Why medicine still needs self regulation

The White Paper on medical regulation may mark the end of self regulation for doctors. The reform of the GMC will see its board reduced, losing its medical majority and the medical members being appointed rather than elected by doctors.

The White Paper says these changes are to 'dispel the perception that councils are overly sympathetic to the professions they regulate'.

This is the nub of the issue. The GMC has existed for over the 150 years and to some conjures up images of a cosy club of Victorian gents looking after their friends. It is an image that suggests that self-regulation is an outdated concept.

It is also an image that is derogatory to doctors, suggesting they would automatically protect one of their own over the safety of patients.

Instead, we should be talking about 'professional regulation' because the issue is what role the members of a profession should have in judging one of their own. However competent the lay members of these bodies are, professional regulatory cases often require technical knowledge about what is widely accepted as good practice.

In academic medicine the views of other professionals is important. It is curious that the DoH and the public are comfortable with, and trust professional oversight or review in one area of medical performance, but not in another.

Although the expectation is that there will be equal numbers of lay and medical members, the proposals allow for a reduction in the proportion of GPs on the GMC council. This strategy runs the risk of lay 'political appointees' being influenced by popular opinion, without the checks and balances of technical expertise. Such a situation would not make for good regulation and would therefore benefit neither public nor profession.

The DoH has admitted it needs to be seen to be doing something on this issue. What it must do is ensure a modern approach to professional regulation with a high level of medical expertise and  recognise that independence from government can be as important as breaking up 'a cosy club'.

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