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The GMC needs to be a good citizen too

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The topic of how corporates act as ‘good citizens’ has been significant in recent years, for example the synthesis of work on strategy and society.

Broadly speaking, this work has identified a number of different concepts which are vital to corporate social responsibility.

The first is a ‘moral obligation’.

This must include honesty and integrity, and directly relates to domain 4 of the code of conduct “Good medical practice” for standards in trust and probity from the “General Medical Council” (GMC). Moral behaviour and legal regulation are dissociable. A legal ‘duty of candour’ or ‘wilful neglect’ are enforcement mechanisms for people telling the truth and protecting against deliberate malicious behaviour. But these are undeniable moral imperatives too. If the clinical regulator finds itself in dealing with a case in an unnecessarily protracted length of time which is disproportionate to reasonable standards, the clinical regulator should make an appropriate apology, ideally.

Sustainability is important if the clinical regulator is to be ‘in the long game’ rather than grabbing headlines for being seen to be tough on misfeasance from individuals. This means in reality that the clinical regulator should be sensitive to the environment and ecosystem in which it operates. If it is felt, for example, that politically and economically it is expedient to pursue ‘efficiency savings’, the regulator must have a sustainable plan to ensure that it is able to ensure that such savings do not impact on patient safety. The raison d’être of the GMC is supposed to be promote patient safety. A proportion of the Doctors will be unwell. The legal precedent is that conduct which is so bad cannot be condoned whatever the reason. However, it is also true that ‘but for’ alcoholism, for example, certain problems in misconduct and poor performance would not have occurred. An ill doctor is about as much use economically as somebody out of the service entirely, so it is an economic sustainable argument that the health of doctors should be an imperative for the NHS. A ‘patient group’ within the GMC would go a long way to demonstrate that the GMC is capable of playing its part within a wider ecosystem. I know of no other important entity which does not have one.

Thirdly, there should be a license-to-operate. This cannot be overstated. ‘Mid Staffs’ commanded much momentum in the media which was a problem for both the medical profession and its integrity, and yet there is still an enduring issue whether the GMC were able to regulate this as best they could under the confines of the English law and codes of practice. The GMC are also yet to report on the deaths of Doctors awaiting Fitness to Practise hearings, and the outcome of this will be essential for Doctors to ‘buy in’ literally into wishing to pay their subs.

Last of all is reputation. This goes beyond the popularity on a Twitter stream. At the moment, there is concern that neither the medical profession nor the public feel very satisfied about the performance of the GMC. There is uncertainty what the public perception of the GMC is; many feel that it is a general complaints agency, when it is, in part, to regulate the performance of individual Doctors. There’s no statutory definition of what ‘unacceptable misconduct is’, and hugely relevant to the reputation of the medical profession. This had been addressed in the English Law Commission’s proposals for regulation of clinical professionals, which are yet to see the light of day. Without this definition, the GMC can simply come down heavily on behaviour which it feels is embarrassing with impunity, whatever the potential other contribution of that doctor might be. It is quite unpredictable what the consistent set of standards where members of the public feel wronged might be for this; the GMC is very unwilling to be seen as a ‘light touch’ against members of the public who want tough sanctions.

There are so many aspects how the GMC could demonstrate its willingness to be a good citizen, which could help with the four points above. I feel as a person who has been through the whole cycle of having been regulated, who takes his credentials of being a NHS patient and being a student lawyer regulated by the Solicitors Regulation Authority rather seriously, there are constructive ways to move forward.

Firstly, I would like to see a ‘user group’ of Doctors who’ve been through the regulatory process, and who have had bad health, who might wish to volunteer on helping the GMC with improving its operational output. Secondly, I understand the temptation to throw ‘red meat’ at the readership of certain newspapers. But likewise, the GMC could make more effective use of local dispute resolution mechanisms, looking at what the Doctor, the Trust and the member(s) of the public would like as a compromise to problems. This could have the aim of having a Doctor where reasonable corrective action has taken place finding himself or herself being able to return to work. The current situation has evolved through history as being adversarial, and this can err towards catastrophising of problems rather than wishing to solve them. Likewise, there is a public perception that some issues are completely ‘shut down’ before any attempt to investigate it. Thirdly, the GMC must be aware, I feel, of the evolving culture and landscape of the medical profession across a number of jurisdictions. This means the GMC, patients and professionals could be, if they wanted to, united in their need to uphold the very highest standards of patient safety. Clinicians work in teams, and techniques such as the ‘root cause analysis’ have as an aim finding out where the performance of a team has produced an inadequate outcome. Furthermore, there is no point in one end of the system urging learning from mistakes and organisational learning with the other end of the system cracking down heavily on individuals, with the effect that some individuals never work again.

Like whole person care in policy, the clinical regulator should be concerned about all the needs of an individual, including health needs, public safety promotion, and the needs of the service as a whole. I have every confidence that the GMC can rise to the challenge. It’s not a question of light touch regulation, but the right touch regulation. 

And, as per medicine, sometimes prevention is better than cure.




  • George Nieman

    Not too many years ago an inspection system named ‘Patients and Public Forum’was formed under the instruction and guidance of the Dept of Health.
    Those who took part gave of their time voluntarily. Inspection of wards and all other departments was carried out for signs of poor cleaning, stained ceilings etc etc and each patient was asked about their experience i.e. treatments,food and staff standards.
    During that time many improvements were made to the benefit of patients and staff, so much so, that we were welcomed wherever we went.
    If patients had a complaint they were uncertain as to whom they should direct it, they waited for a member of the Forum, and sometimes asked for a forum member to visit them.
    Why the system finished no one knows?
    I would strongly recommend that the NHS re-adopt’s this again.

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