Meet the bloated, useless General Medical Council

It used to be little more than a clerk and a disciplinary committee; now it's a nest of power-hungry bureaucrats

18 October 2014

9:00 AM

18 October 2014

9:00 AM

There was a time, not long ago, when British GPs provided the best home doctor service in the world. Patients could telephone their doctor 24 hours a day, seven days a week (including Christmas), ask for a home visit and get one. Patients prepared to visit the surgery could expect to see a doctor the day they called.

Today, it is easier to find a plumber than a doctor at night and weekends. Patients wanting emergency help out of office hours must visit their nearest major hospital and spend hours queuing in the A&E department. In some areas the target waiting time is 12 hours, though in practice, things are often barbaric, with patients forced to lie in an ambulance, parked outside the hospital for up to eight hours before room can be found for them in the accident and emergency department. Patients who might otherwise have been saved are dying while waiting for treatment.

Patients who visit their GP in her surgery can, in many practices, expect to be given just enough time to describe one symptom. If they’ve got two they must make a second appointment.

It is generally assumed that the sudden deterioration in the quality of general practice is the result of the deal done between the government and the British Medical Association, the doctors’ union. The deal allowed doctors to opt out of providing night and weekend cover and, for most of the country, spelt the end of the traditional 24-hour-a-day cover. Those who looked a little closer realised that the deal was itself an inevitable result of EU employment laws, which regulated the number of hours the employees could work.

But although EU laws are responsible for the sudden deterioration in the quality of the NHS, they aren’t the whole answer. There is another organisation which deserves a good part of the blame: the General Medical Council.

The General Medical Council, the GMC, is a curious organisation which is part charity, part quango, part government department and part protection racket. It used to consist of little more than a file clerk, who kept the register of doctors who were qualified to practise medicine, and a committee of rather pompous individuals who sat in judgment when erring doctors were accused of bonking their patients on the consulting-room couch. The filing clerk kept a list of doctors and stored the list in a couple of filing cabinets. Every year the GMC published a couple of thick red books which listed all the doctors in the medical register. The whole thing cost next to nothing to run. As recently as 1973, the GMC’s total income was £662,579. I doubt if that would cover its phone bill nowadays.

Today, the GMC is a vast organisation with a huge budget and a seemingly insatiable yearning for power. It employs a host of administrators with ideas well above their station, though most have little or no experience of medicine in practice. The GMC still does nothing to improve the quality of medical care (it does nothing about dirty hospitals, for instance, or the over-prescribing of antibiotics) but its staff constantly make statements about how doctors should practise medicine. So, for example, the GMC has decided that it no longer approves of the Hippocratic Oath, which it considers rather old-fashioned.

The real problem with the GMC, however, is that it has been given the job of licensing doctors. After the Dr Harold Shipman scandal, it was decided in high places that ‘something’ had to be done to protect the public from dangerous doctors. Shipman, a general practitioner, had spent years methodically slaughtering over 200 of his patients and ministers were embarrassed. It was decreed that some form of regular testing should be introduced so that doctors in practice could be assessed. The plans for doctors to have competence tests every five years, with annual appraisals in between, were drawn up in 2008 by Professor Sir Liam Donaldson, the government’s chief medical officer at the time. Donaldson was instructed to do something by ministers who wanted to weed out rogue practitioners and to make sure that there would not be another Shipman embarrassment.

The GMC was given the job of finding a new way to assess medical practitioners. This was odd because the GMC was the body which was criticised for its culture and procedures in the official report into Shipman’s crimes.

Everyone knew that finding a way to assess doctors was never going to be easy. Older doctors, long out of medical school, were never going to accept any sort of academic assessment, and since modern medicine is still more of an art than a science, it was decided that it would be impossible to create a system which relied on assessing diagnostic skills.

So the GMC designed an entirely bureaucratic system (called ‘revalidation’) which was guaranteed to increase its own power and income and which ignored the fact that if Shipman were still alive and practising he would sail through with flying colours. The revalidation scheme is perfectly suited to the dishonest, the cheat, the silver-tongued and the rogue. There is little doubt among doctors that revalidation will result in a massive deterioration in the quality of medical care and a dramatic increase in the number of patients dying unnecessarily.

To pass their appraisal, doctors have to fill in reams of forms and find a few dozen patients and colleagues prepared to sign report cards. The scheme is a bureaucrat’s dream and a practitioner’s nightmare; it seems to have been designed by the sort of people who have six ballpoint pens in their breast pocket and its rigidity has made life unbearably difficult for thousands of doctors, such as locums and ships’ doctors, who do not fit neatly into the system.

Some parts of the revalidation procedure astonished me. So, for example, the GMC asked for details of all my motoring offences — which included details of a 1984 speeding offence and a £5 fine I received in 1977 when an officious policeman spotted me hurrying to a suspected heart attack patient. (My astonishment abated when I discovered that Ms Lindsey Westwood, who is in charge of the GMC’s revalidation programme, was just two years ago working for the Traffic Penalty Tribunal as an appeals manager. I do, however, find it interesting that the person the GMC have put in charge of checking the fitness to practise of every doctor in Britain was recently checking parking tickets for a living.)

The GMC has designed a scheme which has built it an empire. Doctors now have to pay the GMC £390 a year to be registered and licensed. They charge fees for everything imaginable. Last year the GMC had an income of £95.4 million. And that income is guaranteed to grow.

The risk is that by distracting doctors from the work they should be doing, the revalidation scheme will cause, not prevent, further harm to patients.

The GMC’s new method of assessing medical practitioners has made many doctors hate their jobs and it is pushing doctors into early retirement, with a growing number choosing to retire in their fifties. Doctors already had enough forms to fill in. The revalidation scheme has turned doctors into full-time form-fillers. A survey of GPs showed that 78 per cent thought that the revalidation programme was a waste of money.

Not so long ago, a doctor who retired would often work at his former practice as a locum, covering for holidays or sickness. His expertise, local knowledge and intuition would not be lost. In local emergencies, such as a flu epidemic, he could be called upon to help out. But the revalidation scheme makes that impossible. Once a doctor has retired, he can no longer practise at all. The doctor who retires at 55 must stay retired. As a result, locum doctors, many of whom don’t speak English properly, have to be imported at enormous expense from other EU countries.

It is perhaps not surprising that the GMC now provides private medical care for its staff.

Got something to add? Join the discussion and comment below.

Dr Vernon Coleman is registered and licensed with the GMC.

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Show comments
  • ladyofshalot

    Right on the nail – a brilliant analysis. The remark about GMC providing private healthcare says it all!!

  • beenzrgud

    Authority tends to consolidate power to itself, the best example being the EU.

  • LastmaninEurope

    The GMC’s racket is not unique within healthcare.

    Check out the HCPC. If anything it does less than the GMC. Its sole function is extorting money from its “members” to use in hounding its “members”.

    You cannot work in the NHS unless you are a “member”.
    If it was a Trade Union this closed shop mentality would be deemed illegal.

    The head of the HCPC, another “part quango, part government department and part protection racket” is paid more than the PM of Great Britain.

    Signed into being by the Privy Council, Lord President Nick Clegg.

    Says it all.

  • Fenton!

    Ah, socialized medicine. Meanwhile the American system has long been vilified while the NHS is a sacred cow. But we don’t die while waiting for emergency treatment. Or for the best treatment. Spot the difference?

    While I’m at it, almost everything that English people think they know about American health care is wrong.

    • Terry Field

      Yes, the misinformation by corrupted and rotten leftwing politicos has succeeded in making the benighted population believe the Alice-in-wonderland world.
      ‘NHS – it’s the envy of the World’

      • lailahaillallah

        I think you are posting off point, but maybe one should say, “The envy of much of the world” certainly not all, I would grant you that.

    • lailahaillallah

      Oh yes?

      UK life expectancy for males 2012 79.10 years. USA 78.7 years YET, they spend 17.9% of GDP on health, the the UK is c 9.5%- source- the World Bank.

      I think that is all ANYONE needs to know,

      • Fenton!

        Nonsense. We don’t get bumped from scheduled surgery as people in Britain do. We don’t have long waits for needed treatment as you do. We have far more MRI machines per person than you do — and easier access to them. We have better medicines and more skilled surgeons at the forefront of medical-scientific investigation. We patent far more essential and pathbreaking drugs than you do. We may have an underclass that shoots and kills one another, which all by itself would skew the numbers. But most of us aren’t gangsters in the ‘hood. We also have long had a vastly more heterogeneous society than you, with different ways of life under the Constitution (to say nothing of our illegal immigrants crisis, in the many millions — and growing). In any case, the gap you present is negligible and may itself be subject to different measuring parameters. It’s hardly the basis for a condemnation of the most sophisticated health care system the world has ever seen!

        If I had a life-threatening disease I would CERTAINLY rather be in America than Britain for treatment.

        • lailahaillallah

          So if it is so brilliant, why do you live shorter lives? And if the same life expectancy, why are you paying double for it?

          • Fenton!

            I’ve already answered those objections! Can you read or not?

          • lailahaillallah

            No- you haven’t. I would think it obvious I can read; I respond to your drivel.

          • Fenton!

            You mentioned a negligible age gap for men — I’d like to know precisely which group(s) of men are included in that. I also note that you don’t mention women. I also noted that our society has a greater number of people who don’t take care of themselves because they are essentially Third-Worlders who come here legally or not. That, again, says nothing about our system. It says that we have in some ways a far larger and more varied population, and therefore a bigger challenge — which we meet admirably.

            Again, the quality and quantity of health care in the USA can’t be denied. (Obviously we are going to pay more for what we have, since we have more of it!) I’m not sure why you’re so keen on going after us. People are often hostile to the American way even though it doesn’t affect them. I think it’s because they can’t stand the view of anything superior.

    • Jamie

      Not sure where the chap who wrote this article works. Doubt any ED would lay claim to having a target waiting time of 12 hours. Hefty penalties await depts breaching 4 hour target to be seen and admitted/discharged, and similar fines if ambulances wait longer than 30 mins to offload.

      Methink the author wanted to give our continental and American coousins cause to snipe before going onto talk about the GMC.

      • Fenton!

        I don’t know about that. My grandfather is English and his treatment by the NHS (bumping his surgery date at the last minute, for one thing) gives me plenty of reason to snipe.

    • RodCl

      One thing I do know…… is that a friend (who was at University with me in London, England), and is now a US citizen with his own business in New York, pays more for medical insurance alone, for himself and his wife…..than my wife and I pay in ALL income and other taxes (Federal, Provincial, and Municipal) living in “socialised medicine” Toronto, Canada.
      He was astounded when I showed him my tax bills.

      And we get superlative medical care in every respect, except one.

      That is for a relatively minor complaint, we get triaged in Emergency, and do wait for up to 2-3 hours, which apparently he does not. A small price to pay for saving (according to him) as much as $10,000 a year, .

  • Fenton!

    ‘Many of whom don’t speak English properly’. Well ain’t that wonderful. There I am, dying of bubonic plague or dysentery or plain old heart disease, and the doctor and I can’t communicate. It’s bad enough trying to talk to people with thick accents about your phone service. God only knows what it’s like at death’s door trying to spell out your ills to a foreign speaker.

  • Claire Moore

    To note: medical revalidation was not developed to catch Shipmans. It was designed to hold all doctors account for their professional practice and to encourage improvement. Plans for revalidation were already underway by then but were stalled after Dame Janet criticised the plans in her inquiry report. The GMC went back to the drawing board and came up with something remarkably similar (one the simplification was made). It is more true to say that Bristol was the catalyst although I believe there were similar discussions back in the 70s.

    Although there are a few forms to fill in nothing should be very much of a surprise – reporting on the continuing learning you’ve done? Talking about audits? Recording the complaints and serious events you’ve been involved in? I’d like to think that my doctor is able to complete these sections fairly easily.

    Yes, there are questionnaires, patient and colleague. They only need to be done once every five years and I don’t think that anyone would argue that doctors should not hear what their patients and colleagues think of them.

    Do I think the system is perfect? No. But then a system that covers thousands of doctors working in different specialties and in different ways cannot be perfect. I do think that there is room to improve but it is early days.

    • BMMarvel

      Defenders of revalidation deny it was introduced because of Shipman (maybe he would have breezed through) but history shows it was Shipman who triggered the call for revalidation. And it’s worth remembering that the Shipman enquiry (chaired by Dame Janet Smith roundly criticised the GMC.)

    • BMMarvel

      Defenders of revalidation always deny it was introduced because of Shipman (probably because he’d have breezed through) but history shows it was Shipman who triggered the call for revalidation. And it’s worth remembering that the Shipman Enquiry (chaired by Dame Janet Smith) criticised the GMC.

  • Diggery Whiggery

    Like any union, they control the labour supply to push up wages. Not enough though as huge chunks of British trained doctors go to Canada or the USA or Australia where they can earn much more money leaving the NHS to pinch doctors from poor countries so that when they get an Ebola outbreak they don’t have enough to contain it.

    Even foreign doctors coming here often use it to improve their English before they too go off to earn the big bucks. The NHS is the TEFL training centre of world healthcare.

  • Bring Back Free Speech

    And the Tories have done nothing to counter Labour’s bureaucratic nightmare, with its malign consequences so eloquently expressed here. On this, and so many issues , the Tories simply accept the Labour legacy. That’s why UKIP exists – we want to reverse what Labour has done.

  • Terry Field

    I live in foreign parts.
    I called my doctor for an appointment today.
    No problem, 5.45 I was there.
    I am referred to an acute hospital for a procedure.
    ‘When would I like it to be done says the specialist? ( he spoke to the GP!!!!!! whilst I was there!!!!!!!!!!)
    ‘Next Monday would be convenient for me if that is ok for you’ I said – relayed to the consultlant from my GP – ‘Yes, lets make in 2.30 for a consultation and the procedure done if confirmed as needed’
    ‘pm?’ he said.
    ‘Fine’ I said.
    AND this is not an emergency – no vital requirement for speed due to condition, etc.
    Eat your putrid little heart out Labour; shame on you NHS.
    And we get full family doctor service – and my GP comes to the house any hour of the day or night, as do her partners if needed.
    She referred to the UK and said to go to her patients in their homes is her pride and self respect.
    She knows how much more the uk GPs earn, and expresses contempt for their unwillingness to do the same.
    As do I.

    • lailahaillallah

      And where is this medical Shagri-La?

      • Terry Field

        Well, If you go south of Dover, you will come across three. You should get out more. There are other examples scattered around the world, but book a cross Chanel ferry, and you will get there quickly.
        And their performance is WAY better than the UK.
        And please do ignore the Commonwealth jobbie – please feel free to look at its criteria, weightings of values, make up of its board, etc.

        • lailahaillallah

          Yes, they have many more doctors per capita than the UK and you DO pay a co-payment- do you not?

          • lailahaillallah

            Let me answer that for him: from the DoH website

            In any case, you must pay the practitioner (doctor or dentist) directly. They will then fill out a treatment form (feuille de soins) and a prescription if necessary. The treatment form is necessary to claim any refunds in France. You can claim back around 70% of the standard treatment cost.

            AND World Bank Figures- France 3.2 physicians per 1000 population, UK 2.8.

            So your point is??????

          • Jamie

            3.2 per thousand doesn’t sound much more than 2.8 I know, but its nearly 15% higher. Thats actually rather a lot.

    • Davey

      I wonder if you are paying your own medical expenses over there in ‘foreign parts’? That, I would hazard a guess, is responsible for the difference in service you are experiencing.

      • Terry Field

        No, the system is universal, 83% is covered by general tax, 17% by insurance that has no exclusions of pre-exitinf conditions, and 65% of the capacity in the universal system is private supply – ALL use it however.
        I have paid privately in the USA and that was superb, but is socially unfair for those (then but not now with Obamacare) excluded.
        I believe Britain will adopt this bled of supply and blend of finance, within a decade. The present system is unsustainable – THE PEOPLE ARE NOT THE PROBLEM, LOTS OF TALENT AND COMMITMENT, BUT THE STRUCTURE OF FINANCE AND SUPPLY IS CRAZY. And one Labour Secretary of State for Health agrees completely with me, but says he cannot say so in public, or his career will be finished!!!!!!!!!!

        • Davey

          I agree that the NHS is unsustainable. It is a bottomless pit, which no amount of money could fill up, especially for a country which is £1.4 trn in debt already

          • Terry Field

            The unrepayable debt is what has killed the silly nonsense of State socialism. The debt pile in the UK will wreck any budget; the economy is about to stagnate again, deflation is round the corner, and we are, in effect, capitalising the debt interest at present – 90billion interest, 90 billion deficit!
            My concern is not funding the NHS, it is avoiding social, economic and cultural collapse and serious violence.
            The situation of Britain is really critical.
            People seem to have no idea at all of the reality.
            The UKIP reaction of the electorate is simply bottled rage; but it will do no good, and a great deal of harm.
            By the way, did you notice the accounting ‘error’ of the Office of National Statistics now the new Mr Dynorod is in charge – a slight increase in the measured debt from 1.2 tn, upped by 197 billion to 1.4 tn, to be 1.5 tn next yr, and 1.6 tn the following yr.

          • Davey

            Well, you paint a fairly bleak picture, and certainly the future doesn’t look rosy. If you are in debt to that mind boggling degree, at some point you will be bankrupted, that’s simple economics. We just don’t have the manufacturing or exporting base to buy ourselves out of trouble. This is a tiny island with a huge population which produces little. How did they think it was going to turn out? Perhaps the Germans will bale us out?

          • Terry Field

            There is a real and audacious way out of this.
            The West – (ie the US and Britiain) can change the terms of our issued bonds, making them 200 year 1/2% fixed rate instruments. We have the authority to do this. That isolates the interest rate penalty of stimulating the economy, stuffs the Chinese and Arab sovereign wealth funds, and since there is only one globe for them to continue to work with, there would and could be no come back. It would take balls to do it; it would not threaten the US reserve currency status since there is no alternative, the bonds would have value and could sit as assets in bank and other balance sheets.
            Why will it not be done? Why will the insane actions of Brown and his US copiers not be reversed?
            Politicians have absolutely NO balls.
            And their Civil Servants cannot put the boot in to foreigners for love or money.
            They have forgotten how to do it.

  • tomgreaves

    Pleasure to read a realistic account of the GMC. Inspired by the EU bureaucratic gravy train the GMC, the doctors union, is out of control. It’s the old paradox of who controls the controllers. It behoves the government to take seriously the abuse of GMC power, which is directly effecting the quality of patient care. Healthcare is a political football and the GMC knows that criticism of its practices can be distorted into an attack on the NHS. A significant political figure could make a name by challenging the GMC in a campaign to show the public what leeches they are.

    • Ridcully

      Sorry to be pedantic but the BMA is actually the doctors’ union. The GMC is more of a regulatory body.

  • Hogspace

    If this is all fair and true, and I’m not convinced, why wouldn’t Doctors have done something about it. Elite highly educated well paid group that they are.

  • HJ777

    “… it is pushing doctors into early retirement, with a growing number choosing to retire in their fifties.”

    This is telling. How many people in other occupations can afford to do this?

    • lailahaillallah

      Who cares? they CAN and they DO.

  • lailahaillallah

    The GMC is not fit to run a whelk stall. They are partially responsible for the tide of emigration of doctors. Will the average Spectator reader give a tish? Nope. Not until they or one of theirs is unwell and their nearest source of help is the local over-stretched ED.

    If there is any sort of respiratory epidemic this winter, then we may well see the NHS failing in some areas. Frankly, it would do some of the more right wing papers’ readers good to be REALLY scared for once.

    • Fenton!

      How charming. And how unexpected: a Leftist that prefers miserable low-level equality to the possibility of a ‘tide that lifts all boats’.

      • lailahaillallah

        Watch out who you are calling a “leftist” : you haven’t a clue about my politics. I happen to have a particular view on this issue. (DOI- recently retired doctor who waded through this poo for years.)

        • Fenton!

          You’re a warmed-over squish like so many people in Britain these days. You write just like a Guardian reader. I judge as I find.

  • Managerialism, the mistaken belief that management is a science, allows the people who ought to be just clerks and administrative assistants to take over and boss the professionals around. This is happening in so many areas of society, with very destructive results. Let hospitals be managed by doctors, with admin assistants who assist (not boss), schools by teachers, factories by engineers, farms by farmers, etc. And close down all those ridiculous study programmes in “Management”.

  • Peter Stroud

    A very enlightening, but worrying article.

  • Dan Damon

    This writer hits the nail on the head: the GMC is a bureaucratic nightmare that does absolutely nothing to improve the health of the nation.

  • michael strawson

    Wh y NHS, Gov.UK I can visit a ” GP” without appointment and if needed make my own appointment for further medical advice / treatment with docs ( GPs ) line . I keep my Xray Scan pics etc . what an idiotic antiquated NHS system in UK . I have been 3 times hospitalized / operated on ( more than a week each time ) over 20+ years and have visited a NHS hospital in last 12 months its like Holby City pathetic