BMA warns medical regulation proposals will muzzle doctors

A raft of proposals which together add up to the loss of professionally-led medical regulation have the potential to muzzle doctors in their role of speaking out for their patients, warns the British Medical Association (BMA) today.

In an initial response to the government's White Paper 'Trust, Assurance and Safety - the Regulation of Health Professionals', published today, the BMA warns that with a state-owned NHS, a monopoly employer and an appointed regulatory body also controlled by government, doctors could be compromised in their ability to use their clinical independence to get the best treatment for their individual patients.

Mr James Johnson, chairman of the BMA, said: "The vast majority of doctors perform well and safely but patients must be protected from the rare cases of unsafe or poorly-performing doctors so that the public can maintain the trust it shows in the medical profession. Part of that trust lies in the fact that good doctors will act as their patients' champions, if necessary fighting for the right drug, the best treatment, and the patients' freedom to choose where they receive it. Our concern is that under these White Paper proposals, a doctor's ability to continue working in this way, without fear of falling foul of political imperatives, will be jeopardised.

"Do patients want their doctor to be regulated by the state to do what the government tells them to do, or do patients want their doctor to continue to relate to them as individuals and do what is best for them?"

The BMA believes clinical independence could suffer with consequent risks to patient care if many of the White Paper proposals are implemented.

Regular checks for doctors have the support of the BMA provided they are fair and workable. All doctors will have to be regularly re-licensed, and consultants and GPs will also have to be re-certified under the proposals. The BMA is supportive of doctors being regularly revalidated but is wary of what future requirements might be imposed in order for doctors to get their licence to carry on practising. "Proving to patients that doctors are up to date and safe to practise is a good thing. But any attempts in the future to introduce meeting government targets into requirements for re-licensing would be bitterly opposed by the BMA" warned Mr Johnson, adding: "Doctors as well as patients need to have confidence in any new system if it is to work."

The removal of the adjudication function from the General Medical Council (GMC), the change to having appointed GMC Council members instead of elected doctors, the new composition of GMC Council with 50:50 lay and medical members, and the switch to a lesser burden of proof in fitness to practice hearings against doctors, all add up to a loss of professionally-led regulation, says the BMA.

"Removing a doctor from the GMC Register means he or she loses not only their job but their entire way of earning a living. With such serious consequences it cannot be right to rely on a mere balance of probabilities, rather than the current standard of proof of beyond reasonable doubt. That is why the BMA is opposed to this change. If a sliding scale of proof is to be introduced there must be a guarantee that for the most serious cases nothing less than proof beyond reasonable doubt will be employed," said Mr Johnson.

On a positive note, the BMA welcomes the decision to leave medical undergraduate education within the remit of the GMC. Change to death certification is another area covered in today's announcements. The BMA has been calling for changes for many years - long before Shipman - and will study the proposals in detail and respond to the consultation.

Mr Johnson said: "Doctors recognise the need for change to reassure patients and the GMC has already greatly changed. The BMA supports measures that promote excellence and help reduce instances of poor standards, or negligence. Patients have a right to expect nothing less. But doctors need to have confidence that the regulatory system will lead to support and retraining if necessary and not be merely punitive. Sadly the White Paper proposals could lead to a climate of defensive medicine in which doctors are forever looking over their shoulders instead of concentrating on working in the best interest of their patients."