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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