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Health: Doctors and Patients

My Lords, a patient of mine, a retired plumber in Deptford, once said to me, ““I suppose doctors are like plumbers—a third good, a third average and a third you wouldn’t want anywhere near your drains?. We might argue about the percentages, but most doctors would acknowledge that there is some small truth in the wisdom of the plumber in Deptford. The public want us to take action to address their concerns about the quality of healthcare. We should support any endeavour to improve lifetime professional practice. Liam Donaldson’s report achieves about the right balance between heavy-handed regulation and the developmental supportive approach, which may not be popular with all my colleagues. How the Government respond to that by putting in the bureaucratic processes and systems to support it, I am not sure has been fully worked out. I declare an interest as chair of council at St George’s, University of London, which has a medical school. I want to comment on aspects of medical education. First, I strongly welcome the proposal that the GMC’s judicial hearings should accept the standard of proof of the civil courts; I welcome the flexible approach. As an NHS manager, I was obliged to welcome back many colleagues whom I was pretty sure would get their comeuppance from the GMC, only to have the case fail as a result of inappropriate standard of proof. I was then faced with the horrible disciplinary dilemma of the doctor coming back to the trust without having a proper way to deal with it. The standard of proof is inappropriate. It is crucial that we create a system whereby the GMC system of regulation is more closely related to the local disciplinary processes and support systems within the trusts. Although the new affiliate system may become over bureaucratised, it is, in principle, a good way to achieve that. I support recommendation 23 that students should be registered with the GMC and the proposal for new GMC affiliates on the medical school staff to operate fitness to practise in parallel with the system for registered doctors. However, in view of the fact that expertise in these matters is not easy to come by, regional teams of affiliates with real experience of issues could build up expertise within medical schools. That might be preferable to multiple local affiliates. These issues need sympathetic and careful handling. A first-year student’s problems and bad behaviour may be acceptable in the first year, but not in the final year. We need to develop sympathetic systems to look at fitness to practise in medical students. Overall, I welcome this report and look forward to the Government's further responses.