ABSTRACT
In recent years the medical profession has come under intense scrutiny as a result of a number of scandals in both hospital medicine and general practice. These range from the unnecessary deaths of children at the Bristol Royal Infirmary, the improper retention of organs at Alder Hey, to the unlawful killing of over 200 patients by Harold Shipman. Clifford Ayling was imprisoned in 2000 for abusing female patients over a period of at least seven years, during which time he had been dismissed by a number of employers without action being taken against his registration. In addition to these high profile cases, over a four-year period at least seven GPs were reported to have been jailed for sexually assaulting patients.1 The high profile cases have resulted in inquiries and reports, and the government and profession have responded by reviewing and changing aspects of the regulatory process. However, these cases are likely to be the tip of the iceberg. A former President of the GMC, Sir Donald Irvine has suggested that in excess of 11,000 doctors may be unfit to practise, 5 per cent of the total number of doctors on the medical register. Reasons include failing to keep up to date or other manifestations of incompetence, ill-health and deliberate wrongdoing. The Chief Medical Officer, Sir Liam Donaldson, said in 2001 that among hospital doctors the figure could be 6 per cent, while the Royal
1 For example, a number of incidents were reported by the BBC 1 programme, Real Story, Monday, 8 November 2005. This programme used a number of cases to illustrate problems with the current regulatory system. One case involved a doctor who had been using drugs and vaccines which were significantly out of date. Some patients had to be re-vaccinated and, presumably, were at risk of contracting serious illness in the interim. No effective action was taken after an initial report by the practice manager. Only after the third complaint did the GMC act, imposing restrictions on the doctor but not removing her from practice. Another pair of serious cases involved GPs using and profiting from patients as guinea pigs for clinical trials without their informed consent. Some of the patients involved suffered serious side effects. These doctors were suspended temporarily from practice, but not struck off. The case of a doctor who had restrictions placed on his practice (preventing him treating women alone) by the GMC after being found guilty, inter alia, of having asked a schoolgirl ‘to touch his penis and guess its size’, was also highlighted. The relatively lenient penalty was contrasted
this latter figure, at least 3 million people in Britain could have a sub-standard GP. Doctors in the United Kingdom have increasingly been subject to myriad forms of regulation. These include regulation as part of their employment (for the majority of doctors this will be within the National Health Service); civil action in negligence; criminal prosecution and ‘self’-regulation by the General Medical Council. All but the GMC are limited in their scope. It has been relatively easy for a doctor to escape sanction in the employment context by either moving on before disciplinary action could be taken, or by being ‘eased out’ by the employer by way of voluntary severance to avoid expensive and often protracted disciplinary proceedings. Civil claims depend on the claimant being able to access the resources necessary to bring a claim. The latter are also predominantly compensatory and, because damages will usually be paid by an insurer or the doctor’s employer, have little or no direct disciplinary effect. Criminal prosecutions against doctors will arise rarely and only in relatively extreme cases. This leaves the GMC as the only body which can remove a doctor’s right to practise irrespective of his or her employment situation. The GMC is the only body which has responsibility for doctors from the stage of initial training through to retirement and beyond. It is the only body which can deal with doctors across a significant range of misconduct types – from relatively minor infractions on the one hand to the most serious criminal matters on the other. Unlike civil actions, the penalties imposed by the GMC apply directly against the doctor. In short, the GMC is absolutely central to the regulation of doctors.
