Regulation

Until just a few years ago the GMC was the only regulatory body we had to worry about and they were in the past criticised, with some justification, for being perhaps too sympathetic to the unfortunate medical practitioners who came to their attention.

Step by step things have changed.

Firstly there are now more bodies that a doctor can fall foul of. NCAS, MHRA, CHRE, NHS counter fraud service and others can all make life difficult for doctors, as explained here, in addition to an increasingly belligerent attitude from Trusts as highlighted here.

Secondly the GMC has over the years become less and less sympathetic to doctors and is seen by many as biased against them. Doctors who feel they have been poorly treated by the GMC have no route of complaint. Complaints about the GMC can only be made to the GMC and the outcome is then predictable. The legal principle of “nemo debet esse iudex in propria causa”, meaning no one should be judge in his own cause is clearly ignored by the GMC. In fact the GMC often behaves as if the law is something that does not apply to them. This is well illustrated in this case. Dr P had brought legal action against the GMC for breaches of Data Protection and Human Rights legislation committed during an investigation. The GMC attempted to have the action struck out. The argument they made to the bemused judge was that they, the GMC had been deliberating for a number of years on how to incorporate the relevant legislation into their procedures, but that they had not yet come to conclusions, and therefore these laws did not apply to the GMC. The extraordinary effrontery, and unspeakable arrogance of this argument was dealt with in no uncertain terms by the judge and an out of court settlement followed soon after. It is a shame that the settlement was accepted by Dr P as the GMC were thus able to avoid the adverse publicity of being savaged in court for their attitude. I do not however wish to criticise Dr P. It takes a special kind of tenacity and resilience to tackle a body as powerful, overbearing and underhand as the GMC and Dr P can not be blamed for bringing things to an end.

The GMC can only be challenged in the high court, and they rely on the financial and emotional disincentives to this action to get away with highly questionable actions. If you google “GMC high court” what is apparent is that the GMC almost always lose on those occasions when they are challenged.

And this is a body that is gradually acquiring more and more powers. It is now two years since the burden of evidence used by the GMC to convict doctors was changed from the criminal standard where guilt has to be proven beyond reasonable doubt, to the civil standard of probability.

And soon we will have revalidation. We are going to have to prove that we are are competent, without any suggestion of misdemeanour or lacking performance. I predict that before long perfectly competent and amenable doctors will be finding themselves in difficulty simply because they have not been able to tick a few boxes.

The GMC Knight

The GMC was formed in November 1858, All of it’s presidents except two have been Knights or Lords either prior to or subsequent to appointment. No GMC President has vacated the post untitled since 1892.

Graeme Robertson Dawson Catto succeeded Sir Donald Irvine as President of the GMC in Nov 2001. He was knighted within weeks. Irvine had been forced to stand down or face a vote of no confidence.

No appraisal of Professor Catto’s performance as President of the GMC could exclude consideration of his role in revalidation. Revalidation was first proposed after Harold Shipman was convicted of murder in January 2000. Despite him being the only Doctor in British history convicted of murdering his patients it was felt necessary to introduce measures to prevent a recurrence. This was a pure knee jerk response, but typical for the last government. The GMC made initial proposals but these were criticised by the Shipman enquiry and replaced by proposals from the enquiry. Sir Graeme and the GMC did not initiate these proposals but have been at the forefront of a propaganda campaign designed to have the medical profession accept them, and impose them regardless. Sir Graeme has been deaf to many valid criticisms of the proposals, not the least of which is that revalidation would almost certainly not detect another Shipman. The majority of the profession remain sceptical, suspicious and unconvinced, and finally the BMA have responded to their members’ concerns.

The new government appears lukewarm about the entire concept and the future of the revalidation project is now most uncertain.

So, let’s take a while to look at Sir Graeme’s other achievements as GMC President.

Well that didn’t take long now did it!

This is a pity as there many areas where the GMC could stand some improvement. Sir Liam Donaldson himself has written a report accusing the GMC of inconsistency, “the council causes distress to doctors over trivial complaints while tolerating poor practice in other cases”. It accuses the Council of being "secretive, tolerant of substandard practice and dominated by the professional interest, rather than that of the patient"

There is also the scandalous practice of “draft determinations”,

“its use of draft determinations and predetermined sentences of erasure. It has now been admitted by the GMC’s own solicitors that the assistant registrar, who was also the secretary of the professional conduct committee, would either write or direct clerks to write draft determinations some weeks prior to the professional conduct committee sitting. The draft would then be handed by the committee secretary to the chairman and the panel to be read out as the final determination. In these cases, the draft also contained the predetermined sentence of erasure, which basically means that many of these hearings were effectively a complete sham.”

Hansard 16 March 2009.

This way of conducting hearings is similar to that of the Queen of Hearts from Alice in Wonderland. "Sentence first!, verdict after!." It constitutes a breach of article 6 of the Human Rights Act 1998.

Also in 2008 the burden of proof required for the GMC to convict a Doctor was reduced from the criminal standard (beyond reasonable doubt) to the civil (balance of probabilities). This is grossly unfair. Doctors under investigation are not in dispute with another individual over some civil liability. They are accused, by an enormously powerful authority, of what the GMC considers crimes, with the most potentially disastrous punishments. The only purpose behind this change is to make it easier to convict a doctor without having to bother with troublesome concepts such as evidence.

In summary the GMC has suffered such a (deserved) fall in it’s reputation that even a past President, Sir Donald Irvine, has called for its abolition.

So Sir Graeme Catto, for a complete failure to reform an organisation badly in need of fundamental change, and allowing the GMC to sink deeper into total disrepute, in my view easily qualifies for the description, a suit full of bugger all.

Malice

 

I have often written on this blog about the tyranny and vindictiveness of the GMC, and of their arrogant view that the law somehow doesn’t apply to them. The GMC themselves are overseen and regulated by the Professional Standards Authority for Health and Social care. It is rare indeed for this body to take the GMC to task. The annual reports on GMC performance are little more than congratulatory whitewash exercises for their mates up the road. Even on those rare occasions when the high court finds against the GMC, this is not examined by the authority.

But when the opportunity arises to challenge the GMC in a way that enable the Authority to get the knife into an individual doctor they’re in there like a shot, showing a degree of malice and vindictiveness that makes the GMC look benign.

As in this case. A Belfast Neurologist was the subject of a GMC fitness to practice hearing. I don’t want to go into the allegations. They may be substantial, or the GMC may just be bullying, to which they’re not averse. The Doctor in question decided, understandably, to quit the profession entirely, and applied for voluntary erasure. Any registered medical professional has the right to do this. DZ looks forward to doing this in the near future. Once that happens I may reveal my identity. And then again I may not. Once erased the GMC have no more authority over the practitioner, who from then on has escaped their tyranny for ever. And to give the GMC their due they granted the request, erased the doctor, and the fitness to practice hearing then became moot, and was terminated. The Dr and the GMC went their separate ways. For once the GMC are not the villains of this peace.

The Professional Standards Authority weren’t happy with this. They went so far as to go to court to force the GMC to reregister the doctor, so that the fitness to practice hearing could proceed. Now, the ultimate sanction available to the GMC in a hearing is erasure. So the Authority wanted to  reinstate the doctor so that they could potentially erase him again. A case of. “You can’t quit, we want to fire you”. All it could possibly achieve was to subject the doctor to more stress, more humiliation, more harassment. An action so pointlessly vindictive and malicious you wonder what sort of vile cunts would want to do such a thing.

I’m pleased to say the judge told them to fuck off.

Fairness

I have been castigated after my last post for changing the subject. Apparently we “need to talk about the GMC just now” I make no apology. I have broader interests and would not like to be thought of as having only a single string to my bow.

Regular readers will know full well that I have no time for that collection of scum and villainy that calls itself the GMC. I would argue that we need to talk about the GMC, not just now, but constantly until something is done to bring them under some form of supervision  and control. 

I would also argue that at the moment we do not know if the GMC has done anything, on this occasion, that should concern us. Dr No has now confirmed that two doctors have been reported to the police and under paragraph 58 of the good practice guide that means the GMC must now be involved. What matters is not their involvement but their response. What I would expect of any fair regulator is that if the police feel there is no case to answer then there should automatically be no further action from the GMC.  I have previously published this communication from the GMC.

"In January 1999 the Standards Committee of the GMC met to consider issues involving the behaviour of doctors who comment in the media. It was their view that the GMC should not attempt to curtail doctors' rights to express their personal opinions. Doctors, like anyone else commenting in the media, are subject to the same constraints imposed by media regulatory bodies, and the libel laws. Furthermore, the committee considered that the professionals reputation depends principally on the standards of care and conduct provided by doctors to their patients, and not on personal opinions as put forward in published letters or articles. Whilst you may disagree with the comments Dr Y has made, we cannot take action against a doctor who is expressing a personal opinion".

If the GMC choose to respond contrary to their own policy then that would be cause for concern.  As yet there is no evidence that they have, or will.

A woman with her head up her arse.

I've not been able to find a picture of Lisa Elisabeth Smith. She it is who found Dr Christian Solomonides guilty of professional misconduct, and suspended him for two months. The sheer wrongness of this verdict can't be overstated. Ms Smith actually did comment on the doctor's right to freedom of speech, before, in the same breath, contradicting herself and depriving the doctor of that very right. I have no doubt that had the victim of this kangaroo court stood up and challenged the GMC in the high court he would have won, but the GMC works by intimidation and fear, designed to break down the victim's will to fight.

Not only is this verdict a breach of the Human Rights act, it is also contradictory to the GMC's own policy.
"In January 1999 the Standards Committee of the GMC met to consider issues involving the behaviour of doctors who comment in the media. It was their view that the GMC should not attempt to curtail doctors' rights to express their personal opinions. Doctors, like anyone else commenting in the media, are subject to the same constraints imposed by media regulatory bodies, and the libel laws. Furthermore, the committee considered that the professionals reputation depends principally on the standards of care and conduct provided by doctors to their patients, and not on personal opinions as put forward in published letters or articles. Whilst you may disagree with the comments Dr Y has made, we cannot take action against a doctor who is expressing a personal opinion".
In it's actions it is clear that the panel were not even aware of the GMC's own policy on the matter. How fucking incompetent can you get?

Dr Solomonides has been victimised for doing something he has every right to do. It is no different from many others' writings, including mine.

I wondered perhaps if Ms Smith is some super legal brain who has based her judgement on some legal point not clear to us lesser mortals. But not so. She has no legal training whatsoever. She was formerly a civil servant at the department of work and pensions. She is manifestly a complete fuckwit, no more fit to judge doctors than my dog. The one four feet under the earth at the bottom of my garden.

It is utterly abominable that the GMC should appoint as chairs of panels people like this, with no legal knowledge, no legal training, no legal expertise. It is a true expression of the contempt with which the GMC views doctors. That we should be judged by people so ignorant, so incompetent, so utterly unsuitable is something we should not have to put up with. Is it too much to ask that those on panels should have some relevant knowledge?

Ms. Smith. If you had a shred of integrity, shame, or insight you would apologise to Dr Solomonides, and resign your position. You are not fit to judge a pet show.

Double jeopardy, double standards

As far as I am aware no registered medical practitioner has been arrested in connection with the recent riots and opportunistic looting. If they had they would not only be facing the courts, but the GMC as well. At para 58 of the good practice guide it states “You must inform the GMC without delay if, anywhere in the world, you have accepted a caution, been charged with or found guilty of a criminal offence.”

If you are tried and found guilty in a court of law the GMC will accept that verdict without question and proceed accordingly. You will have no opportunity to argue your case, you are guilty and that is that.

You might think that if the court of law finds you not guilty, and acquits you that that would also be taken by the GMC as final and no further action would be taken. However that would require the GMC to behave in a fair, unprejudiced and balanced way. In fact if you are acquitted you may still have to face the GMC at a fitness to practice hearing where, notwithstanding the decision of the court, you can still be found guilty and punished. The GMC view seems to be that there is no smoke without fire, we all know you dunnit, and if you managed to escape justice undoubtedly on some legal technicality, we will be there, untroubled by legal niceties to give you what you deserve.

The theoretical possibility exists that you can be tried in a country you have never visited, for something that is not a crime in the UK, and the GMC can then hold you to account in their own unique way.

In the UK we are all supposed to be equal under the law. However doctors seem to be less equal than others.

GMC inconsistency.

When I made that little dig about the GMC in my last post I had no idea I was commenting on the tip of the iceberg. Researching that post I came across this article about the Hospital, North Devon, Where Dr Thomson worked. In the last couple of years two of their consultants have been convicted  of sexual offences. As I commented Dr Thomson does not appear to be of concern to the GMC, and neither do these two consultants.

In a previous post I commented on a GMC case in which a Consultant was pursued, and suspended for doing something that he had every right to do. The GMC fully admitted that the doctor in question was to be unlawfully deprived of his rights under the human rights act in order to be disciplined, as if they were perfectly entitled to do that. What he did was certainly not unlawful. And yet the same GMC doesn't seem to be inclined to pursue a paediatrician convicted of possessing child pornography.

Is it not reasonable to expect a little consistency? Competence? Propriety? Of course not. This is the GMC after all. 

Tribunal del Santo Oficio de la Inquisición

The General Medical Council was established in 1858. It is a registered charity, registration with it is mandatory for any doctor who wishes to work, and it is answerable to no-one. For many years the many unsatisfactory aspects of the GMC were justified to doctors by assertions that the existence of the GMC constituted “self regulation” of the profession, and that this was preferable to state regulation. This self regulation is also the reason why it is financed by the doctors themselves through the annual retention fee.

What few seem to have noticed however is that this concept of self regulation has been eroded by stealth. Over the years more and more positions within the GMC  have been filled by non medical individuals. On at least one occasion an individual was appointed known to have a pathological animosity towards the medical profession, and one doctor in particular. Only half of the 24 members of the council itself are medically qualified. Although the Chair of the Council is a doctor, the real power resides with the Chief Executive, Mr Niall Dickson, who has been a teacher, a medical journalist, and CE of a Quango. Not a doctor then.

So now we have only the illusion of self regulation, and a GMC seemingly intent on making life as difficult as possible for doctors. Not content with tyrannising us at work they are now even suggesting they should regulate our personal lives as well, as is detailed here. 

True to form, the fact that these suggestions would constitute breaches of articles 8, 9 and 10 of the Human Rights Act is being ignored but the GMC have always had this attitude that they are somehow above the law. However in this case they would also be in breach of their own policy as laid out below; (found on another bloggers site, thanks to RP)

"In January 1999 the Standards Committee of the GMC met to consider issues involving the behaviour of doctors who comment in the media. It was their view that the GMC should not attempt to curtail doctors' rights to express their personal opinions. Doctors, like anyone else commenting in the media, are subject to the same constraints imposed by media regulatory bodies, and the libel laws. Furthermore, the committee considered that the professionals reputation depends principally on the standards of care and conduct provided by doctors to their patients, and not on personal opinions as put forward in published letters or articles. Whilst you may disagree with the comments Dr Y has made, we cannot take action against a doctor who is expressing a personal opinion".

So not only are they malicious, tyrannical and vindictive, they are illogical, inconsistent  and incompetent with it. Why do we put up with them?

High Court kicks GMC in the bollocks (again)

Back in April I wrote about the case of Dr Phillipp Bonhoeffer who had been suspended by the GMC, and was facing a fitness to practice hearing on the thinnest of evidence, evidence which was purely hearsay. 

My view that the behaviour of the GMC was outrageous and biased has been confirmed by the high court, who have described the intention of the GMC to proceed against Dr Bonhoeffer as “irrational”, and a breach of article 6 (Right to a fair hearing) of the Human Rights Act. 

The GMC in their typical arrogance are in denial. That twat Niall Dickson astoundingly has stated that the case remains open, and Dr Bonhoeffer remains suspended, despite the fact that the high court judge has forbidden the GMC from using the only evidence they had.

What makes that fool Dickson think that the GMC are above the law? What does it take to get any humility from these people? They should drop this case immediately, reverse the suspension and apologise.

What arseholes.

GMC thickos

As some of you are probably aware the GMC are not my favourite organisation. In my view they have the degree of arrogance only found in those who have power, without accountability. Most public bodies are accountable to someone, usually an Ombudsman. Even the police are accountable, through the Police Complaints Commission, which, in theory at least is independent. So why then if you want to complain about the GMC is your sole and only route to the GMC itself? So what happened to the legal principal of “Nemo Debet Esse Judex In Propria Causa”?

I used to think that their attitude to the quarter of a million UK doctors who keep the GMC alive through the retention fee, was one of indifference at best and malicious contempt and disdain at worst, and their attitude to whistleblowing seems to support this view. 

But I have now started to think that they are in fact simply incompetent and stupid. I have come to this view by reading something recently sent my way by a reader.

The GMC recently held a hearing against a doctor who I shall not name. Since the hearing concerned itself greatly with a matter of the doctor’s health the press and public were excluded from the hearing to protect the doctor’s right to medical confidentiality.

“The Panel passed a resolution, under Rule 41 (3) (b) of the General Medical Council (Fitness to Practise) Rules 2004, that from time to time, the press and public be excluded from those parts of the hearing where the Panel considered information relating to the physical or mental health of the practitioner.”

So why then, having excluded the press and public from the hearing, did they subsequently publish the entire proceeds of the hearing on the internet, revealing these medical details? I am not going to provide a link to this page, but I have seen it and you will have to take my word for it that the unfortunate doctor’s full medical details are laid bare for the public to see.

What are the GMC thinking? I have no way of contacting the doctor in question, and have no idea if he is aware of what they have done, but if it was me I would pursue this as far as it would go. 

Bloody arseholing hypocrites.

GMC gets it wrong

Just when you cut the GMC some slack and agree with one of their actions they go and spoil it all.

A locum surgeon in Hereford operated on an 8 year old girl to take out her appendix, but removed an ovary instead. I think even most medical students know their anatomy better than that and this can be nothing other than gross incompetence. She did not even realise what she had done, the error being discovered by a presumably bemused histopathologist examining the specimen.

So what do the GMC do about it. Nothing.

The GMC stated “Her actions fell seriously below the standard expected but it was an isolated case and there was no need to issue a warning” and “the doctor did not pose a risk to patients and that confidence in the profession had not been undermined as a result of her actions.”

The doctor has now done three appendicectomies under supervision and the GMC think that that is enough to allow her to be let loose on patients again. The GMC further stated “it was not necessary to issue Dr Abdullah with a warning and she remains eligible to apply for work in the UK.”

One of the unacceptable aspects of the GMC is that the panels that make these decisions are anonymous, even the accused doctor does not know who they are. Which is a shame because I would like to write to these clueless fuckwits to ask one simple question.

Would you let this doctor operate on your young daughter?

Witchfinder General

I have written before about how GMC procedures are skewed against doctors who are unfortunate enough to come to their attention. How unlikely these doctors are to receive fair and impartial treatment of the sort they could expect as a legal right (article 6) in a proper court. 

Within the GMC there are laid down some safeguards for doctors that should ensure some balance but the GMC is perfectly prepared to ride roughshod over these safeguards when they have the scent of blood in their nose.

Dr Phillipp Bonhoeffer, a paediatric cardiac surgeon, has recently been suspended by the GMC, over allegations of child sex abuse supposedly committed before 2004. I have no way of knowing whether or not there is any basis to the allegations, but spurious allegations of abuse are by no means rare. It is imperative therefore that guilt should be properly established before punishment is imposed. (article 7)

The police have investigated, and have brought no charges, partly because of the length of time that has elapsed since the alleged offences were committed, but also because the sole evidence for the offence is the testimony of a third party, hearsay evidence, which would not normally be accepted in a criminal court.

The GMC are not hindered by such inconveniences. Although their own policy is not to investigate allegations going back for more than 5 years they have decided to ignore that. They have also decided to accept hearsay evidence going back to events of eight years ago. The GMC of course are above the Human Rights Act, in their own eyes at least, and in this attitude they have previous form.

The unfortunate Dr Bonhoeffer therefore is at a great disadvantage. He is not going to have the opportunity to have his accuser cross examined, to question the only “evidence“ against him, which he denies strongly. The GMC, freed from any obligation to prove the offence to criminal standards, have probably made up their mind already. Fair trial my arse.

A rock and a hard place

There is no doubt that patients’ lifestyles influence their state of health. Their dietary habits, alcohol consumption, smoking and sexual practices are the main, but not only factors in this. To doctors this is of limited relevance. Certainly we should adopt a preventive role in advising our patients of their lifestyle practices that can potentially impinge on their health, but even this has it’s limits. While no-one would argue that we should encourage our patients to stop smoking, how many doctors would advise patients to give up horse riding (128 deaths/yr per 100,000 participants) or other risky sports.

By the time patients present to us with the consequences of a lifetime of bodily abuse however lifestyle becomes unimportant when it comes to treatment options. At this stage we simply have to treat to the best of our ability. This is crystallised by the GMC good practice guide at para 7; “You must not refuse or delay treatment because you believe that a patient's actions have contributed to their condition.” and “You must not unfairly discriminate against them by allowing your personal views to affect adversely your professional relationship with them or the treatment you provide or arrange.  This includes your views about a patient's age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.”

So what do you do when your Trust proposes to engage in precisely that sort of discrimination as is happening here, and is going to require your co-operation to apply it. To co-operate puts you in breach of GMC good practice guidelines, while to defy puts you most definitely in the firing line as far as your employer is concerned.

The GMC does seem to have this covered as they state; “If inadequate resources, policies or systems prevent you from doing this, and patient safety is or may be seriously compromised, you must follow the guidance in paragraph 6.”

So what does it say at paragraph 6? This is where suddenly the crystal clarity suddenly deserts the GMC and they are a little more wooly” you should draw the matter to the attention of your employing or contracting body. If they do not take adequate action, you should take independent advice on how to take the matter further. You must record your concerns and the steps you have taken to try to resolve them.”  Firstly you are supposed to stick your head above the parapet and start making a fuss. And when, inevitably, your expressed concerns are ignored then what. Then all of a sudden it is for someone else (unspecified) to advise you. What a cop out. The logical next step of course is whistleblowing but as I have pointed out before this is likely to have catastrophic repercussions, despite the presence of legislation supposed to protect you. 

And when your Trust turns on you like a rabid psychotic dog, because you have followed GMC guidelines, just how much support do you suppose you will get from the GMC?

CONFESS! CONFESS!!

The GMC are undergoing some changes to their fitness to practice procedures at the moment. It had been intended that the GMC would restrict itself to investigation and prosecution, with adjudication being taken up by a separate body, but this proposal, sadly, has now been shelved so the new changes are going to be little more than cosmetic. 

The GMC will continue to fulfil the roles of investigator, prosecutor, judge, jury and executioner. So doctors who come to the attention of the GMC can expect to be treated as fairly and impartially as Captain Blackadder, the Flanders pigeon murderer. Add to that the fact that the GMC only have to satisfy themselves of guilt to the standards of a civil court, and not to criminal standards. In other words, to their own satisfaction.

Their attitude towards doctors can be summed up as “you are guilty until proved innocent, and if by some miracle you do escape conviction then you are still guilty but you just got off with it this time matey.” Indeed a fellow blogger has likened referral of a colleague to the GMC as like handing him over to the Gestapo. 

In fact it seems they find the whole process of a hearing a tedious waste of time before getting to the sentence. It is no exaggeration to say that sometimes the verdict and sentence are determined before the hearing, a process known as “draft determination.” 

This attitude is illustrated by their latest ruse, where they intend to “encourage doctors to accept proposed sanctions .....without the need to refer the case for a hearing.” In other words if you confess, and accept punishment, you can save yourself the bother of a trial, rather like the Spanish inquisition. Despite their ludicrous assertions that this is somehow to the doctor’s benefit it is in fact just a way for them to screw you without having to go through the bothersome and tedious business of finding some evidence. 

My advice to anyone presented with this option is NOT to confess to anything. Make them go through the hearing process, it is your one chance to present your case and have everything in the open. And if it still goes against you you can then take it further, to the high court where the bastards consistently lose. And by calling their bluff you will probably find they are the ones who back down, knowing they have bugger all.

Excuses

 As a follow up to my last post, the (not a) doctor in question has now been sentenced to 7 years in prison.

As comment I'd like to quote from the article;

“That the degree certificate and supporting letter were accepted by the GMC represents an abject failure of scrutiny." (of the GMC)

“such clearly false documents” and why it took a journalist rather than a professional governing body (the GMC) to uncover the truth.

The GMC claimed in court that documents in the 1990s were not subject to the “rigorous scrutiny” now in place."

That does not fill me with confidence. The incompetence involved is staggering, and DZ sees no evidence to suggest that scrutiny is now more rigorous. Unless of course they are referring to the appraisal and revalidation process. A process that the lady in question successfully negotiated for years.

The GMC are ingrained with incompetence, ignorance, complacency, amateurism, rank stupidity and pomposity. They are utterly unfit for purpose, root and branch.

If our Health minister really wants to do something about the massive and manifest failings of the GMC it would not be enough to reform or tinker. Step one is to terminate it totally and start from scratch with a proper regulatory body, staffed by properly qualified people, rather than a bunch of aimless retirees wanting a hobby. And not one current employee of this failed organisation should have any involvement with the replacement.

Freedom of speech

A Citizen’s freedom of speech is considered one of the most important rights in any civilised democratic society. In the United States this right is guaranteed by the First Amendment to the Constitution. In Europe, and the UK it is covered by article 10 of the Human Rights Act 1998. Despite freedom of speech being a right guaranteed in law there are bodies and individuals who seem not to understand what this means, and will attempt to silence or punish those who choose to exercise this right.

For example if you are familiar with this site, it will be apparent that the author does not like pharmacists very much, and has expressed views likely to offend. That is his right. Anyone offended has the right to express their disagreement, but one pharmacist reported the Doctor to the GMC claiming that what he had written was “unprofessional” and that his “behaviour falls seriously short of what would be expected from a doctor”. Interference with a convention right is unlawful and the pharmacist in question, in attempting to have the doctor disciplined, was undoubtedly guilty of such interference. Further the Medical act does not give the GMC the right to override other laws and in even considering this complaint the GMC were also guilty of interference with a convention right. This was a complaint that should not have been pursued yet it took the GMC six months to finally agree that there was no case to answer. There have been other similar cases where the GMC have shown considerable inconsistency in their approach to article 10.

Article 10 is not however an absolute right. It is a qualified right. What this means is that there are circumstances where Article 10 is overridden. Threatening behaviour is one example. Incitement to violence is another.

There is one body, and one body alone, that can specify when article 10 does not apply, and that is Government. There is one means, and one means alone, by which they may do this, and that is by legislation. Circumstances where article 10 does not apply must be clearly and precisely defined in law, and it is not open to the GMC or any other body or individual to themselves decide what constitutes acceptable behaviour in the field of freedom of expression. They may not pursue individuals simply because those individuals express views which piss people off. This has been verified in a legal case where it was made clear that “Article 10 applies not only to information or ideas that are favourable and inoffensive but also to those that offend, shock or disturb the State or a sector of the population.”

In a future post I will be looking at how article 10 affects the relationship between an individual and his employer.

Tipped scales.

 DZ thought that he knew all of the machinations used by the GMC to make it easier to screw over doctors who come before a Medical Practitioners Tribunal.

Such as the original idea that the MPT should be independent of the GMC, which never happened.

Or the change in burden of proof from the criminal standard, (beyond reasonable doubt) to the civil, (balance of probabilities).

Or the fact that the only appeal against the penalty set by a fitness to practice hearing is to the High Court, an expensive, daunting and difficult path making appeal almost impossible for most doctors.

But what I didn't know was that, if the GMC themselves are dissatisfied with the judgement of a FPH and want a more severe punishment, then they themselves do have an appeal system for that. An appeal pathway not open to the accused doctor. And who gets to adjudicate this appeal of the GMC. Why the GMC themselves of course. 

The government noticed this and recommended abolition of this unfair practice over six years ago but nothing happened.

I din't know why the fuckers bother with a FPH at all. It's so biased against the doctor that it would be laughable if the consequences weren't so devastating

The prisoner

Until DZ retirement his registration with the GMC was very much in the background. The money got taken, unnoticed, from his account on a regular basis but that was about it. He does remember back in the 90s when, due to an error in the GMC itself his direct debit was cancelled, by them and the fee not paid. In their usual style when they discovered their own error their response was to write to me aggressively and rudely threatening erasure if I didn't pay up. As if it was my fault. Arrogant pigs!
So for the entire duration of his career, DZ had no idea what his GMC number was. No-one ever asked for it. It was not in his memory.
So when he started doing agency work he was a little surprised to find the number of times he was required to put his GMC number on various forms, including prescription forms and various other records.
A month ago I mentioned another line I've been wanting to use for some time. The opportunity hasn't arisen yet, but it's only a matter of time.

The disembodied voice in this clip I think sounds a lot like the GMC would sound, if it had a voice.

Contempt

“Any material written by authors......as doctors......may reasonably be taken to represent the views of the profession more widely”

In my last post I criticised this statement by the GMC as baseless. Perhaps though what they are really afraid of is that bloggers are actually expressing the majority view of the rank & file of the medical profession. Particularly in areas such as revalidation, where there is no doubt that most of us are opposed to the concept. 

And as for the GMC itself. Other bloggers, and I have been openly critical of the GMC and with good reason, as explained here. And talking to my colleagues I am in no doubt that contempt of the GMC is felt by a considerable majority of doctors. If anyone at the GMC is reading this, it's not just us bloggers who disrespect and despise you. Most doctors think you're a bunch of cunts!

Appraisal Appraised

Not long ago I posted on the utter waste of time that is "Mandatory Training". I pointed out that the obsession with this bollocks takes doctors away from their patients for a not insignificant period of time, to learn stuff, much of which is of no relevance to their profession whatsoever.

In similar vein I thought I'd look at that universally reviled, ridiculed and disrespected process of annual appraisal.

As Doctors we are used to the concept of examining potential therapies for our patients on the basis of how the potential benefit balances against the potential downsides. We look not only at the  expectations of therapy, but also the possible adverse effects, and, ideally, present these facts to the patient, to ensure truly informed consent. We also consider cost.

So how does appraisal stack up using this approach?

1. Benefits of annual appraisal.
This of course is going to be difficult to objectively assess. The GMC approaches this difficulty by not even trying. Their concept of "success" seems to rest heavily on compliance rates. Almost all doctors are now participating in the process and that alone is considered success. But participation is not enough. There is little reason to believe that this man should not have been able to comply and retain his license to practice. The GMC would have considered that a success

 Although it is claimed that there is evidence that the profession has a very positive attitude to the process, this appears to be based entirely on surveys. Try getting research published where the database consists entirely of surveys and see how far you get.
The claim is that appraisal and revalidation will identify underperforming doctors and thus raise the standard of practice. Really?

So how come that, as the GMC admits, complaints made to the GMC about doctors have doubled in the last 4 years? Doesn't speak of a raising of standards does it?
How about claims against the NHS for clinical negligence? In 2004/5 there were 5609 such claims, in 2015/16 there were 11000, and in 2016/17 a staggering 17338. The numbers are rising steadily and apparently inexorably. That doesn't support the idea that standards have risen since appraisal came along either does it?
Excess hospital deaths show the same trend.
Let's face it, the assertion that appraisal and revalidation improves standards is not supported by evidence.
So Benefits?   Zero!

2. The downsides.

GMC propaganda would have you believe that doctors are warming to the concept of appraisal. Odd... I have yet to meet a single doctor who has any respect or regard for the process at all. Indeed there is evidence that most find the process demoralising to the point where it is a significant cause of  doctors taking early retirement. Or deserting the UK altogether.
The BMA estimates that annual appraisal takes the typical doctor about 40 hours, a full working week, to prepare for and endure. There are approximately 250,000 fully registered medical practitioners in the UK, so that means that total doctors time spent with patients is reduced by 250,000 weeks every year to accommodate appraisal. Assuming 6 weeks annual leave a year, plus 2 weeks study leave a full time doctor will work 44 weeks per year. So appraisal causes the effective removal from the NHS of 5681 full time doctors..............and a part timer. Put another way, if appraisal was abolished tomorrow the NHS would benefit with an effective rise in clinician numbers of 5681, without cost!

Whichever way you look at it, appraisal and revalidation for doctors is a failed experiment. One that virtually no other country has sought to emulate.

An utter bag of shit tied up with string.