Samar Singh Discusses " Student Fitness to Practise"

Bare Bones of Student's Fitness to Practise.

For information regarding the manner in which the GMC treats medical students who raise valid concerns about inequality - see www.examfraud.co.uk . Following the piece regarding Professor Timothy David's role in Student Fitness to Practise issues, we present the following as a historical snapshot of how matters have developed. Essentially, Student FtP is a pointless concept that only serves the establishment and not the public.

We refer to the article below first published in the Times Higher Educational Supplement on the 21st July 2006. Following the furore regarding medical student regulation, we felt it was important to turn back the time clock and analyze a number of issues.

"Medics riled by training reforms" Claire Sanders
Published: 21 July 2006 [THES]

Medical schools reacted with alarm this week to news that the General Medical Council could lose its regulatory role for undergraduate education, writes Claire Sanders.

In what is being seen as the biggest shake-up in medical regulation in 150 years, Sir Liam Donaldson, the Chief Medical Officer, has proposed radical changes to how doctors are assessed and disciplined, many of which will mean a reduced role for the GMC.

The move is in response to criticisms of the GMC by Dame Janet Smith, chair of the inquiry into the Harold Shipman murders.

Katie Petty-Saphon, executive director of the Council of Heads of Medical Schools, said: "The GMC has an outstanding track record in safeguarding the standards of undergraduate medical education and stimulating curriculum reform. This success has been recognised internationally."

Sir Liam is proposing transferring these roles to the newly established Postgraduate Medical Education and Training Board. "This will enable the approach to curriculums, standards and inspection in medical education from undergraduate through to postgraduate to be addressed more seamlessly than at present," says his report, Good Doctors, Safer Patients.

Dr Petty-Saphon said: "The training board is a fledgling organisation that is only just getting to grips with major reform of specialty training. It simply lacks the experience and infrastructure to take on regulating undergraduate education, a task the GMC does extremely well."

Medical schools are calling for the role of the GMC to be extended to cover postgraduate training, rather than see a transfer in the other direction. While many of the reforms were widely anticipated, the decision to remove undergraduate education from the GMC took medics by surprise. Sir Graeme Catto, president of the GMC, said: "We had no idea this was on the cards. I have asked Sir Liam if he was dissatisfied in any way with our work and he said 'no'." But what he wrote in his report is in public domain and it makes sense! (Kindly read ‘archive’ on “GMC and medical education (‘Meducation’)” below).

Dr Petty-Saphon added: "The proposed transfer would erode the essential autonomy provided by the current reporting structure." Under the proposals, the GMC will report to Parliament, whereas the board reports to the Department of Health.

The board was set up last year to oversee postgraduate medical education, including the second year of the foundation programme that all medical students undertake in hospitals.

The British Medical Association was also concerned about the proposals, which are out for consultation until November 2006.

Archive on “GMC and medical education (‘Meducation’)”:

Further to the news item in 18th May 2006 issue of Hospital Doctor [‘GMC to advise on ‘student-FTP (Fitness-to-Practise)’] here are , some common-sense observations on GMC’s bungling of medical education in particular & medical regulation in general.

1. Student FTP is a silly misnomer. As everybody except the arrogant clerks at GMC would understand, one doesn’t get ‘license to practise’ until after passing their basic medical qualification examination MB BS or MB ChB, etc., and naturally isn’t fit to practise’ as a medical student. A qualified doctor gets ‘full registration’ only after completion of a year’s supervised practise as PRHO [nowF1]

2. Fitness-to-learn’ (FTL), perhaps? If the GMC (clerks or Catto) meant ‘fitness-to-learn’ (FTL) then this must be the most crackpot concept by GMC to date! Ivory-tower-vultures are wrong again as assessing prospective ‘wannabe’ doctors’ ‘fitness to learn’ is the remit of the universities at the admission stage through UCAS and GMC rightly should have no say in it.

3.Medical Curriculum and educational standards: But of course, under the Medical ‘Act’ the GMC was responsible to set medical curriculum, to supervise and maintain standards of medical education (‘Meducation’) in UK. GMC’s greedy fiasco of exporting PLAB to the third-world over past 10 years resulted in draining young medics from these countries and effectively putting them out of circulation and out of pocket. The GMC were filling their coffers in the style of the colonialist 21st Century East India Company! Sir Liam must be right and seamless regulation of all stages of medical education by one single body makes obvious sense.

4. Back to GMC’s brain-storm of ‘student-FTP’. Students qualify to enter medical schools on their academic grades, then they are like a lump-of-clay in the Meducators’ hands! If the universities couldn’t impart that education to adequate standard, it can be the fault of the system, not the individual and the buck would stop with the University-schools, or again the GMC. It can not be the fault of a student’s ‘fitness to practise’… “studying”; precisely.

5. Even thinking of “judging on any medical student’s fitness-to-practise” is preposterous; and can be compared to diagnosing a newborn baby with ‘feco-urinary (stool-urine) incontinence’, ‘learning disability’, ‘autism’, ‘dyslexia’, ‘ADHD’, etc.’ all at once and then declaring it "unfit to become an adult" in its bare infancy!

We have stalwarts like Count Peter Rubin as the then Chairman of GMC’s Education Committee who mistakes ‘campus-conduct and disciplinary procedures’ as the impossible “medical schools’ current FTP proceedings” for students. Who can blame the GMC clerks for their incompetence?

Perhaps Prof Rubin needs a Frankenstein designed 440 volt to make him understand that a ‘yet-to-be-licensed-to-practise’ medical student can not be ‘danger to public’ any more than any other uni-student ‘trashing the student-bar’!

Mr Irfan Halim was stating the obvious that GMC is unfit for the purpose (see attachment Dame Janet Smith’s lecture before RSM in May 2005, published 2006). There is over 23 years of catalogue of blunders and gaffes in opaque, inconsistent and patently incompetent medical regulation by the GMC since the Medical Act of 1983; to cap with the recent indictment of Prof James Drife, a GMC member, medical screener & Catto’s rival who was found guilty of ‘serious professional misconduct’ of being directly instrumental to Richard Neale’s spate of maiming mayhem up and down England for 14 years.

What did GMC do to Prof James Owen Drife, who gave 2 references to Richard Neale [even without knowing him professionally] and 'screened out' a complaint about the same Neale while sitting as medical screener on the GMC!

Nothing much! They just ousted him from the GMC [to Catto’s relief] which stopped him ‘being a medical screener’! “Protecting patients, or protecting Drife-Neale?”

It goes to prove that subjective professional regulation by the GMC (GentleMen’s Club) in UK-NHS has been strategically protective of the GMC, for the GMC (GentleMen’s Club): people in grey suits with English birth, who fit into the club; including people like Shipman, Neale, Ledward, Kerr, Haslam, Drife, etc.

Time and again, the GMC has failed public and doctors alike. Most of GMC’s significant decisions are overturned by High Court on referral by CHRE, or on appeal; trampling the doctor under multiple jeopardy in the process, funded by doctors alone!

The Shipman Inquiry has found GMC unfit for the purpose of medical regulation [as well as revalidation] and recommended that this should be conducted by ‘anybody but GMC’. Dame Janet Smith has recommended that GMC should be removed from the FTP function which is unconstitutional by its nature, as it breaches doctors’ Human Rights.

This is because the GMC has all 4 functions converged into one body.

These are

(1) the legislative (“Rules on Good Medical Practice”),
(2) the administrative (conducting investigations on doctors in response to complaints from public, NHS-employers and other bodies ---but not from other doctors of junior grade and/or or alien-origin!),
(3) the judicial (subjecting doctors to inquiries on their professional conduct or performance and making findings of ‘serious professional misconduct’-SPM or ‘seriously deficient performance’-SDP; both without any objective definitions or thresholds) and
(4) the executive (suspension or erasure of the doctors from the medical register). In other words, GMC is the kangaroo-court of ‘MP-police- jury- judge-executioner all rolled in one’. This is just like how Saddam Hussain’s rule was in Iraq.

If a shop or a business provided substandard service, consumers could complain to the Trading Standards. With the GMC, they are vastly incompetent but there is no recourse in the law to the wronged. This state of affairs is untenable. The best way forward to end this ‘double jeopardy’ against doctors seems to be by ‘removing the incompetent body GMC --the ‘weakest link’-- from the process of medical regulation. GMC should be abolished.An organisation who cannot get its own house in order is in no position to judge medical students.

As Prof Richard Baker once put it, ‘a fantastic opportunity for the government to make medical regulation more accountable to public’.

All ‘complaints against doctors’ should be processed by CHRE and heard by court judges, so that fairness and transparency are maintained and doctors victimised wrongly could obtain due redress for malicious or unsustained complaints. This could also mean that 100 good testimonials would (as they should) be considered in ruling on an honest mistake or a clinical error, and findings of SPM could be considered ‘spent’ after, say - 5 years.

This would also diffuse the “blame culture” prevalent in medical practice [which could never be entirely free of a certain small amount of unaccountable risk].

Samar Singh