A Step Forward In Patient Care?
The Chief Medical Officer, Sir Liam Donaldson, has announced a
shake-up in the assessment of doctors which is set to be the
biggest change to the regulation of the medical profession in 150
The need for further regulation has long been put forward by
organisations representing the medical profession, including the
General Medical Council (GMC). The issue was highlighted by the
inquiry into the actions of Harold Shipman, who murdered up to 250
of his patients, often with the use of narcotic drugs that he had
stockpiled. The inquiry criticised the regulation of doctors as not
being focused enough on patients. But given that Harold Shipman was
a criminal who may well have passed the new proposals, what will
further assessment and regulation achieve? Will it result in better
standards for patients, or an increased burden on doctors and the
practice of 'defensive medicine' with doctors having less
time for patients?
The intention of the reforms is to standardise what is currently
a patchy system of monitoring and not to be a disciplinary
mechanism. Doctors face no formal reassessments between entering
practice as a GP or consultant and retiring. This lack of
reassessment has been compared to airline pilots who are assessed
approximately 100 times during their career.
The present system is carried out on the basis of an annual
appraisal to consider a doctor's prescribing habits, career
development and general performance. This has been described by the
Chief Medical Officer as not appropriate for the renewal of
licences. It is thought that some Trusts are not carrying out the
appraisals each year and there is concern over the consistency of
the assessments. There is also no process for gathering feedback
from patients which is a key element of the new proposals.
The new system has two strands: relicensing (confirming that
doctors practice in accordance with the GMC's standards) and
recertification (confirming that doctors conform to the standard
appropriate for their speciality of medicine).
The relicensing component will require a uniform module of
appraisal, based upon the GMC's Good Medical Practice, while
there will be scope for other aspects of the appraisal to be a
matter for local employers.
The recertification component will involve a clear set of
standards developed by the relevant medical Royal College in
conjunction with specialist associations. The basis of...
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