BMA rejects CMO's ‘scale of proof'

The BMA is holding out for a criminal standard of proof in fitness-to-practise cases despite the CMO for England's suggested compromise of a sliding scale according to the severity of the misdemeanour.

Launching the BMA’s response to Good Doctors, Safer Patients, Mr James Johnson, chairman of BMA Council, acknowledged that a sliding scale is a ‘step forward’ but said the BMA ‘would much prefer to maintain the existing arrangements’.  

He said the BMA feels that it would be ‘too harsh’ to deprive someone of their living without a criminal standard of proof.  

Lowering the standard of proof would ‘open the way for any vexatious or malicious accusation to gain currency’, the BMA warned.  

The CMO Sir Liam Donaldson recently softened the proposal in his post-Shipman report that required proof should drop from the criminal to the civil standard by introducing a sliding scale of misdemeanours, proof and penalties.  

The BMA said that the DoH’s post-Shipman report on medical regulation was ‘a missed opportunity’. The planned restructuring of the GMC was a ‘huge step away’ from professionally led regulation and would lead to disempowered doctors practising defensive medicine and a ‘tickbox attitude’, Mr Johnson said.  

The proposed GMC workplace affiliates were inadequate, expensive and a replacement of the discredited system of three wise men with one wise man, the BMA said.  

‘One person in every workplace seems crazy,’ Mr Johnson said. ‘But the real danger is that this would convince primary care organisations that clinical governance is no longer a core activity.’ For the BMA this was the ‘most disappointing aspect’ of the report. The BMA accused the CMO of seeking to ‘bring regulation into the workplace as a means of compensating for poor clinical governance’. 

The BMA response

  • FOR more support for doctors with performance problems.
  • FOR more resources for the National Clinical Assessment Service (NCAS) and closer working between NCAS and GMC.
  • FOR GMC to be accountable to parliament.
  • FOR statutory duty for PCOs to learn from specific medical errors and complaints.
  • FOR single medical register, subsuming performers’ lists.
  • AGAINST medical members of GMC to be appointed by Public Appointments Commission.
    Alternative: doctors to elect medical members.
  • AGAINST lowering standard of proof needed to strike a doctor off.
    Alternative: None offered.
  • AGAINST Removing adjudication from GMC.
    Alternative: None offered EU-law compliant and scrutinisable by courts and Council for Healthcare Regulator Excellence.
  • AGAINST Undergraduate education to move to Postgraduate Medical Education Training Board.
    Alternative: GMC’s education committee to have three-way responsibility for undergraduate, postgraduate and continuing education.
  • AGAINST UK citizens and graduates to take a language exam.
    Alternative: No change needed. 

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