Ұлыбритания медициналық тіркеушісінің кеңесі

Healthcare regulator for medical profession in the UK

The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the public" by controlling entry to the register, and suspending or removing members when necessary. It also sets the standards for medical schools in the UK. Membership of the register confers substantial privileges under Part VI of the Medical Act 1983. It is a criminal offence to make a false claim of membership. The GMC is supported by fees paid by its members, and it became a registered charity in 2001.

The Medical Act 1858 established the General Council of Medical Education and Registration of the United Kingdom as a statutory body. Initially its members were elected by the members of the profession, and enjoyed widespread confidence from the profession.

All the GMC's functions derive from a statutory requirement for the establishment and maintenance of a register, which is the definitive list of doctors as provisionally or fully "registered medical practitioners", within the public sector in Britain. The GMC controls entry to the List of Registered Medical Practitioners ("the medical register"). The Medical Act 1983 (amended) notes that, "The main objective of the General Council in exercising their functions is to protect, promote and maintain the health and safety of the public." Thirdly, the GMC is responsible for a licensing and revalidation system for all practising doctors in the UK, separate from the registration system, since 3 December 2012.

Due to the principle of autonomy and law of consent there is no legislative restriction on who can treat patients or provide medical or health related services. In other words, it is not a criminal offence to provide what would be considered medical assistance or treatment to another person – and not just in an emergency. This is in contrast with the position in respect of animals, where it is a criminal offence under the Veterinary Surgeons Act 1966 for someone who is not a registered veterinary surgeon (or in certain more limited circumstances a registered veterinary nurse) to provide treatment (save in an emergency) to an animal they do not own. Parliament, since the enactment of the 1858 Act, has conferred on the GMC powers to grant various legal benefits and responsibilities to those medical practitioners who are registered with the GMC a public body and association, as described, of the Medical Act 1983, by Mr Justice Burnett in British Medical Association v General Medical Council. Through which, by an Order in the Privy Council, the GMC describes "The main objective of the General Council in exercising their functions is to protect, promote and maintain the health and safety of the public". The GMC is funded by annual fees required from those wishing to remain registered and fees for examinations. Fees for registration have risen significantly in the last few years: 2007 fees = £290, 2008 fees = £390, 2009 fees = £410, 2010 fees = £420, 2011 fees = £420, with a 50% discount for doctors earning under £32,000. In 2011, following the Command Paper "Enabling Excellence Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers", registration fees were reduced by the GMC in accordance with the Government's strategy for reforming and simplifying the system for regulating healthcare workers in the UK and social workers and social care workers in England and requiring that "[A]t a time of pay restraint in both the public and private sectors, the burden of fees on individual registrants needs to be minimised."

Registration with the GMC confers a number of privileges and duties. 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. 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. The form and content of the register is specified in The General Medical Council (Form and Content of the Register) Regulations 2015. Details recorded include name, address, date of qualification, gender, date of birth, photograph, fitness to practice history, restrictions and whether or not they hold a licence to practice. Not all details on the register are made available to the general public. 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 practise medicine in the UK as a registered doctor. A registered practitioner found to have committed some offences can be removed from ("struck off") 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. Unlicensed but registered doctors are likely to be non practising lecturers, managers, or practising overseas, 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. No doctor may now be registered for the first time without also being issued a licence to practice, 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. 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.

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. 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. 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.

A registered medical practitioner may be referred to the GMC if there are doubts about their fitness to practise. The GMC is concerned with ensuring that doctors are safe to practise. Its role is not, for example, to fine doctors or to compensate patients following problems (compensation might be addressed through a medical malpractice lawsuit). The outcomes of hearings are made available on the GMC website. Historically the handling of concerns had two streams: one regarding health, the other about conduct or ability, but these streams have been merged, into a single fitness to practice process. 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 remove them from the medical register (when they are said to be 'struck off'). It has been repeatedly established that the GMC's fitness to practise processes disproportionately affects non white doctors. Black and ethnic minority doctors are complained about more, investigated more frequently, issued the most severe punishment more frequently, and are least represented in all aspects of governance in the GMC. On the 18th of June 2021 the GMC, for the first time in its history was found guilty of racial discrimination against a non white doctor by a UK court. A ruling from Reading employment tribunal found that the GMC had discriminated against Dr Karim a consultant urologist based on his race by continuing an investigation into him when it did not investigate the same allegation against a white doctor. The tribunal heard Dr Karim was an internationally renowned urologist of mixed black African and European descent who had been a whistle blower in a case about surgeons performing operations without appropriate training. Following the GMC investigation, Dr Karim attended a fitness to practice hearing in 2018, after which he was cleared of any wrongdoing. After the hearing, Dr Karim said: "Right from the outset, the GMC saw me as a guilty black doctor and withheld evidence that could have proven my innocence. Dr Karim described being wrongly accused of bullying was "pretty devastating". He said: "You feel as though everything has collapsed and is falling apart. When you've done nothing, you realise people can be so vindictive. I was discriminated against by the GMC and I had clear cut evidence that I was innocent but they withheld evidence during my fitness to practice tribunal in 2018. It is a landmark victory and the first time it has ever been done against the GMC. They basically look at your name and where you are from and they decide the case beforehand based on that — it is pretty shocking, to be honest. My background was the only difference between me and the guy who was let off and he was my main comparison throughout this whole case. He was white and I have a Muslim name and I'm mixed race. Unfortunately, with the NHS, there is an undercurrent of hidden racism and, sadly, it is rife throughout the system, right up to the regulator".

Gaining registration with the GMC (whether provisional or full) also allows the registrant to fit and utilise green flashing lights to their car. Such lights can be used when attending a medical emergency to alert other road users to their presence and intentions. They can also make a doctor's car more visible if they have stopped at an accident scene. They do not confer exemptions to road traffic legislations.

The GMC was registered as a charity with the Charity Commission of England and Wales on 9 November 2001. 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. 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.

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. 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. 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.

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. 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. 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."

Controversy arose in July 2016 when the General Medical Council announced it would be appointing Charlie Massey as its new CEO. 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. 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. Massey had also signally failed to distinguish himself in front of the Public Accounts Committee of Parliament.

The Council is composed of six medical professionals and six lay members. All members are appointed by the Privy Council. The current Chair is Dame Carrie MacEwen who has served since May 2022. The current chief executive and registrar is Charlie Massey. Christine Murrell was the first woman elected to the GMC in 1933, however she died before she could take her seat. In 1950, Hilda Lloyd became the first female member of the Council.