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Last Updated: Friday, 14 July 2006, 13:14 GMT 14:14 UK
Q&A: Doctor regulation
The GMC was criticised in the Shipman Inquiry
The regulation of doctors is to undergo a radical overhaul under proposals put forward.

What does the General Medical Council do?

The GMC was established under the 1858 Medical Act.

It has four main functions - to maintain the register of qualified doctors, foster good practice, promote high standards in education and deal with fitness to practice cases against doctors.

In the 1990s, changes were made to streamline the fitness to practice process and lay participation on the council has increased to give patients more of a say.

Why is change needed?

The review was carried out after the inquiry into GP killer Harold Shipman raised concerns about the GMC.

Shipman was convicted of killing 15 patients in 2000, although he is believed to have killed at least 200 more.

Dame Janet Smith, the chairman of the inquiry, said there was a need for reform as the regulator was "too likely to support the interests of doctors rather than protect patients".

In particular, she said an independent body should handle disciplinary matters.

However, she did clear the GMC of its handling of the Shipman case.

What are the MOT-style checks?

The report, produced by Chief Medical Officer Sir Liam Donaldson, said doctors should face revalidation every five years.

There will be two strands to this process. Re-licensing will assess the doctor's general skills as a medic and will be carried out by the local GMC affiliate.

The testing of a doctor's competence in their speciality - re-certification - will be carried out by royal colleges, professional bodies which are set up to maintain standards.

Sir Liam said revalidation was required as doctors could spend the last 30 years of their careers after qualifying without facing any sort of assessment.

Such leeway was unheard of in other high risk occupations such as aviation and oil exploration.

Why is the GMC being stripped of its adjudication powers?

The GMC has traditionally acted as the prosecuting body, judge and jury in fitness to practice cases.

But the review warned this was not appropriate and has recommended the adjudication role by stripped away and handed to an independent tribunal.

Instead, the GMC will be left to assess and investigate serious complaints. Minor cases will be dealt with by the local GMC affiliate.

Doctors and the GMC will then have a right of appeal against the decision of the tribunal to the High Court.

Another key change in regards to fitness to practice cases will be the burden of proof needed.

To date, the GMC has worked on the basis of criminal cases which requires the case to be proved beyond all reasonable doubt.

However, Sir Liam said this has meant that there are doctors who are still on the register, but are considered almost unemployable as NHS trusts do not have faith in their competence.

He proposed a case need only be proved on the balance of probability.

This has already been opposed by the British Medical Association trade union which warned it could lead to "miscarriages of justice".

Are there any other proposals?

Yes. In total there are 44 different recommendations. Some of the more radical include making the GMC accountable to parliament by being quizzed yearly by a committee of MPs.

The GMC is to also lose its role in setting the content of medical undergraduate curriculum to the relatively newly-formed Postgraduate Medical Education and Training Board.

Medical students should also be required to have a "student registration" with the GMC with schools required to have a local GMC affiliate to ensure standards are adhered to.

And he added members of the GMC should be appointed through the public appointments commission rather than elected as many currently are.

He said this would help remove vested interests and allow for greater diversity.

Doctor checks 'to be easier'
01 Mar 03 |  Health

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