Select Committee on Health Written Evidence


Memorandum by the General Medical Council (PI 43)


  The objective of the GMC is to protect, promote and maintain the health and safety of the public.

  We do this by the exercise of our functions in:

    (a)  Establishing standards of good medical practice, which reflect what   society, and the profession, expect of doctors.

    (b)  Assuring the quality of basic medical education in the UK and co-ordinating all stages of medical education.

    (c)  Setting and administering fair systems for entry to and remaining on the medical register.

    (d)  Dealing firmly and fairly with doctors whose fitness to practise is questioned. The "fitness to practise" procedures are the legal processes which the GMC applies to cases where a doctor's continued right to registration is called into question because of alleged serious deficiencies in their fitness to practise, that is, their conduct, health or performance.

  The GMC was established under the Medical Act 1858. The GMC's duties and powers continue to be conferred and regulated by primary and secondary legislation. The current powers derive from the Medical Act 1983, as amended.

  The GMC is committed to promoting equality and valuing diversity and to operating processes and procedures that are fair, objective, transparent and free from discrimination.

  In June 2001 the Charity Commission announced that it had decided on 2 April 2001 to recognise the GMC's charitable status. On 9 November 2001 the GMC was formally registered as a charity.


  The GMC does not regulate the pharmaceutical industry and has not researched, or developed a corporate policy on, the industry's impact on medical practice.

  Our guidance on professional standards covers both the therapeutic use of medicines and medical research. We give general guidance in our core booklet Good Medical Practice and more specific advice in Research: the role and responsibilities of doctors. Copies of both booklets are enclosed.

  Good Medical Practice establishes the principles which should underpin all doctors' professional work. This includes putting patients' interests first, including when prescribing, keeping up to date, and reporting any adverse drug reaction. (See paragraphs 3 and 10-11). Good Medical Practice also warns doctors against involvement in any relationships with pharmaceutical or other companies which could raise, or be seen to raise, a conflict of interests (see paragraph 55). This is intended to cover matters such as accepting hospitality or gifts from pharmaceutical companies, other than those which are trivial. Our guidance does not, of course, operate in isolation, but is just part of the regulation of this area of practice. The Medicines (Advertising) Regulations 1994 and the Code of Practice issued to the pharmaceutical industry provide further controls over the hospitality or gifts which may be offered to doctors by pharmaceutical companies.

  Good Medical Practice also makes clear that doctors must be honest and open about any financial or commercial interests they have in pharmaceutical companies and ensure that those interests do not affect their independent judgement in providing and arranging patient care (paragraphs 56-57).

  We give more detailed guidance on how the principles established in Good Medical Practice apply in research in our booklet Research: the role and responsibilities of doctors. You may be interested to note in particular the statement of principles set out in paragraph 5 of the booklet, and the paragraph on conflicts of interest in paragraph 13.

  The booklet also emphasises the need for openness and honesty in all financial and commercial matters, and in particular the obligation to make clear to research ethics committees, and participants in research, how research is funded and the fees or other payment or rewards to be made to researchers.

  It is unusual for the GMC to receive complaints about doctors asking for or accepting inappropriate fees or hospitality from pharmaceutical companies. However, cases relating to the honesty of doctors involved in clinical drugs trials are more frequent, and many lead to the doctor being struck off, or suspended from the register. Such cases often involve doctors inventing patients and data relating to their care, or involving "real" patients in clinical trials without consent. Our concerns are with these actions in themselves and with their effect on research data available to other practitioners, rather than whether, for example, the methods of payment for such work, have an influence on, or affect, doctors' conduct.

  Alongside its role in setting standards for medical practice, the GMC issues guidance and sets outcomes for medical education and training. We ensure that the outcomes are met through our programme of Quality Assurance of Basic Medical Education which includes visits to medical schools. Tomorrow's Doctors sets out the competencies required for graduation and admission to the provisional register. We have been revising our guidance on the Pre-Registration House Officer year that follows graduation and aim to publish a new edition of The New Doctor later this year. This will set out the competencies required to complete PRHO training and achieve full registration. We have recently published new guidance on Continuing Professional Development, which is often funded by the pharmaceutical industry. Our website includes a list of organisations that can help doctors to undertake appropriate CPD. Throughout our educational guidance we stress the importance of clinical competence alongside probity and patient-centredness in medical practice and research.

  Some doctors do fail to maintain the standards that we expect. We work closely with the NHS and the National Clinical Assessment Authority, and with other organisations, to ensure that problems are dealt with at the appropriate level in the best interests of patients. Where necessary we can take action on doctors' registration. We summarise the results of fitness to practise cases in GMC News, which is distributed to all doctors on the medical register. Our fitness to practise work contributes to the environment in which we develop our guidance on standards of medical practice and the outcomes required of those undertaking medical education and training.

  While acting within our statutory role and functions, we can therefore promote medical practice which puts patients first and is not compromised by external pressures or financial incentives.

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