A clear rejection of some of the fundamental changes to the regulation of doctors proposed by England's Chief Medical Officer (CMO), Sir Liam Donaldson, has come from the British Medical Association. In particular the BMA is against lowering the standard of proof required to strike off a doctor.

In its official response to the consultation on the CMO's report Good doctors, safer patients the BMA describes the review as a "missed opportunity" which has failed to harness the profession's enthusiasm for change.

Mr James Johnson, chairman of the BMA, said: "We welcome several of the CMO's recommendations, particularly those that move towards supporting doctors with performance problems. Other recommendations we oppose outright. One of these is the proposal to drop the criminal standard of proof in adjudication upon concerns about a doctor and instead adopt the civil standard of proof. It cannot be right, when a person's entire means of earning a living is at stake, to rely upon a balance of probabilities rather than proof beyond reasonable doubt."

The prime objective of changing the medical regulatory system should be to protect patients and to support doctors with performance difficulties, says the BMA (Conclusion:1). It states "We will always be in favour of measures that promote excellence in medical practice and that help to reduce instances of poor standards, negligence or criminality amongst doctors." Accordingly it supports recommendations such as placing a statutory responsibility on primary care organisations for assuring that lessons are learned from specific medical errors and complaints (recommendation 35).

Conversely the BMA is in complete disagreement with the proposal to move undergraduate medical education from the General Medical Council (GMC) to the Postgraduate Medical Education and Training Board (PMETB) - a relatively new body. The BMA states: "The GMC should retain the responsibility for undergraduate medical education as this is critical to the process of producing professionals and no good case has been made for changing this." (Conclusion:13).

Nor does the BMA see any point in requiring UK doctors and graduates of British universities to sit a language exam. "Communication is a critical issue as our Patient Liaison Group has emphasised, but this is not the most effective way to address the issue" states the Association (Introduction:5).

Strong opposition comes from the BMA to the CMO's proposal to have a doctor working as a GMC affiliate in each healthcare provider. Instead the Association proposes a regional network of doctors and lay people providing an affiliate function, but not as part of an employer organisation. The BMA says: "The idea of creating a single affiliate and lay pairing in each institution is half-hearted, impractical and an ineffective use of resources." (Introduction:7). The BMA adds: "Regulation has to be independent of the employer if it is to retain professional confidence and credibility. Instead we would like to see a GMC function across each region."

Clinical governance has a vital role to play and must be further developed, says the BMA. It states "From a quality perspective, and in general terms, probably the most disappointing aspect of the report is the white flag it seems to raise in the face of the slow development of clinical governance." (General comments:20).

On proposals to restructure the GMC itself, the BMA welcomes making the Council accountable to Parliament but rejects the idea of the GMC's medical members being appointed by the Public Appointments Commission. Doctors should elect the medical members of the GMC says the BMA, adding it would be prepared to consider a system where potential candidates were first approved by the Public Appointments Commission. (Conclusion:14).

The BMA says it does not believe the case has been made for establishing a separate and independent tribunal to carry out the adjudication process in serious fitness to practise cases. "Any transfer of adjudication from the GMC could only be properly considered once the credentials, funding and accountability of any new body were established" says the BMA.

In a general comment on the CMO's report, the BMA says: "Throughout the report we found ourselves more often in sympathy with the identification of a problem, recognising the issues that needed to be addressed, rather than with the proposals suggested to deal with them." It regrets there was no opportunity to debate the ideas while they were being formulated. The Association is now keen to discuss its own proposals with the CMO and government.

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The full text of the BMA's response to the consultation on Good doctors, safer patients can be found at: bma/ap.nsf/Content/CMOresponse1106

For further information please go to:
British Medical Association
Source:
BMA News, the membership magazine of the British Medical Association