`How the General Medical Council is killing the NHS'
Dr Vernon Coleman MB ChB DSc FRSA
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.
Those were the good old days.
Today, it is easier to find a plumber than a doctor at nights 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 symptoms 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’ trade 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 assumed that the deal was itself an inevitable result of EU employment laws which regulated the number of hours employees could work.
But although the EU laws are partly 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 half charity, half quango, half government department and half protection racket.
It used to consist of a little more than a file clerk, who kept the register of doctors who were qualified to practice medicine, and a committee of rather pompous individuals who sat in judgement 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 on 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 pay the current organisation’s phone bill.
Today, in contrast, 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, the over prescribing of antibiotics or the fact that doctors are now officially encouraged to murder elderly patients who have been in hospital for too long) but its staff constantly make statements about how doctors should practice medicine. So, for example, the GMC has decided that it no longer approves of the Hippocratic Oath, which it considers rather old fashioned, and it has happily overseen the disappearance of the principle of medical confidentiality.
The real problem with the GMC, however, is that it has been given the job of licensing doctors. And as a result the GMC probably kills more people than influenza. It is no stretch to say that the GMC is such a threat to the nation that it should be classified as a terrorist organisation.
The reason for the GMC’s new power is simple.
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 of assessing medical practitioners. This was odd because the GMC was the body which let Shipman kill roughly 10% of his patients without a murmur of concern. In any sensibly run society the GMC would have been roundly bollocked and disbanded, with the responsible officials sent off to cold climates to count penguins.
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 its own income and which ignored the fact that if Shipman were still alive and practising he would sail through with flying colours. Lister, Snow and other medical greats would have failed. But Shipman would have been revalidated with no problems. So will the inept, the incompetent, the corrupt and the cruel. Drug company cheerleaders will sail through. 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 ball point 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 staggering that the person the GMC have put in charge of checking the fitness to practice of every doctor in Britain was recently checking parking tickets for a living.)
The GMC’s power and money grab has been enormously successful; they’ve designed a scheme which has built them an empire. Doctors now have to pay the GMC £390 a year to be registered and licensed. There are fees for everything imaginable and the power and money grab has been enormously successful. In 2013 the GMC had an income of £95,400,000. And the income is guaranteed to grow.
The small problem is that by distracting doctors from the work they should be doing the revalidation scheme will, I believe, result in vastly more deaths than Shipman managed in years of medical mayhem.
The big problem is that 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 50s. 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% thought that the revalidation programme was a waste of money.
In the `old’ days, 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 GMC’s new revalidation scheme makes that impossible. Once a doctor has retired he can no longer practice 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.
The bottom line is that whereas Dr Harold Shipman killed retail, the GMC is now killing wholesale. And it isn’t just killing patients; it’s destroying the NHS too.
It is perhaps not surprising that the GMC now provides private medical care for its staff.
Copyright Vernon Coleman 2016