Domhnall MacAuley: A visit from the GMC

Domhnall MacauleyRevalidation fatigue…there is so much in the news, post, and medical media that I had begun to switch off.  But, Niall Dickson, from the GMC, gave us a very reassuring talk on revalidation recently and it all sounded very reasonable, sensible, and non threatening. Revalidation based on appraisal seems fair and we are well used to annual appraisals in general practice. Dare I even concede that I look forward to my appraisal and find it very helpful in my own continual professional development. Discussing areas for possible clinical improvement with someone older and wiser (though not many appraisers are older now!) has always been a very positive experience.

Complaints against doctors.  A completely different story. The GMC receives 8,000 complaints per annum. Now, that does scare me. I don’t know the size of the denominator but, by any scale this is a significant proportion of registered doctors.  And, I also know that middle aged male GPs are a high risk demographic. Thankfully I have never had a letter from the GMC other than routine correspondence. Even the sight of the envelope makes me anxious. I thought I might be unusual but chatting to my colleagues, many feel the same.

But, 8,000 complaints. Are there really so many reasonable and appropriate grievances? Having to respond to a GMC enquiry must be very alarming—how do those doctors feel? No one can defend bad medical practice, and I entirely support professional accountability. Patients must, of course, be encouraged to complain when there is a problem. Many good, conscientious, and caring GPs will tell you, however, that patient expectation exceeds anything they can hope to provide. Even reasonable patients make unreasonable demands. You can feel it at the sharp end in general practice. But, its worse. Unreasonable patients make impossible demands. And, if you don’t acquiesce they sometimes threaten GPs. “I will report you to the GMC,” has become part of the dialogue of daily practice.

The GMC must protect patients. But, expectations are extraordinary and doctors are an easy target.

Domhnall MacAuley is primary care editor, BMJ