Revalidation Consultation

General Medical Council

1. Thank you for inviting the Society’s response.

It might be helpful to mention first that BMA News (29th May 2010) devoted its front page to urging “root-and-branch rethink of revalidation plans”.  Although somewhat belated on the part of the BMA it is a most welcome comment as far as it goes.

2. Our general stance on revalidation since the earliest suggestion over the last decade of replacement of medical self-regulation via the GMC with politically-driven external governance, evidence-lacking revalidation plans and 40% lay appointees (of unclear provenance) on Council has been hugely damaging to the corpus of medicine. Ineluctably, (as Sir Graeme Catto conceded, see para5 ), this has damaged patient care. International survival healthcare outcome statistical comparisons on such as heart disease and cancers confirm this. Even closer to the bone is the scandal of such as the Mid Staffordshire Foundation Trust debacle last year with estimated avoidable deaths of between 400 and 1200 patients. Interestingly, the public press remains truly self-regulated and long may it remain so.

3. The justification posited by the GMC  mostly conflated ‘Bristol’ and ‘Shipman’  as justifying shambolic upheaval of medical self regulation removal together with claims that these had undermined public confidence and trust in the medical profession. Public survey after survey (including those taken in the immediate aftermath of these inquiries) still held doctors generally in high esteem. This was  in stark contrast to that of politicians.. The public are not foolish.

4. Distrust of politicians is not new and as Jeanne L Brand observed (Doctors and the State.p142. The Johns Hopkins Press, Baltimore, Maryland, 1965)....”at the time [1858] of the Council’s creation, government regulation for the control of medical standards was unacceptable to the average Englishman”.

5. Issue 16 February 2003 GMC News (Pp4-5) published an interview with then GMC President Sir Graeme Catto conducted by Dr Ian Bogle following legislation aimed at “the overhaul of medical regulation”. During that interview Sir Graeme reminded us that “when independent regulation (of the medical profession) has been  removed in other countries, patients have seen a fall in standards.

6. Sadly, despite its wealth (from doctors contributions over years) and its potential clout as a trade union (‘Association’ did not satisfy politicians who insisted that without trade union status government would not negotiate terms and condition of service with it–so the BMA obliged). A pliant BMA seemed incapable of obstructing  government and bureaucrat driven erosion of doctor self-regulation  and self esteem thus was devalued what registered medical practitioners do best, whatever their specialty.

7. Typical of this has been not only the chaotic revalidation which now might be addressed but also the decision (never addressed by a ballot of the profession) to withdraw prescribing rights from, by definition, the most experienced, albeit  retired, registered medical practitioners. There was not then, and there isn’t now,  any evidence base suggesting harmful or irresponsible prescribing from this group of practitioners. Indeed, custom and practise had it that their contribution in treatment of minor illness conditions in family and friends helped to reduce the healthcare burden on family doctors. Experienced doctors were only too aware (without reminders from less informed bodies) about respecting the boundaries of more serious illness treatment and the necessity of involving non-retired colleagues. 

8. Remarkably this anomalous decision was taken (again without any balloting of doctors) at a time when prescribing rights were being extended to professions allied to medicine which few would dispute do not receive (and there is no good reason why they should) the breadth and depth of a medical education, training, experience and skills involved in the process of becoming a registered medical practitioner. The medical consultation  involves patient examination, investigation, diagnosis and treatment.              

 9. Few of us will fail to remember Modernising Medical Careers (MMC), and Medical Training and Application Service (MTAS), the junior doctor recruitment,  training, and employment debacle despite strong warning forecasts of trouble ahead by concerned and experienced practitioners (ignored by GMC and Academy of Royal Colleges, its authority undermined by political interference).  Then there has been the slavish insistence on implementation of the European Working Time Directive (EWTD ) which so many disciplines consider will result in inadequately experienced doctors being unleashed on a vulnerable public when the EU principle of Subsidiarity could have been invoked by politicians in England and thereby protected adequacy of training time in the public interest.

9. Quite possibly the need for a vigorous  medical profession has never been as strong as it is now and many have endorsed the sentiment on revalidation expressed by Dr Peter Magauran of Newchapel  Surrey when in an elegant but elegiac  letter in 2004 to BMANEWS he wrote:-

“ I regard the great professions as vocations for life. The priesthood and the law do not rely on the equivalent of CPD [continuing professional development] points to give them meaning. Imagine a parish priest removed by his Bishop. not because of a disciplinary matter, but because he had not attended sufficient courses. Imagine George Carman (a famed barrister) – who I’ve had the privilege of coming up against – being told that his license was being revoked because his CPD points were inadequate.

Unfortunately, the medical profession has got caught up in a maelstrom of its own making from which I see little hope of extrication. Until now I have enjoyed my work mainly as an anaesthetist, but also doing voluntary work for St John’s Ambulance as  BASICS doctor for the local ambulance service. In the latter role I attend seriously injured patients involved in road traffic accidents, and receive no payment nor seek it.

I feel that the first doctor to have their name removed from the register because they have not fulfilled some arbitrary paperwork should become the martyr around whom all doctors should unite. Should this not happen I fear for the future of a once great profession. It is no coincidence that I cannot in conscience encourage my children to join that which I shall shortly leave – after such good times.”

10. We did not feel we could add more of significance at this juncture.

Dr Dermot J Ward. 4th June 2010