Self-regulation by doctors will only work if the interests of patients are placed first

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The latest report from the Shipman inquiry calls into question not only the medical profession's ability to regulate itself, but the very survival of the General Medical Council. The inquiry's chairman, Dame Janet Smith, yesterday painted an unflattering picture of an organisation that is supposed to be the medical community's watchdog but has become its lapdog instead. While the report stopped short of blaming the GMC for the failure of the medical profession to stop the mass-murdering GP, Harold Shipman, it makes abundantly clear that the regulator has neglected its duty of care towards the general public.

It is hard to fault the report's major recommendations for improving this regrettable state of affairs. The GMC's lay membership may have increased, but it is still widely seen as a cosy club for doctors because it is dominated by representatives of the medical profession. The proportion of lay council members should be increased further to reinforce the organisation's independence of the profession it is supposed to be regulating.

The report also makes a strong critique of the present system for evaluating the performance of individual doctors. In the old days, a GP would qualify, probably in his mid 20s, and never have to justify his actions for the rest of his career. Things have improved since then, but not a great deal. The GMC proposed five-year "MOTs" for doctors a few years ago, in which they are called on to account for their performance. But, as the report makes clear, these have since been watered down and are now rarely more than a formality. They should be much more rigorous.

The crimes of Harold Shipman cast a long shadow. As a result, the question of how doctors are investigated for possible serious malpractice is especially sensitive. The custom whereby doctors both investigate and discipline each other cannot be allowed to continue. Too often there is an emphasis on being "fair" to the doctor rather than the patient who complains. There must be a wholly independent and impartial tribunal to examine accusations of malpractice, as Dame Janet recommends. The GMC itself should have no power over it. There also needs to be a simpler way for patients to file complaints about their GPs.

The report recognises that patients have a right to information about their doctors. The idea of giving patients access to a central NHS database containing the records of all the GPs working in Britain is sensible, and one that arguably should have been acted upon sooner.

The report does not call for the dissolution of the GMC, but that by no means guarantees its survival. After the baby heart scandal at Bristol Royal Infirmary in the late 1990s, the GMC was perceived to be drinking in the last- chance saloon. It is nonetheless unlikely that the Government will seek its abolition. The risk of alienating the medical profession is too great. And it would raise difficult questions about what could replace it.

It is impossible to regulate a profession without harnessing the expertise of people who work in, or have experience of, that area. This is true not just of doctors, but the police, the press and many other specialist professions and trades. The ideal of self-regulation is that a high level of professional expertise is harnessed to a proper concern for the wider public interest. In theory, this is a far more attractive proposition than asking the state to police an industry that it barely understands. But there is a definite tendency, as the GMC has shown, for self-regulation to become biased towards vested interests.

At one time, doctors could get away with closing ranks and dismissing patients' grievances. But we now live in a less deferential age. People are less and less amenable to being fobbed off or ignored - by doctors or anyone else. A system of self-regulation will only survive if it enjoys public confidence. The GMC's only hope is to strike a balance between being part of the medical profession and serving the public. An acceptance that its job is to put patients first, not doctors, would be a useful start.

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