BMA annual meeting: GMC should be funded by public not doctors, says BMA
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3484 (Published 22 June 2016) Cite this as: BMJ 2016;353:i3484
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A major achievement of the New South Wales Medical Board in the late 1980s was to have its funding removed from the whims of government budgeting by switching to funding by all registered doctors.
This enabled the Board to significantly improve its roles in enquiring into disciplinary issues (but without the power to strike off – that was reserved for the Medical Tribunal of the District Court), to initiate a program of care for impaired doctors and medical students, to initiate enquiries into doctors' overall competence after a number of complaints had been made against them, to develop guidelines for handling HIV-infected patients and so on,
None of these costly advances would have been likely had the Medical Board remained dependent on funding by the state government, always struggling to balance its budget.
That said, the GMC should not have the power to strike doctors off, depriving a citizen of his or her livelihood. That should, as in New South Wales, be the responsibility of the courts.
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Are we paying for Devil's Advocate?
The GMC internal review report in December 2014 identified that 114 doctors died and nearly 25 committed suicide between year 2005-2013 who were under investigation under GMC. This is such an alarming situation , social dilemma and its not less than any emergency .
The sad view of all this is that doctor's community is quiet whereas this issue should be dealt on emergency basis.There is certain element of discontentment among doctors that they are paying for an organisation and licensing body where perception of " Proven guilty unless proven otherwise" overshadows the original idea of support.
Doctors are already under stress due to ever evolving processes like appraisal, re validation, PALS complaints etc which symbolises an outlook of continuous surveillance ensuring competency and suitability for particular job.
An airborne passenger in the plane has blind faith in the captain of the plane and this is due to the common belief and fact that airline industry is quite strict in maintaining safety management systems, similarly our patients needs to know that doctors are continuously assessed throughout their careers and they should get this feeling that they are in the safe hands.However this is the time to rethink and its a fair argument that like BBC, fire brigade or like any other public sector service ; the GMC should be funded by Tax Payer and not by doctors because 25 deaths clearly shows that "Fear prevails as opposed to Support" when doctors know that any body can approach GMC and can complain irrespective of big / serious or small / trivial and inconsequential complaint in nature.
Only notion and stance of " proven innocent unless proven otherwise" can change the perception of fear into support.
Competing interests: No competing interests
Re: BMA annual meeting: GMC should be funded by public not doctors, says BMA
Regulatory bodies like the GMC and Medical Boards/Councils in Australia often state that their first duty is to protect the public. However, if the perceived large burden of their regulations, and the fear of their prolonged and career-destroying inquisitive processes, inadvertently encourage doctors to dissemble or shirk problems, then protection of the public suffers.
Dr Arnold implies that a regulatory body beholden to doctors is more likely to achieve worthwhile reforms, and hence protect the public. I would argue that any regulatory body - particularly if paid for by doctors - should be entirely elected from doctors. Elections will not always choose the best people to run a regulatory body - but further elections allow removal of people who step beyond what the profession believes is practical and worthwhile, so democracy achieves balance and trust over time. Appointments, however well meant and researched, tend to select people with particular sets of beliefs - which don't always coincide with the majority of their peers, and lead to affirmation of existing (but poor) ways of working.
The trend to put administrative, legal and community representatives on such bodies, I believe, has been a mistake. I am sure the dedicated lay people who have been involved in these roles have added to discussions, and perhaps steered the bodies in important directions. However, each one of them sitting on a board or council is one less voice of a practising doctor. Some of the doctors likely to stand for election to regulatory bodies will have additional legal qualifications, and all will have some experience as patients themselves, or experiences with close family members in this regard.
As Dr Arnold also implies, regulatory bodies with a light and cheerful touch are also probably most effective. Leaving investigation and possible prosecution and penalties to law enforcement bodies seems desirable. First, that allows a regulatory body to be seen as the friend and encourager of good practice - rather than as a potential enemy ambusher, waiting to pounce. Second, although law enforcement can be clumsy and slow to act, it is bound by centuries of legal practice and legislation aimed to see fair treatment of the accused, as well as the accuser. This fairness has been missing from some regulatory bodies - to the great detriment of many doctors' lives, and of the bodies' reputations.
Despite these points, it seems likely that existing, part-appointed, part-lay, prosecuting regulatory bodies will seek to preserve their composition, structure and function. Few of us like to admit that the model of working we have built up and are accustomed to may be less good than another model. But perhaps the medical profession will push for democratic, medical regulatory bodies that use light touches to regulate our profession - and leave prosecution to the legal profession. And in time such bodies will emerge. If this had happened sooner in the UK, arguably many good doctors' careers and lives might have been saved - which would have helped the public too.
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