General Medical Council

Registration with the GMC confers a number of privileges and duties.[11] GMC registration may be either provisional or full. Provisional registration is granted to those who have completed medical school and enter their first year (F1) of medical training; this may be converted into full registration upon satisfactory completion of the first year of postgraduate training.[12] In the past, a third type of registration ("limited registration") was granted to doctors who had graduated outside the UK and who had completed the Professional and Linguistic Assessment Board examination but who were yet to complete a period of work in the UK. Limited registration was abolished on 19 October 2007 and now international medical graduates can apply for provisional or full registration depending on their level of experience – they still have to meet the GMC's requirement for knowledge and skills and for English language.[13]

The GMC administers the Professional and Linguistic Assessment Board test (PLAB), which has to be sat by non-European Union overseas doctors before they may practice medicine in the UK as a registered doctor.

A registered practitioner found to have committed some offences can be removed ("struck off") from the Medical Register.

The GMC is now empowered to license and regularly revalidate the practice of doctors in the UK. When the licensing scheme was introduced in 2009, 13,500 (6.1%) of registered doctors chose not to be licensed.[14] Unlicensed but registered doctors are likely to be non-practising lecturers, managers, or practising overseas,[15] or retired. Whereas all registered doctors in the UK were offered a one-off automatic practise licence in November 2009, since December 2012 no licence will be automatically revalidated, but will be subject to a revalidation process every five years.[16] No doctor may now be registered for the first time without also being issued a licence to practice,[17] although a licensed doctor may give up their licence if they choose. No unlicensed but registered doctor in the UK is subject to revalidation. However, unlicensed but registered doctors in the UK are still subject to fitness-to-practice proceedings, and required to follow the GMC's good medical practice guidance.

The GMC sets standards of professional and ethical conduct that doctors in the UK are required to follow. The main guidance that the GMC provides for doctors is called Good Medical Practice.[18] This outlines the standard of professional conduct that the public expects from its doctors and provides principles that underpin the GMC's fitness to practise decisions. Originally written in 1995, a revised edition came into force in November 2006, and another with effect from 22 April 2013. The content of Good Medical Practice has been rearranged into four domains of duties. Their most significant change is the replacement of a duty to, "Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk," to a new duty to, "Take prompt action if you think that patient safety, dignity or comfort is being compromised". Alongside the guidance booklet are a range of explanatory guidelines, including a new one about the use of social media. The GMC also provides additional guidance for doctors on specific ethical topics, such as treating patients under the age of 18, end of life care, and conflicts of interest.[19]

The GMC regulates medical education and training in the United Kingdom. It runs 'quality assurance' programmes for UK medical schools and postgraduate deaneries to ensure that the necessary standards and outcomes are achieved.[20]

In February 2008 the then Secretary of State for Health, Alan Johnson, agreed with recommendations of the Tooke Report which advised that the Postgraduate Medical Education and Training Board should be assimilated into the GMC.[21] Whilst recognising the achievements made by PMETB, Professor John Tooke concluded that regulation needed to be combined into one body; that there should be one organisation that looked after what he called 'the continuum of medical education', from the moment someone chooses a career in medicine until the point that they retire. The merger, which took effect on 1 April 2010, was welcomed by both PMETB and the GMC.[22]

A registered medical practitioner may be referred to the GMC if there are doubts about their fitness to practise in the UK. These are divided into concerns about health and other concerns about ability or behaviour. In the past these issues were dealt with separately and differently, but now pass through a single fitness to practise process.[23] The GMC has powers to issue advice or warnings to doctors, accept undertakings from them, or refer them to a fitness to practise panel. The GMC's fitness to practise panels can accept undertakings from a doctor, issue warnings, impose conditions on a doctor's practice, suspend a doctor, or erase them from the medical register ('struck off').[24] The GMC is concerned with ensuring that doctors are safe to practice. Its role is not, for example, to fine doctors or to compensate patients following problems.[25] The outcomes of hearings are made available on the GMC website.[26]

Concern has resulted from several studies that suggest that the GMC's handling of complaints appears to differ depending on race or overseas qualifications, but it has been argued that this might be due to indirect factors.[39]

The mortality and morbidity among doctors going through GMC procedures has attracted attention. In 2003/4 between 4 and 5% of doctors undergoing fitness to practice scrutiny died.[40] In response to a request for information in accordance with the Freedom of Information Act 2000, the GMC revealed that 68 doctors had died recently whilst undergoing a fitness to practice investigation,[41]

In an internal report, "Doctors Who Commit Suicide While Under GMC Fitness to Practise Investigation",[42] the GMC identified 114 doctors, with a median age of 45, who had died during the previous eight years, and had an open and disclosed GMC case at the time of death, and in which 28 had committed suicide [43] and recommended 'emotional resilience' training for doctors.[44]

The Health and Safety Executive's provisional figure for the number of workers fatally injured in 2013/14 was 133,[45] and corresponds to a rate of fatal injury of 0.44 deaths per 100 000 workers. According to the recent Horsfall review, the number of deaths of doctors under GMC procedures in the eight years between 2005 and 2013 accounted for more than 10% of the country's death rate at work of the entire UK workforce, annually and consistently. No other organisation besides the GMC had come anywhere near this occupational fatality rate. [46]

In a warning on "over-regulation" Dr Clare Gerada, a former chair of the Royal College of General Practitioners, commented:

Following the suicide of Professor John E Davies from Guy's Hospital, London, HM Senior Coroner for the area wrote to Niall Dickson with her Regulation 28: Report to Prevent Future Deaths:[48]

Academics at King's College London researched the effects of increased regulatory transparency on the medical profession and found significant unintended consequences. As doctors reacted anxiously to regulation and media headlines, they practised more defensively.[50][51]

The GMC was registered as a charity with the Charity Commission of England and Wales on 9 November 2001.[52] The Commissioners having considered the court and the Commission's jurisdiction to consider an organisation's status, which had previously been considered by the courts, in issues of charitable status.

Charities do not normally have to pay income tax or corporation tax, capital gains tax or stamp duty. Following the granting of charitable status the GMC obtained tax relief backdated to 1 April 1994.[53] Charities pay no more than 20% of normal business rates on the buildings they use and occupy. The GMC received confirmation of 80% business rates relief effective from April 1995.

As of 2014 the accounts submitted by the GMC to the Charity Commission showed an income of £97 million, spending of £101m with reserves of £68m.[54]

The GMC was most heavily criticised by Dame Janet Smith as part of her inquiry into the issues arising from the case of Dr Harold Shipman. "Expediency," says Dame Janet, "replaced principle." Dame Janet maintained that the GMC failed to deal properly with Fitness to Practise (FTP) cases, particularly involving established and respected doctors.[55]

In response to the Shipman report, Sir Liam Donaldson, the then Chief Medical Officer, published a report titled Good doctors, safer patients, which appeared in 2006.[56] Donaldson echoed concerns about GMC FTP procedures and other functions of the Council. In his view, complaints were dealt with in a haphazard manner, the GMC caused distress to doctors over trivial complaints while tolerating poor practice in other cases. He accused the Council of being "secretive, tolerant of sub-standard practice and dominated by the professional interest, rather than that of the patient". Former President of the General Medical Council, Sir Donald Irvine, called for the current Council to be disbanded and re-formed with new members.[57]

In July 2010 the GMC was severely criticized in an open letter in the British Medical Journal by Professionals Against Child Abuse for the decision to include Penny Mellor on the GMC's Expert Group on Child Protection. According to the letter, Penny Mellor had been convicted and imprisoned for conspiring to abduct a child, and had led protracted hostile campaigns including false allegations against doctors and other professionals involved in child protection cases. She had also campaigned against Sir Roy Meadow and Professor David Southall, who were erased from the medical register by the GMC but subsequently re-instated after court rulings.[58] Penny Mellor subsequently resigned from the Expert Group.

In March 2012, the High Court of England and Wales overturned a 2010 decision by the GMC to strike pediatric gastroenterologist John Walker-Smith off the medical register for serious professional misconduct.[59] In his ruling, the presiding judge criticized what he said were the GMC's "inadequate and superficial reasoning and, in a number of instances, a wrong conclusion," and stated, "It would be a misfortune if this were to happen again."[60]

Controversy arose in July 2016 when the General Medical Council announced it would be appointing Charlie Massey as its new CEO.[61] Massey had been an adviser to health secretary Jeremy Hunt on the controversial Junior doctors contract, which had led to several days of industrial action by doctors over concerns about feasibility and patient safety.[62] Many doctors felt this reflected a clear conflict of interest and signed a petition to the medical council for transparency in its appointment process. The medical council issued a response claiming that they were still an independent body.[63] Massey had also signally failed to distinguish himself in front of the Public Accounts Committee of Parliament.