Page last updated at 17:10 GMT, Wednesday, 21 February 2007

Q&A: Doctors' regulation

Surgeon in action
Doctors will have less regulatory power
Ministers have proposed a radical shake-up in the way medicine is regulated.

A look at what they have proposed and how it will be implemented.

What has happened?

The government has put forward a range of proposals in the biggest overhaul of medical regulation in a generation.

At the heart of the proposed changes, which will now be debated by parliament, is a reorganisation of the GMC's duties and powers.

They are to be stripped of their responsibility to adjudicate on fitness-to-practise cases, leaving them to concentrate on investigating them instead.

In effect, the GMC will be in charge of collating the evidence and presenting the case just as the Crown Prosecution Service would to a criminal court.

An independent body would then judge the case, although the GMC would retain a right to appeal any decision.

Senior doctors, such as consultants and GPs, are to face five-yearly MOT-style checks to close a loophole whereby senior doctors can go there whole career without facing assessments.

Why is change needed?

The government has acted after an inquiry into GP killer Harold Shipman raised concerns about how doctors are regulated.

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.

But Shipman is not the only scandal to have dogged the medical profession. The government also cited several sex abuse and incompetence cases over recent years.

Last year, Chief Medical Officer Sir Liam Donaldson carried out his own review, making the case the doctor MOTs and stripping the GMC of some its powers.

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.

How is the make up of the GMC changing?

The government has told the GMC that its membership must be comprised of at least 50% lay people.

This means it is quite likely that in the near future the president, or chairman as they are likely to be called, would be someone who was not medically trained - something that would be controversial among many doctors.

A network of local GMC affiliates is also to be established with one placed in each hospital and primary care trust.

These people would be in charge of handling minor complaints against doctors.

What are the MOT-style checks?

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.

The testing process is expected to just take the doctors out of work for one day every five years.

They may be asked to undergo computer simulated treatment scenarios. If they fail the tests, they will be subject to training and supervision and may even be struck off the medical register.

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 Sir Liam's review last year warned this was not appropriate and ministers accepted his recommendation that the adjudication role be handed to an independent body.

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 evidence which requires the case to be proved "beyond all reasonable doubt".

The government's proposals say this should change to the civil standard "on the balance of probability".

However, this will be done on a sliding scale with more evidence required to prove the most serious allegations.

What do doctors think of the proposals?

The British Medical Association, the doctor's trade union body, has mixed views over the changes.

It has opposed any moves to reduce the burden of proof, but has welcomed the MOT-style checks in principle.

However, Dr Hamish Meldrum, chairman of the BMA's GP committee, said he did not want to see half of the doctors "charging around the country" appraising the other half.

Are any other professions affected?

Yes. Similar recommendations have been made for eight other professional bodies - the Health Professions Council, which includes psychologists and counsellors, the Nursing and Midwifery Council, the General Dental Council, the Royal Pharmaceutical Society of Great Britain, the General Osteopathic Council, the General Optical Council, the General Chiropractic Council and the Pharmaceutical Society of Northern Ireland.

All of the bodies have to ensure they have at least 50% lay membership, but it is still to be finalised just how regulation will work.


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