The GMC: out of its depth?

Mention the General Medical Council (GMC) to a group of UK doctors at the moment and you must be ready for anger and despondency. The view, widely held among doctors, that the verdict on Roy Meadow was disproportionate and inappropriate may be the opening gambit, but the conversation soon turns to the GMC itself. What I hear from a growing number of doctors who have been referred to the GMC are troubling accounts of officiousness, inefficiency, and delay; of prolonged and painful pursuit of cases that are subsequently found to have no grounds. What I hear from others is loss of faith in the GMC's abilities to manage its affairs, with damage to patients and doctors alike. This week's BMJ draws attention to the problem of underinvestigation of research fraud (pp 245, 281, 288). Should we now be talking about the problem of overinvestigation of doctors?

The sheer number of doctors who have been referred to the GMC is surprising. I had thought this was a rare event. Indeed, according to Wendy Savage, who retired in April after 16 years on the GMC (p 256), in the past it was a rare event. When she joined, the GMC received about 35 cases of professional misconduct a year. Now, she says, the cases are numbered in the hundreds. Savage puts this down to higher expectations, greater willingness among patients to complain, and greater likelihood that complaints will be referred on to the GMC. An alternative explanation might be that standards of care have fallen. Or that the GMC is pursuing cases that should be dismissed or referred back to employers for local resolution.

The GMC says that it ruled on Roy Meadow to restore public confidence in the profession. Others, including Richard Horton, editor of the Lancet (bmj.com/cgi/eletters/331/7508/66-a#112701), suggest that it may have been more concerned with shoring up its own reputation in the eyes of government. Either way it is likely to be disappointed. Making examples of people who come before its fitness to practise panels is more likely to continue the downward spiral of loss of public confidence in the profession and loss of professional and government confidence in the GMC.

What we need is a strong profession that puts patient safety at the heart of everything it does. The GMC can't achieve this alone but it has a key part to play and most people want it to succeed. Wendy Savage was its fiercest critic but also a fierce champion of self regulation. As she points out, “the GMC with all its faults is better than a government run system.”

But the GMC currently seems overwhelmed by the turning tide of public opinion, with a leadership that is out of its depth and lacks the wisdom needed to navigate its way through. That the president of the GMC, Sir Graeme Catto, did not resign after Janet Smith delivered her damning report last year was a surprise to many. The question is how long he can justify continuing in his role while presiding over a GMC that risks losing the confidence of both the people it regulates and the people it is there to protect.