Shipman inquiry finds GMC has "fundamental flaws"
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《英国医生杂志》
The General Medical Council, which regulates UK doctors, has "fundamental flaws" and its responsibility for disciplinary hearings that decide whether a doctor is fit to continue to practise should be handed over to an independent body, the Shipman inquiry concluded this week.
In a hard hitting report that she acknowledged would be "bruising" for the GMC, the inquiry's chairwoman, the appeal court judge Dame Janet Smith, said the council should no longer act as both investigator and judge under its new fitness to practise procedures. From November, these have replaced the old disciplinary regime under which panels decided whether doctors had been guilty of serious professional misconduct ( BMJ 2004;329: 1366, 11 Dec, News Extra).
Dame Janet said it was inappropriate for the same body to carry out the investigative and judicial function and that she would have made the recommendation to hive off the final stage even if the GMC had not, as she found, continued to perpetuate a doctors' culture of "mutual self interest" at the expense of patients.
She stopped short of recommending that the GMC should lose the right to regulate doctors altogether, but she put the profession on notice that it could ultimately lose the power of self regulation.
She said it should be allowed to try to further improve the fitness to practise procedures and a new revalidation scheme for doctors, due to start in April 2005. Subsequent to the report, the government has announced that it is to review the GMC revalidation scheme. (See p 8.)
Dame Janet said that in three to four years' time, an independent body, either the Council for Healthcare Regulatory Excellence or another body on its instructions should evaluate the GMC to see if it was operating effectively in protecting patients.
"If they are not operating satisfactorily by then, the time will have come to consider whether that function should be undertaken by a different body."
The report is the fifth from the inquiry into the activities of the serial killer GP Harold Shipman, set up by the government to try to ensure patients are protected in the future. Shipman, who was found by the inquiry to have murdered at least 215 of his patients with fatal injections of diamorphine over more than 20 years, committed suicide in prison last year just before his 58th birthday.
The GMC pointed out that it had brought in the biggest reform package in its 150 year history, with sweeping changes to the way it investigates and disciplines doctors, 40% lay membership, and five-yearly revalidation of doctors from next April.
But Dame Janet said: "I am by no means convinced that the new GMC procedures will adequately protect patients from dysfunctional or underperforming doctors. I have concluded that there has not yet been the change of culture within the GMC that will ensure that patient protection is given the priority it deserves."
Dame Janet Smith said the GMC perpetuated a culture of "mutual self interest" among doctors
Credit: PHIL NOBLE/PA/EMPICS
Her report called for a lay majority on the GMC and more lay members on disciplinary panels.
Dame Janet said the revalidation process had been so watered down since the GMC originally proposed it that it no longer provided adequate protection for patients and needed to be strengthened to achieve that purpose.
The report made more than 100 recommendations. These included:
A telephone helpline for patients and health professionals to raise concerns about doctors' performance or conduct
A central database of information about every doctor in the United Kingdom to which primary care trusts and employers would have access
Improved monitoring of prescribed drugs
The GMC to be accountable to parliament
The GMC's constitution to be changed so it has more appointed members who are "not beholden to an electorate" and do not see themselves as representing doctors
Patients to have the chance to refuse to be treated by a doctor who is subject to conditions.
The GMC welcomed Dame Janet's conclusion that it could not have suspected Shipman's true nature and could not be criticised for allowing him to return to unsupervised general practice in 1977 after his conviction for drug offences in 1976. (See p 1.)(Clare Dyer, legal correspondent)
In a hard hitting report that she acknowledged would be "bruising" for the GMC, the inquiry's chairwoman, the appeal court judge Dame Janet Smith, said the council should no longer act as both investigator and judge under its new fitness to practise procedures. From November, these have replaced the old disciplinary regime under which panels decided whether doctors had been guilty of serious professional misconduct ( BMJ 2004;329: 1366, 11 Dec, News Extra).
Dame Janet said it was inappropriate for the same body to carry out the investigative and judicial function and that she would have made the recommendation to hive off the final stage even if the GMC had not, as she found, continued to perpetuate a doctors' culture of "mutual self interest" at the expense of patients.
She stopped short of recommending that the GMC should lose the right to regulate doctors altogether, but she put the profession on notice that it could ultimately lose the power of self regulation.
She said it should be allowed to try to further improve the fitness to practise procedures and a new revalidation scheme for doctors, due to start in April 2005. Subsequent to the report, the government has announced that it is to review the GMC revalidation scheme. (See p 8.)
Dame Janet said that in three to four years' time, an independent body, either the Council for Healthcare Regulatory Excellence or another body on its instructions should evaluate the GMC to see if it was operating effectively in protecting patients.
"If they are not operating satisfactorily by then, the time will have come to consider whether that function should be undertaken by a different body."
The report is the fifth from the inquiry into the activities of the serial killer GP Harold Shipman, set up by the government to try to ensure patients are protected in the future. Shipman, who was found by the inquiry to have murdered at least 215 of his patients with fatal injections of diamorphine over more than 20 years, committed suicide in prison last year just before his 58th birthday.
The GMC pointed out that it had brought in the biggest reform package in its 150 year history, with sweeping changes to the way it investigates and disciplines doctors, 40% lay membership, and five-yearly revalidation of doctors from next April.
But Dame Janet said: "I am by no means convinced that the new GMC procedures will adequately protect patients from dysfunctional or underperforming doctors. I have concluded that there has not yet been the change of culture within the GMC that will ensure that patient protection is given the priority it deserves."
Dame Janet Smith said the GMC perpetuated a culture of "mutual self interest" among doctors
Credit: PHIL NOBLE/PA/EMPICS
Her report called for a lay majority on the GMC and more lay members on disciplinary panels.
Dame Janet said the revalidation process had been so watered down since the GMC originally proposed it that it no longer provided adequate protection for patients and needed to be strengthened to achieve that purpose.
The report made more than 100 recommendations. These included:
A telephone helpline for patients and health professionals to raise concerns about doctors' performance or conduct
A central database of information about every doctor in the United Kingdom to which primary care trusts and employers would have access
Improved monitoring of prescribed drugs
The GMC to be accountable to parliament
The GMC's constitution to be changed so it has more appointed members who are "not beholden to an electorate" and do not see themselves as representing doctors
Patients to have the chance to refuse to be treated by a doctor who is subject to conditions.
The GMC welcomed Dame Janet's conclusion that it could not have suspected Shipman's true nature and could not be criticised for allowing him to return to unsupervised general practice in 1977 after his conviction for drug offences in 1976. (See p 1.)(Clare Dyer, legal correspondent)