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The General Medical Council (the GMC) registers and regulates doctors in the United Kingdom. It has the power to revoke the registration, or place restrictions on it, if they deem a doctor unfit to practise in the UK. The current president of the council is Professor Peter Rubin.

Contents

History

The GMC was established by the Medical Act 1858. It was founded in a room now located on the City Campus of the University of Worcester.

Purpose

The purpose of the GMC is to protect, promote and maintain the health and safety of the community by ensuring proper standards in the practice of medicine.[1] The council was formed in 1858. A practitioner not on the Medical Register of the GMC is forbidden to hold oneself out as a registered medical practitioner in the UK. The GMC regulates medical schools in the UK, and liaises with other nations' medical and university regulatory bodies over medical schools overseas, leading to some qualifications being mutually recognised. The Council is funded by annual fees required from those wishing to remain registered and fees for examinations. Fees for registration have risen significantly in the last few years: 2007 fees = £290, 2008 fees = £390, 2009 fees = £410.

Powers, activities and sanctions

A registered medical practitioner may be referred to the GMC if there are doubts about their fitness to practise in the UK. These are divided into concerns about health and other concerns about ability or behaviour. In the past these issues were dealt with separately and differently, but now pass through a single fitness to practise process.[2]

The GMC and its members, with substantial agreement in principle from government and from the professional bodies in UK medicine, e.g. the British Medical Association (BMA) and the medical royal colleges, represent their regulatory activity as aimed with an overwhelming priority at assuring the safety of individual patients. As the regulatory body for a profession and because the perceived reliability of the profession is significant in assuring treatment is sought and followed, the GMC has from its establishment explicitly regarded maintaining public confidence in the profession. Hearings may result in reprimands, restrictions on practice, temporary suspension or erasure from the register.

The GMC also administers the Professional and Linguistic Assessment Board test (PLAB), which has to be sat by non-European Union overseas doctors before they may practice medicine in the UK.

The main guidance that the GMC provides for doctors is called Good Medical Practice.[3] This outlines the standard of professional conduct that the public expects from its doctors and provides principles that underpin the GMC’s fitness to practise decisions. Originally written in 1995, a revised edition came into force in November 2006 following a two-year consultation process. The content of Good Medical Practice has been changed with a major focus on working in partnership with patients, one of the new duties for doctors outlined in the revised document. The care and treatment of children and equality and diversity are the other specific new areas of guidance introduced to reflect the key themes which arose during the consultation.

Types of registration

The most common types of GMC registration are provisional and full. Provisional registration is granted to those who have completed medical school and enter their first year (F1) of medical training; this may be converted into full registration upon satisfactory completion of the first year of postgraduate training ("house jobs"). In the past, a third type of registration ("limited registration") was granted to foreign graduates who had completed the PLAB examination but required a period of work in the UK before their registration could be converted to "full". Limited registration was abolished on 19 October 2007.

Reform

Since 2001, the GMC has itself become answerable to the Council for Healthcare Regulatory Excellence (CHRE, initially "Council for the Regulation of Healthcare Professionals"), which oversees GMC activity and may overturn previous verdicts.

Following recent legislation the GMC is implementing a comprehensive and wide-ranging reform of the organisation and its role. This is a result of considerable social change, but also highly publicised scandal cases such as the Shipman affair

One of the recent changes is the shift of emphasis from simple registration to revalidation of doctors, more similar to the periodic process common in American states, in which the professional is expected to prove his or her professional development and skills. The revalidation process was expected to start in 2004, although it is being delayed by the publication and implementation of the Shipman Inquiry Report.

Merger with the Postgraduate Medical Education and Training Board

In February 2008 the Secretary of State for Health, Alan Johnson, agreed with recommendations of the Tooke Report which advised that GMC should merge with the Postgraduate Medical Education and Training Board (PMETB)[4]. Whilst recognising the achievements made by PMETB, Professor John Tooke concluded that regulation needed to be combined into one body; that there should be one organisation that looked after what he called 'the continuum of medical education', from the moment someone chooses a career in medicine until the point that they retire.

The merger, which is due to happen no sooner than 1 April 2010, was welcomed by both PMETB and the GMC.

Criticism

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Self-regulation and complaints handling

Due to its nature the GMC is positioned between the medical profession and the public, and has drawn criticism from both sides - from professionals for being overly harsh in fitness to practise decisions and from the public for being too mild. Calls have been made to abolish self-regulation by the profession, but a 2000 vote by doctors was 80% in favour of continued self-regulation, although many demanded reforms,[5] one of which became revalidation.

Concern has also resulted from several studies which have shown that GMC handling of complaints appear to differ depending on race or "overseas qualification", but it has been suggested that this might be due to indirect factors.[6]

The mortality and morbidity amongst doctors going through these procedures has been open to question. In 2003/4 9 of 215 doctors undergoing Fitness to Practice died [7]. Overall, the suicide rate of people undergoing a GMC's Fitness To Practise Panel is very high, fuelling doubts about their sentences being proportionate and fair.

Shipman Inquiry

The GMC was most heavily criticised by Dame Janet Smith as part of her inquiry into the issues arising from the case of Dr Harold Shipman. "Expediency," says Dame Janet, "replaced principle." Dame Janet maintained that the GMC failed to deal properly with Fitness to Practise (FTP) cases, particularly involving established and respected doctors.[8]

In response to the Shipman report, Sir Liam Donaldson, the Chief Medical Officer, published a report titled Good doctors, safer patients, which appeared in 2006.[9] Donaldson echoes concerns about GMC FTP procedures and other functions of the Council. In his view, complaints are dealt with in a haphazard manner, the council causes distress to doctors over trivial complaints while tolerating poor practice in other cases. It accuses the Council of being "secretive, tolerant of sub-standard practice and dominated by the professional interest, rather than that of the patient". Former President of the General Medical Council, Sir Donald Irvine, called for the current Council to be disbanded and re-formed with new members.[10]

Other bodies regulating healthcare professionals

UK

Many of the above bodies, together with the GMC, are represented on the Council for Healthcare Regulatory Excellence.

Elsewhere

Other countries, including New Zealand, South Africa and Singapore, have a central regulator similar to the GMC. In the USA and Australia, each state has its own regulatory board for doctors. In Germany, each state has an Ärztekammer with lawful authority to regulate the medical profession, there is no federal level authority for the Federal Republic of Germany. Nevertheless, the Bundesärztekammer, a voluntary association of private law, was founded to support the professions' interests. The Irish Medical Council acts as regulator in the Republic of Ireland.

References

  1. ^ General Medical Council
  2. ^ Transitional arrangements - FAQ on GMC website.
  3. ^ Good Medical Practice - GMC website.
  4. ^ PMETB - Merger of PMETB with the GMC
  5. ^ Celia Hall. British Doctors pass historic Vote of No Confidence in the General Medical Council (GMC. Daily Telegraph, 2000-06-30. Accessed 2006-09-30.
  6. ^ Simon Bowers. GMC cleared of race bias charge. The Guardian, 2002-08-02. Accessed 2006-09-21.
  7. ^ Health Review Group 2005. GMC publications
  8. ^ Shipman inquiry. Safeguarding patients: lessons from the past—proposals for the future. 5th report, 2004. Online version.
  9. ^ Donaldson, L. Good doctors, safer patients: Proposals to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients; a report by the Chief Medical Officer. Department of Health, 2006-07-14. Accessed 2006-09-17.
  10. ^ The Royal Society of Medicine. Current GMC should be disbanded, says former President. Accessed 2006-09-16.

External links


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