General Medical Council

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General Medical Council

QuotationMarkLeft.png The Office of Health Professionals Adjudicator takes over all fitness to practise hearings as from April 2011. 70 GMC staff will transfer to the body and existing GMC panel members will to begin with make up the new panels. Longer term the plan is for three person panels made up of one legal expert, one medical professional and one lay person. The body promises to strip out huge levels of bureaucracy currently in GMC hearings with strict new limits on the quantify of evidence allowed and hearings costs. QuotationMarkRight.pngPulse On Line, 2010 (30 June)[1]

The General Medical Council (GMC) is the independent body which regulates the medical profession in the United Kingdom. It issues guidelines/sets standards by which the professional behaviour of medical doctors (or, strictly, "registered medical practitioners") is judged. Legally established by the Medical Act 1983.

The GMC is regulated by the Professional Standards Authority.

Medically qualified doctors have to be registered with the GMC in order to practice medicine in the UK. Such doctors are also known as registered medical practitioners.

Registered medical practitioners are further subdivided into:

  1. Those with conditions of practice
    • The commonest condition of practice is the endorsement "may only legally practice in approved practice settings. FY2 doctors or others with such endorsements need to be particularly careful as much charity or private work and some locum work is outside approved settings. They also need to be careful to apply to have this endorsement removed after completing a year of registered practice in such an approved setting as it is not removed automatically.
    • Limitations due to GMC fitness to practice determination
  2. Those with no conditions of practice
  3. Those on the specialist register (a register of doctors who are eligible to work as substantive, fixed term or honorary consultants in the health service in the UK)
    • It can be difficult to go into independent specialist practice without being on the specialist register as most private medical insurers and hospitals expect such registration.

The GMC is based in London, UK.

Following the Bawa Garba case (and indeed on previous occasions where doctors have felt that the GMC has lost their confidence) there have been calls to boycott the GMC. Doctors need to be very cautious about this - if they lose their GMC registration, they may lose their jobs and livelihood. The BMA has provided an FAQ on this.[2]

Contents

Medical Practitioners Tribunal Service

In June 2012 the GMC established the Medical Practitioners Tribunal Service (MPTS) in shadow form to run hearings at which decisions are made about serious concerns about doctors. They write:

"This was to make sure this adjudication role is separate from our role in investigating complaints about doctors.
"The Department of Health (England) is taking forward changes to the Medical Act 1983 to establish the MPTS in law as a statutory committee of the GMC to run fitness to practise hearings. This means Parliament must approve any fundamental changes that we want to make to the MPTS in future. The MPTS will be directly accountable to Parliament and will submit annual reports to the Privy Council. The MPTS has an operational role in running hearings and these changes will transfer all of the powers for running hearings to the MPTS Committee, including, for example, appointing and maintaining the lists of panellists. The legislation will allow these powers to be delegated to the chair of the MPTS."[3]

See the An introduction to the MPTS at the GMC website, and the MPTS' website.

It is noteworthy that the GMC decided to appeal the MPTS decision re Dr Bawa-Garba.

GMC controversies

It is, perhaps, unsurprising that the medical profession's regulator should strike fear into doctors, and that some of its decisions will be perceived as ill conceived, illiberal, and wrong. Some doctors, faced with a fitness to practice hearing or tribunal, have committed suicide. [4][5][6][7][8]

Some controversies are described below.

Racism

A disproportionate number of cases reported to and sanctioned by the GMC are from minority groups, black and ethnic minority in particular. This has provoked accusations that the GMC is inherently racist.

In March 2018 Charlie Massey, the GMC Chief Executive, announced that the BMA was set to launch a ‘very serious piece of work’ looking into the high level of complaints against black and minority ethnic doctors compared with white doctors.[9][10]

In 2018 the GMC's then chief executive, Charlie Massey, denied that Dr Bawa-Garba's race or sex had played any part in the General Medical Council’s decision to remove Hadiza Bawa-Garba from the UK medical register. Jenny Vaughan of Manslaughter and Healthcare responded that "We know there is an excess in referrals of BME doctors for GMC investigations. I’ve seen it at the sharp end myself with criminal prosecution, but underneath all that there is an excess in BME doctors being referred for fitness to practise processes… There is a problem here, and what we need to know is whether there is prejudice and whether there is a racial bias. We have to answer those questions."[11]

On 21 April 2018 the GMC announced that it had commissioned new research into fitness to practise referrals and racism or unconscious bias. Roger Kline and Dr Doyin Atewologun have been commissioned by the GMC to lead a major project to better understand why some doctors are referred to the regulator for fitness to practise issues more than others.[12] This research is due to report in early 2019.[13] Kline and Atewologun have previously published on discrimination in the NHS.[14][15]

Bawa-Garba case

On 4 November 2015 Dr Bawa-Garba was convicted, at Nottingham Crown Court, of manslaughter, on the grounds of gross negligence. Many doctors considered that the prosecution was ill-advised and contrary to the public interest and that the conviction was unsafe. The MPTS decided that Dr Bawa-Garba should not be struck off. The GMC, however, used its recently acquired power to appeal this decision in the appeal court, which over-ruled MPTS. See The Bawa Garba case for more details.

Medical anonymity

In 2013 the GMC consulted on an update to its guidance for doctors Good Medical Practice. A consultation draft included a proposed section 17 which read:

"If you are writing in a professional capacity, you should usually identify yourself. Any material written by authors who represent themselves as doctors are likely to be taken on trust and/or to represent the views of the profession more widely. You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin."

This was reasonably uncontroversial; but the final version of the guidance read:

"If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely."

This was viewed as amountinting to a ban on doctors participating in social media11 anonymously, unless they never let on that they are a doctor. It was viewed by many as inappropriately and unnecessarily draconian. As a ganfyd editor advised doctors at the time in his personal blog:

"If, in one tweet or another you mention that you're a doctor, or it's in your biography, then, according to these guidelines you "should" also provide your name, and not post anonymously. So, in effect, you must choose between
  • "posting anonymously and being obliged to keep the fact that you're a doctor a carefully protected secret and
  • "identifying yourself - at least by name."

Although this guidance relates specifically to social media, it would logically apply to any publication by a somebody who is (and admits to being) a registered medical practitioner.

See also

References

  1. I Quinn. Fears over introduction of 'fast-track' GP fitness to practise hearings. Pulse On Line, 2010 (30 June). Last viewed 2010 (30 June)
  2. BMA. FAQs - removal from the GMC medical register. Last viewed 2018 (10 February). Last updated 2018 (02 February).
  3. General Medical Council. Reforming our fitness to practise investigation and adjudication processes: a public consultation on changes to our rules. London: General Medical Council, 2015 (March); 1-49
  4. Davis J. 13 doctors died while GMC 'failed to act' on suicides risk, review finds. Pulse, 2016; Updated 30 November 2015; Accessed: 2018 (26 March): (http://www.pulsetoday.co.uk/your-practice/regulation/13-doctors-died-while-gmc-failed-to-act-on-suicides-risk-review-finds/20030569.article).
  5. Hawton K. Suicide in doctors while under fitness to practise investigation. BMJ : British Medical Journal 2015;350, DOI: 10.1136/bmj.h813 (http://www.bmj.com/content/350/bmj.h813).
  6. Tonkin T. GMC pledges to improve fitness-to-practise procedures. BMA; Updated 14 June 2016; Accessed: 2018 (25 March): (https://www.bma.org.uk/news/2016/june/gmc-pledges-to-improve-fitness-to-practise-procedures).
  7. Horsfall S. Doctors who commit suicide while under GMC fitness to practise investigation: General Medical Council, 2014(14 December); (https://www.gmc-uk.org/Internal_review_into_suicide_in_FTP_processes.pdf_59088696.pdf).
  8. GMC Performance and Resources Board. Review of doctors who commit suicide while under fitness to practise investigation – Action Plan: General Medical Council, 2015(18 Jun); (https://www.gmc-uk.org/15___Review_of_doctors_who_commit_suicide_while_under_fitness_to_practise_investigation___Action_Plan.pdf_61128384.pdf).
  9. Wickware C. GMC to launch 'very serious' review into complaints against BME doctors. Pulse, 2018; Updated 27 March 2018; Accessed: 2018 (28 March): (http://www.pulsetoday.co.uk/your-practice/regulation/gmc-to-launch-very-serious-review-into-complaints-against-bme-doctors/20036441.article).
  10. Chand K. It is time for the GMC to take ‘very serious’ action on racism. Pulse, 2018; Updated 28 March 2018; Accessed: 2018 (28 March): (http://www.pulsetoday.co.uk/views/dr-kailash-chand/it-is-time-for-the-gmc-to-take-very-serious-action-on-racism/20036443.article)
  11. Rimmer A. Race played no part in Bawa-Garba decision, says GMC. BMJ 2018;361, DOI: 10.1136/bmj.k1787 (https://www.bmj.com/content/361/bmj.k1787).
  12. General Medical Council. GMC commissions new research into fitness to practise referrals. GMC, 2018; Updated 21 Apr 2018; Accessed: 2018 (09 May): (https://www.gmc-uk.org/news/media-centre/media-centre-archive/gmc-commissions-new-research-into-fitness-to-practise-referrals).
  13. @GMCUK Twitter post. @rogerkline and Dr Doyin Atewologun will be leading on research into fitness to practise referrals and will be reporting their findings in early 2019. 2018 (09 May, 09:50)
  14. Kline R. The “snowy white peaks” of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England. London: Middlesex University Business School, 2014(March); 1-76 (https://www.mdx.ac.uk/news/2014/04/the-snowy-white-peaks-of-the-nhs).
  15. 'Doyin Atewologun, Val Singh, (2010) "Challenging ethnic and gender identities: An exploration of UK black professionals’ identity construction", Equality, Diversity and Inclusion: An International Journal, Vol. 29 Issue: 4, pp.332-347, https://doi.org/10.1108/02610151011042394.
  16. BMJ article Rimmer A. What should I do if I’m being investigated by the GMC? BMJ 2018;361, DOI: 10.1136/bmj.k2070 (https://www.bmj.com/content/361/bmj.k2070)
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