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Ethics briefings
  1. Veronica English,
  2. Danielle Hamm,
  3. Caroline Harrison,
  4. Julian Sheather,
  5. Ann Sommerville
  1. BMA Ethics Department;

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    Medical governance and the General Medical Council

    Good doctors, safer patients, the report of the Chief Medical Officer on medical regulation in the UK, was published by the Department of Health in July 2006, having stemmed from Dane Janet Smith’s inquiry into the Shipman murders. The report offers 44 recommendations for the future of medical regulation in the UK, which, if implemented, will constitute a radical change in structure and function of the General Medical Council (GMC).

    The first recommendation proposes that in the adjudication of concerns about a doctor’s performance, health or conduct, the standard of proof should be the civil standard “on balance of probability” rather than the traditional criminal standard “beyond reasonable doubt”. This will reduce the number of cases where a doctor is not deemed “bad enough” to enter formal GMC procedures but is still considered to be a cause of serious concern to colleagues or patients.1

    While welcoming some aspects of the report, the British Medical Association (BMA) has expressed concerns about this recommendation, and has argued that lowering the burden of proof in this way opens the door to potential miscarriages of justice. If implemented, the recommendation will have implications for the status and interpretation of the GMC’s good practice guidance, which sets out the standards by which doctors must abide.


    The revised version of the GMC’s guidance on good medical practice was published in November 2006. The revision process started in 2004 and involved informal consultation with key stakeholders, a formal public consultation, a series of public meetings across the UK, and research on patient, public and professional views on the key issues underlying the guidance. One of the main debating points during the revision was the use of the words “must” and “should” to differentiate standards that are obligatory and those where some personal judgement may be …

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