Regulation of the medical profession: fantasy, reality and legality

The past decade witnessed a series of high-profile inquiries that cast a noxious miasma over the medical profession and provoked demands for strict regulation. Somehow, a balance must be struck whereby the public can be confident that doctors practise competently, with due regard to ethical and technical standards, yet the regulations are not so overwhelming as to represent a sword of Damocles permanently hanging over doctors ’ heads. This article explores the current regulatory framework, exclusion from the workplace, serious professional misconduct and seriously deficient performance. The General Medical Council deals with a large number of regulatory cases each year, of which a small proportion are appealed. As well as providing valuable insight into judicial thought, case law in this area is helpful in understanding the balance between social policy and medical regulation. THE REGULATORY FRAMEWORK The notion that doctors have complete professional freedom has long been a fantasy. However, the standards have been set largely by the profession itself. This self-regulation, which allows wide latitude in dealing with problems within the profession, has been roundly condemned in the wake of recent imbroglios.1–3 Statutory regulation has been repeatedly endorsed as an apposite regulatory mechanism since it carries the force of law4 and also provides a proper foundation for the contract of the medical profession with society.5 The Medical Act 1858 established the General Council of Medical Education & Registration of the United Kingdom, now known as th