CMO's regulation plan threat to PBC

The CMO recommendations on doctor regulation would increase defensive medicine, increase referrals, discourage GPSIs and could even hamper practice-based commissioning (PBC), experts warn.

The CMO’s proposals in ‘Good Doctors, Safer Patients’ include the recommendation that the standard of proof for imposing disciplinary procedures should be reduced from ‘beyond reasonable doubt’ to the ‘balance of probability’.  

GPC chairman Dr Hamish Meldrum said that it is a principle ‘that we could never agree to’ when dealing with a person’s livelihood, and GP leaders are now saying it could damage wider general practice.  

GPC negotiator Dr Richard Vautrey said that the changes could hamper the implementation of PBC because GPs may shy away from innovative services themselves because it may leave them open to more complaints.  

‘There is a risk that the CMO’s recommendations will increase defensive medicine,’ he said. ‘This in itself means GPs are more likely to refer rather than bear risk themselves. This would have an impact on PBC and may make it less likely that GPs would want to develop GPSI skills.’  

However, although many GPs agree with him that the reforms would increase defensive medicine, a number of PBC leads also told GP that they hoped it would not affect new commissioning structures.  

Dr Tim Kimber, a PBC lead in West Sussex, said that even though defensive medicine was a possible consequence of the proposals, it should not affect PBC.  

‘Innovators tend to be bold,’ he said. ‘These are litigious times, and we live in fear of complaints. One learns to live with such a fear and can compartmentalise it.’  

But Dr Stewart Findlay, chairman of Durham Dales PCT professional executive committee and a PBC expert, said there were still concerns about the affect of defensive medicine  

‘If we are more likely to have a judgment upheld against us as a result of those changes, we will practise more defensive medicine,’ he said.  

Consultation on the CMO’s recommendations closes on 10 November. 

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