Last update 9th. December 2004
THE General Medical Council cancelled its Christmas party last month, doubtless aware of the unfortunate juxtaposition of seasonal jollity and the coruscating criticism from the latest instalment of the Shipman Inquiry. But for all her outpourings, chair Dame Janet Smith hasn't told doctors or readers of this column anything they hadn't realised years ago: the GMC can't protect patients from dangerous doctors, but no one else wants the job.
MD has long argued that self-regulation has to be devolved and independent. The GMC, which operates out of smart offices in Euston Road, can't possibly monitor what goes on in the front-line of the NHS. As one council member put it: "We're more of a long stop than a wicket keeper." Alas they've dropped so many catches, from the Bristol Inquiry onwards, that their preoccupation is as much with their own survival as protecting patients. As Dame Janet put it: "So far as the GMC was concerned, Shipman was free to practise medicine unrestricted."
The GMC's response to this criticism was predictable; having ignored whistleblowers for decades, they apprehended a handful of Hyde doctors for not blowing the whistle on Shipman. As if it would have made any difference. And neither would the plethora of revalidation and reappraisal programmes that have been spawned by the GMC and Royal Colleges post-Shipman. An ingenious psychopath could easily jump through such hoops. To suggest these watered down competency checks might pick up another Shipman is akin to introducing tests for lorry drivers to pick up another Peter Sutcliffe. Shipman was not an incompetent doctor - he was a mass murderer who happened to be a doctor.
There will hopefully never be another Shipman but, according to former GMC president Donald Irvine, there may still be as many as 11,000 incompetent doctors working in the NHS. Alas, like the rest of the GMC, he doesn't know where they work. So what's the solution? Doctors remain the best people to judge the quality of work of other doctors, provided they don't have a vested interest. Dr William Pickering has long argued for a medical inspectorate independent of the NHS, GMC or royal colleges, present in every region and dedicated to picking up errors and mistreatment by acting swiftly on tip-offs from whistleblowers and patient complaints.
As Pickering puts it: "All clinical complaints, plus a copy of the written response to the patient will pass across the inspectorate's desk. This will press medical personnel and NHS managers into prompt, open and accurate explanations. If indicated, the inspectorate would examine the medical records and if sub-standard clinical practice is evident, it will swiftly inform the doctor and the regulatory bodies. Its very presence will force all doctors to examine their practice. Clinical standards may be expected to quickly rise. Expensive legal defence costs and awards are likely to drop. Above all, patients can be sure that their doctors are, at last, meaningfully clinically accountable." But who will pay for it?
(Dr Pickering's proposals are expanded in Regulating Doctors, edited by D Gladstone, ISBN 1-903 386-0.)
M. D. Private Eye January 7th 2005