The UK Government’s current consultation on how we regulate doctors in future is about much more than rules and process. It’s about a proportionate approach to meeting the changing needs of the profession and the patients they care for, argues the GMC’s chief executive Charlie Massey.
In 1983, Margaret Thatcher had just won a second term as Prime Minister, David Bowie’s ‘Let’s Dance’ was topping the charts and aerobic classes were all the rage. It was also the year that the Medical Act, which governs the GMC and its functions, was passed.
40 years on and the world as we know it has been transformed.
In the health sector, the arrival of email, the internet and new technologies have changed medical practice beyond recognition. An ageing population and growth in comorbidities has led to growing demand for care. And the international movement of health professionals combined with a desire for greater flexibility have changed both the profile of UK clinicians and their working patterns.
But while the world in which doctors practise today is fundamentally different, the legal framework governing how they’re regulated has remained largely unchanged. The model is no longer fit for purpose.
The GMC exists to protect the public, not to punish the profession. But one look at the laws that frame our regulation and you’d be forgiven for thinking otherwise.
Until now, we’ve tried to work around these constraints, pushing at the boundaries of legislation to make our interventions more responsive. But we’ve reached the limits of what we alone can do. To support both patients and the doctors who treat them, fundamental change is required.
That’s why news that legislative reform is on the horizon is so welcome. It gives us the chance to do away with the anachronisms of the Medical Act, so regulation can meet modern needs.
These limitations affect the whole gamut of our activities – from who can work in the UK, to how we investigate complaints. All too often, the result is a mismatch between our powers and the reality for doctors on the ground.
Currently, we’re required to fully assess every complaint we receive, even if it doesn’t raise fitness to practise concerns and won’t meet our legal thresholds. This is perverse. It means we end up investigating complaints that don’t need investigating, creating unnecessary distress for doctors and diverting our resources away from the things we want to focus us, like supporting good practice.
The proposed reforms give us the chance to make the complaints process more proportionate and less adversarial. Rather than defaulting to lengthy hearings, we could make greater use of ‘accepted outcomes’, where doctors would have the option to accept that their practice is impaired and that a sanction is necessary. This would do away with the need for a stressful panel hearing, with cases concluded more quickly.
As well as being inflexible, the prescriptive nature of the legislation can create unintended consequences. We’ve known for a long time that the medical workforce is under-resourced and under pressure. But efforts to redress the balance between supply and demand are being undermined because of barriers imposed by the legal framework.
Overseas doctors make an invaluable contribution to the health service. But, as it stands, senior medics from outside the EU face a series of bureaucratic hurdles if they want to work as a consultant or GP in the UK. This includes having to supply over 2,000 pages of evidence to support their application. This onerous process not only makes the UK a much less attractive destination for experienced international specialists, but also means the clinical experts already here are not working to their full potential.
Reforming this outdated legislation means regulation can do what it’s meant to do – protect patients and support its registrants to be first-class doctors.
For both clinicians and the patients in their care, change is long overdue. The needs of today’s health service have moved on since 1983. It’s about time the laws that govern it did too.
The Department of Health and Social Care consultation, Regulating healthcare professionals, protecting the public, closed on 16 June 2021.