help this.
The inquiry also set out to enhance the prospect of detecting aberrant behaviour or substandard performance in doctors. The new systems of appraisals and revalidation do that, and I hope that the current delay in their introduction is as short as possible. Developing revalidation has been difficult for the profession, but doctors have worked determinedly with the GMC to produce a system that would work. They deserve credit for that.
The third aim of the inquiry was to allow scope and opportunity for the continued improvement of "the good quality care provided by the large majority of doctors." Response to the inquiry has to be proportionate, and this last aim must not suffer in the rush to secure the first two. Doctors in the United Kingdom already feel more regulated, micro-managed, and subject to bureaucracy than colleagues in other countries.
Smith says that wherever there has been a trade off between protecting the public and being fair to doctors the GMC has taken the side of doctors. Is this borne out by the facts? Most doctors still work in fear of a letter from the GMC, and recent events suggest the GMC has been bending over backwards to ensure that it is not seen as protecting doctors.
Dame Janet recognises that, as well as protecting patients, the GMC has a duty towards doctors and "must be fair in all its dealings with them," but she believes that the balance has been wrong. I do not regard being fair to doctors as a crime. I would expect any regulator to ensure that it is fair to all parties.
The BMA is in favour of professionally led regulation. It backed the need for change in the GMC, now let us allow time for the benefits of those changes to be shown as being fair to doctors and protecting patients.
James Johnson, chairman, BMA Council
BMA House, London WC1H 9JP jjohnson@bma.org.uk
Competing interests: None declared.
References
Abbasi K. Editor's choice. An important debate on the GMC. BMJ 2005;330: 0. (1 January.)
Smith R. The GMC: expediency before principle. BMJ 2005;330: 1-2. (1 January.)
Richard Smith, a long-term critic of the GMC, says that Dame Janet Smith finds deficiencies in the GMC's new fitness to practise procedures introduced in November 2004. Would it not be sensible to allow the new system a chance to prove itself before condemning its existence? In chapter 27 of her latest report Dame Janet says that broadly speaking the changes are an improvement, stating: "I do not know how well they will operate in the interests of patient protection." She believes it would be sensible to allow the new procedures "to develop and settle down before their adequacy and fitness for purpose is judged." The editorial does not reflect this.
The inquiry set out to ensure that another Shipman would be detected very quickly. The BMA supports the suggested reform of the coronial system, death certification procedures, and drug monitoring that will help this.
The inquiry also set out to enhance the prospect of detecting aberrant behaviour or substandard performance in doctors. The new systems of appraisals and revalidation do that, and I hope that the current delay in their introduction is as short as possible. Developing revalidation has been difficult for the profession, but doctors have worked determinedly with the GMC to produce a system that would work. They deserve credit for that.
The third aim of the inquiry was to allow scope and opportunity for the continued improvement of "the good quality care provided by the large majority of doctors." Response to the inquiry has to be proportionate, and this last aim must not suffer in the rush to secure the first two. Doctors in the United Kingdom already feel more regulated, micro-managed, and subject to bureaucracy than colleagues in other countries.
Smith says that wherever there has been a trade off between protecting the public and being fair to doctors the GMC has taken the side of doctors. Is this borne out by the facts? Most doctors still work in fear of a letter from the GMC, and recent events suggest the GMC has been bending over backwards to ensure that it is not seen as protecting doctors.
Dame Janet recognises that, as well as protecting patients, the GMC has a duty towards doctors and "must be fair in all its dealings with them," but she believes that the balance has been wrong. I do not regard being fair to doctors as a crime. I would expect any regulator to ensure that it is fair to all parties.
The BMA is in favour of professionally led regulation. It backed the need for change in the GMC, now let us allow time for the benefits of those changes to be shown as being fair to doctors and protecting patients.
James Johnson, chairman, BMA Council
BMA House, London WC1H 9JP jjohnson@bma.org.uk
Competing interests: None declared.
References
Abbasi K. Editor's choice. An important debate on the GMC. BMJ 2005;330: 0. (1 January.)
Smith R. The GMC: expediency before principle. BMJ 2005;330: 1-2. (1 January.)