General Medical Council

The General Medical Council (the GMC) is the regulator of the medical profession in the United Kingdom. It licenses doctors to practise, and has the power to revoke the licence, or place restrictions, in cases of questions about a doctor's fitness to practise. The current president of the council is Professor Sir Graeme Catto.

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History

The GMC was established in 1858 by Act of Parliament.

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 themselves 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.

Powers, activities and sanctions

A registered medical practioner may be referred to the GMC if there are doubts about their fitness to practise. 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 BMA, the 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.

Modes of licensing

Three types of GMC licence exist: provisional, limited and full. Provisional registration is granted to those who have completed medical school; this may be converted into full registration upon satisfactory completion of the first year of postgraduate training ("house jobs"). Limited registration is granted to foreign graduates who have completed the PLAB examination but require a period of work in the UK before their registration can be converted to full. Limited registration is expected to be discontinued.

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.

Criticism

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,^[4] 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.^[5]

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.^[6]

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.^[7] 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.^[8]

Other healthcare regulatory bodies

UK

• Health Professions Council (regulates other health professions in the UK)
• Nursing and Midwifery Council (regulates nurses and midwives)
• General Optical Council
• General Dental Council
• General Chiropractic Council
• General Osteopathic Council
• Royal Pharmaceutical Society
• Pharmaceutical Society of Northern Ireland
• United Kingdom Accreditation Forum

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

Elsewhere

Many 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.

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