Commentary

UK medicine: what are we to do?

The new professionalism evolving in UK medicine is fundamentally different from the past. Founded on the General Medical Council's (GMC) Good Medical Practice, the new professionalism is an explicit statement of professional duties, responsibilities, values, and standards for doctors, developed and agreed on by the public and the profession. Compliance is being secured by embedding the culture of Good Medical Practice into medical education and by linking it directly with medical registration (licensure). From 2004 doctors will have their abilities assessed regularly by peers and by members of the public to ensure that they remain up-to-date and fit to practise medicine. Disciplinary action will follow if they are not. To ensure patient safety, the new professionalism requires professional leadership with great public input to medical regulation, a modern GMC, and a closer fit between the licensure of doctors and the quality assurance of the organisations in which they work.

The recent politicization of medical regulation in the United Kingdom has destabilized the historic relationship between medicine, society and the state. The purpose of this article is to present a political analysis of that relationship and its likely future by identifying the essential elements of power which determine its composition and its capacity to change. That analysis is in three parts. First, it identifies the underlying political tensions in the relationship between medicine, society and the state and the implications of those tensions for any proposed settlement on the future of medical regulation. What are the political criteria by which such a settlement must be judged if the tensions are to be resolved? Secondly, it explores the ideological conflict concerning the nature of medical regulation between the major players, the expression of that conflict in their use of quite different discourses, and the incompatibility of the power assumptions contained therein. Thirdly, it examines the medical profession’s particular response to the pressures for change. Finally, the article reflects on the necessary dialogue which must take place between medicine, society and the state before a lasting resolution of the present tensions can be achieved.