General Medical Council: Difference between revisions

The General Medical Council (GMC) is a fee-based registered charity^[1] providing a voluntary register of medical practitioners within the United Kingdom. The current chair of the council is Professor Sir Peter Rubin and current chief executive and registrar is Niall Dickson.

The GMC was established by the Medical Act 1858.

All the GMC's functions derive from a statutory requirement for the establishment and maintenance of a register, which is the definitive list of doctors licensed to practice as "registered medical practitioners", within the public sector in Britain. The GMC controls entry to the List of Registered Medical Practitioners ("the medical register").

The GMC also regulates and sets the standards for medical schools in the UK, and liaises with other nations' medical and university regulatory bodies over medical schools overseas, leading to some qualifications being mutually recognised. Since 2010, it also regulates postgraduate medical education.

Due to the principle of autonomy and law of consent and

Contrary to what may be the public perception or expectation there is no legislative restriction on who can treat patients or provide medical or health-related services (ie, it is not a criminal offence to provide what would be considered medical assistance or treatment to another person – and not just in an emergency). This is in contrast with the position in respect of animals, where it is a criminal offence under the Veterinary Surgeons Act 1966 for someone who is not a registered veterinary surgeon (or in certain more limited circumstances a registered veterinary nurse) to provide treatment (save in an emergency) to an animal.

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Parliament, since the enactment of the 1858 Act, has conferred on the GMC powers to grant various legal benefits and responsibilities to those medical practitioners who are registered with the GMC - a public body and association, as described, of the Medical Act of 1983, by Mr Justice Burnett in British Medical Association v General Medical Council.^[3]

Registration brings with it the privileges, as they are described, set out in Part 6 of the Act. In reality, they comprise prohibitions for all those not registered. Section 46 prohibits any person from recovering in a court of law any charge rendered for medical advice, attendance or surgery unless he is registered. Section 47 provides that only those registered can act as physicians, surgeons or medical officers in any NHS hospital, prison, in the armed forces or other public institutions. Section 48 invalidates certificates, such as sick notes or prescriptions, if signed by someone who is unregistered. Section 49 imposes penalties via criminal offences for pretending to be a registered medical practitioner.

Through which, by an Order in the Privy Council,^[4] the GMC describes "The main objective of the General Council in exercising their functions is to protect, promote and maintain the health and safety of the public".

The GMC is funded by annual fees required from those wishing to remain registered and fees for examinations. Fees for registration have risen significantly in the last few years: 2007 fees = £290, 2008 fees = £390, 2009 fees = £410, 2010 fees = £420, 2011 fees = £420, with a 50% discount for doctors earning under £26,000.^[5][6]

In 2011, following the Command Paper "Enabling Excellence-Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers", registration fees were reduced by the GMC in accordance with the Government's strategy for reforming and simplifying the system for regulating healthcare workers in the UK and social workers and social care workers in England and requiring that ^[7]

At a time of pay restraint in both the public and private sectors, the burden of fees on individual registrants needs to be minimised.

The GMC maintains a register of medical practitioners. However, no law expressly prohibits any unregistered or unqualified person from practicing most types of medicine or even surgery. A criminal offence is committed only when such a person deliberately and falsely represents himself as being a registered practitioner or as having a medical qualification. The rationale of the criminal law is that people should be free to opt for any form of advice or treatment, however bizarre…

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Registration with the GMC confers a number of privileges and duties.^[9] The most common types of GMC registration are provisional and full. Provisional registration is granted to those who have completed medical school and enter their first year (F1) of medical training; this may be converted into full registration upon satisfactory completion of the first year of postgraduate training ("house jobs"). In the past, a third type of registration ("limited registration") was granted to foreign graduates who had completed the Professional and Linguistic Assessment Board examination but required a period of work in the UK before their registration could be converted to "full". Limited registration was abolished on 19 October 2007 and now international medical graduates can apply for provisional or full registration depending on their level of experience – they still have to meet the GMC’s requirement for knowledge and skills and for English language.^[10]

The GMC administers the Professional and Linguistic Assessment Board test (PLAB), which has to be sat by non-European Union overseas doctors before they may practice medicine in the UK as a registered doctor.

The GMC sets standards of professional and ethical conduct that doctors in the UK are required to follow. The main guidance that the GMC provides for doctors is called Good Medical Practice.^[11] This outlines the standard of professional conduct that the public expects from its doctors and provides principles that underpin the GMC’s fitness to practise decisions. Originally written in 1995, a revised edition came into force in November 2006 following a two-year consultation process. The content of Good Medical Practice has been changed with a major focus on working in partnership with patients, one of the new duties for doctors outlined in the revised document. The GMC also provides additional guidance for doctors on specific ethical topics, such as treating patients under the age of 18, end of life care, and conflicts of interest.^[12]

The GMC regulates medical education and training in the United Kingdom. It runs 'quality assurance' programmes for UK medical schools and postgraduate deaneries to ensure that the necessary standards and outcomes are achieved.^[13]

In February 2008 the then Secretary of State for Health, Alan Johnson, agreed with recommendations of the Tooke Report^[14] which advised that the Postgraduate Medical Education and Training Board should be assimilated into the GMC.^[15] Whilst recognising the achievements made by PMETB, Professor John Tooke concluded that regulation needed to be combined into one body; that there should be one organisation that looked after what he called 'the continuum of medical education', from the moment someone chooses a career in medicine until the point that they retire. The merger, which took effect on 1 April 2010, was welcomed by both PMETB and the GMC.^[16]

A registered medical practitioner may be referred to the GMC if there are doubts about their fitness to practise in the UK. These are divided into concerns about health and other concerns about ability or behaviour. In the past these issues were dealt with separately and differently, but now pass through a single fitness to practise process.^[17] The GMC has powers to issue advice or warnings to doctors, accept undertakings from them, or refer them to a fitness to practise panel. The GMC’s fitness to practise panels can accept undertakings from a doctor, issue warnings, impose conditions on a doctor’s practise, suspend a doctor, or erase them from the medical register ('struck off').^[18] The GMC is concerned with ensuring that doctors are safe to practise. Its role is not, for example, to fine doctors or to compensate patients following problems.^[19] The outcomes of hearings are made available on the GMC website.^[20]

Since 2001, the GMC has itself become answerable to the Council for Healthcare Regulatory Excellence (CHRE), which oversees GMC activity and may challenge fitness to practise verdicts which it considers too lenient.^[21]

The GMC is also accountable to Parliament through the Health Select Committtee. In its first report on the GMC, the Committee described the GMC as "a high-performing medical regulator", but called for some changes to fitness to practise rules and practices, including allowing the GMC the right to appeal verdicts of its panels which it considers too lenient^[22].

In the 2000s, the GMC implemented wide-ranging reforms of its organisation and procedures. In part, such moves followed the Shipman affair. They followed a direction set by the UK government in its white paper, Trust, Assurance and Safety ^[23]. One of the key changes was to reduce the size of the Council itself, and changing its composition to an equal number of medical and lay members, rather than the majority being doctors^[24].

In 2011, the GMC proposed further changes to separate its role in investigating cases from its role in managing doctors' hearings by establishing a new body to run hearings, to be called the Medical Practitioners Tribunal Service^[25]. The GMC had previously been subject to criticism for combining these two roles under one roof^[26].

A forthcoming reform to medical registration is the introduction of revalidation of doctors, more similar to the periodic process common in American states, in which the professional is expected to prove his or her professional development and skills. Revalidation is scheduled to start in 2012.^[27]

On 16 February 2011, The Secretary of State for Health, Andrew Lansley, made a Written Ministerial Statement in the Justice section entitled ‘Health Care Workers, Social Workers and Social Care Workers’ in which he said:^[28]

I have today laid before Parliament a Command Paper, "Enabling Excellence-Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers" (Cm 8008)^[29] setting out the Government's proposals for how the system for regulating health care workers across the United Kingdom and social workers in England should be reformed.

Due to its nature the GMC is positioned between the medical profession and the public, and has drawn criticism from both sides - from professionals for being overly harsh in fitness to practise decisions and from the public for being too mild.

Concern has also resulted from several studies which have shown that GMC handling of complaints appear to differ depending on race or "overseas qualification", but it has been suggested that this might be due to indirect factors.^[30]

The mortality and morbidity amongst doctors going through these procedures has been open to question. In 2003/4 9 of 212 doctors undergoing Fitness to Practice died.^[31] Overall, the suicide rate of people undergoing a GMC's Fitness To Practise Panel is very high ^{[citation needed]}, fuelling doubts about their sentences being proportionate and fair.

In a warning on 'over-regulation', the Royal College of General Practitioners chair Dr Clare Gerada commented ^[32]

We already spend up to £1bn regulating doctors. We are one of the most over-regulated professions around and there will always be people who fall through. If we pile on more and more regulation we will never win.

The GMC was registered as a charity with the Charity Commission of England and Wales on 9 November 2001. The Commissioners having considered the court and the Commission’s jurisdiction to consider an organisation’s status, which had previously been considered by the courts, in issues of charitable status.

Charities do not normally have to pay income tax or corporation tax, capital gains tax or stamp duty. Following the granting of charitable status the GMC obtained tax relief backdated to 1 April 1994.^[33] Charities pay no more than 20% of normal business rates on the buildings they use and occupy. The GMC received confirmation of 80% business rates relief effective from April 1995. According to accounts submitted by the GMC to the Charity Commission for the year ended 31 December 2010^[34] Income was £101.34m, Spending £87.34m with a Retained Income of £14m for the year and Reserves of £40.672m.^[35]

The GMC was most heavily criticised by Dame Janet Smith as part of her inquiry into the issues arising from the case of Dr Harold Shipman. "Expediency," says Dame Janet, "replaced principle." Dame Janet maintained that the GMC failed to deal properly with Fitness to Practise (FTP) cases, particularly involving established and respected doctors.^[36]

In response to the Shipman report, Sir Liam Donaldson, the then Chief Medical Officer, published a report titled Good doctors, safer patients, which appeared in 2006.^[37] Donaldson echoed concerns about GMC FTP procedures and other functions of the Council. In his view, complaints were dealt with in a haphazard manner, the GMC caused distress to doctors over trivial complaints while tolerating poor practice in other cases. He accused the Council of being "secretive, tolerant of sub-standard practice and dominated by the professional interest, rather than that of the patient". Former President of the General Medical Council, Sir Donald Irvine, called for the current Council to be disbanded and re-formed with new members.^[38]

In July 2010 the GMC was severely criticized in an open letter in the British Medical Journal by Professionals Against Child Abuse for the decision to include Penny Mellor on the GMC's Expert Group on Child Protection. According to the letter, Penny Mellor had been convicted and imprisoned for conspiring to abduct a child, and had led protracted hostile campaigns including false allegations against doctors and other professionals involved in child protection cases. She had also campaigned against Sir Roy Meadow and Professor David Southall, who were erased from the medical register by the GMC but subsequently re-instated after court rulings.[1] Penny Mellor subsequently resigned from the Expert Group.

• Health Professions Council (regulates other health professions in the UK)
• Nursing and Midwifery Council (regulates nurses and midwives)
• General Optical Council
• General Dental Council
• General Chiropractic Council
• General Osteopathic Council
• General Pharmaceutical Council
• Pharmaceutical Society of Northern Ireland
• United Kingdom Accreditation Forum

Many of the above bodies, together with the GMC, are represented on the Council for Healthcare Regulatory Excellence.

Other countries, including New Zealand, South Africa and Singapore, have a central regulator similar to the GMC. In the USA and Australia, each state has its own regulatory board for doctors. In Germany, each state has an Ärztekammer with lawful authority to regulate the medical profession, there is no federal level authority for the Federal Republic of Germany. Nevertheless, the Bundesärztekammer, a voluntary association of private law, was founded to support the professions' interests. The Irish Medical Council acts as regulator in the Republic of Ireland.

• MacAlister, D. Introductory Address on the General Medical Council (lecture, 1906)

• Official website