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It is difficult to be dispassionate when one is personally involved in a profound disagreement. But responses to my Personal View in the BMJ1 last September have shown that I am speaking for many. Since I wrote that article, matters have moved on and decisions have been taken. At a well attended meeting of the Retired Fellows Society of The Royal Society of Medicine on 4 October, we got these from the horse's mouth—the Head of the Division of Policy and Regulation at the General Medical Council, Mr David Skinner.
The GMC originally gave the impression that we could all be revalidated if we chose: ‘All doctors in medical practice will be permitted to participate in revalidation’2. I for one did not realize that I was not in medical practice just because I was no longer working in the National Health Service (NHS). However, at the RSM meeting Mr Skinner was quite specific that retired doctors would not be eligible for revalidation, except for a few still engaged in medical policy and development whose expertise depended on their being medically qualified, such as members of NICE or CHI.
The GMC bases its stance on the premise that the retired will not be able to demonstrate that they are keeping up to date and cannot, therefore, be allowed to prescribe even for themselves and close family. But why not, pray—at least in respect of how we actually intend to practise? The main reason was stated in a reply by Mr Skinner to an MP (a copy of which I have seen) to the effect that the retired could not be allowed to prescribe for themselves because if they could do so there would be no way of stopping them from prescribing for friends, and where might that end?
However, the GMC does not seem to consider this a problem with revalidated hospital consultants. An orthopaedic surgeon will be able to prescribe privately for a headache, a dermatologist for indigestion or an ophthalmic surgeon for an acute attack of gout, although their revalidation will be quite irrelevant to such practices.
The GMC response is that they would then be practising outside their sphere of competence and thus running the risk of being disciplined by the GMC ‘if anything went wrong’. This is pure sophistry. No doctor, I suggest, could be disciplined for prescribing 10 mg of nitrazepam privately to anyone. The same applies to a wide range of well-established and accepted therapy with drugs which are not ‘over-the-counter’ but not ‘controlled’. There is a great gulf between advising one group of doctors not to do something on ethical grounds and preventing another group from doing the same thing by legislation. The GMC should be focused on the action—is it safe or is it not?—not on who performs the action.
As to that, I have news for those who assert that doctors should not prescribe for themselves or their families. Whilst very few admit to doing so as a regular practice, when it comes to the unexpected minor illness it is regarded as one of the significant ‘perks’ of being a doctor. My BMJ article generated letters and website responses from many respected men and women who admit to the practice. If the GMC really believes it so dangerous, it should also take steps to prevent hospital consultants from prescribing outside hospital. Why have they not proposed this? Even to ask the question is to invite ridicule. They would never survive the resulting uproar. The real reason for preventing retired doctors from offering themselves for revalidation was also disarmingly admitted by Mr Skinner in answer to this very question at the RSM meeting. The matter was considered, he said, but it was thought too difficult and complex.
Retired doctors in the UK are to be treated like no others in the civilized world because the GMC cannot work out how to give them equality with younger colleagues. And yet the problem of revalidating the retired is not beyond solution. If revalidation within a specialism does not cover the private actions of hospital doctors the GMC must be relying on their ethical behaviour and good sense; and revalidation of these attributes must entail methods unrelated to their specialist knowledge. Therefore this part of the process can also be applied to those not offering a specialism. If not, the GMC is saying that the senior members of the profession uniquely cannot be trusted to exhibit adequate ethical standards.
However, control (which, after all, is the GMC's historic focus) can be exercised in practice, and is exercised in France. There, retired doctors agree to give up the practice of medicine as a condition of drawing their equivalent of the NHS pension. However, they are allowed to continue to prescribe for themselves and their families. The machinery for checking on their good faith exists (even if it may not be regularly used) because all doctors have a unique number that must appear on all their prescriptions. Computerization ensures that the identity of all prescribers can be matched against all drug recipients. This suggests that the GMC is not the right body to be trying to manage this revolution.
In answer to another question, Mr Skinner could not recall a single incident in which a retired practitioner fell foul of the GMC for prescribing for himself or his family. So to deal with a non-problem in a way which is the merest expedient, the GMC propose to treat the senior members of an honorable profession in a uniquely punitive fashion. I understand that it is the lay members of the GMC who are particularly keen on this proposal and the majority (i.e. the doctors, very few of whom are themselves retired) who feel unable to make a good case against, despite having logic on their side. A case for the status quo can, of course, be made: it is not powerful, but retired doctors issue private prescriptions, saving the NHS money and its active workforce unnecessary work. But, I submit, it is not necessary for there to be ‘a case’. The proposed action is unnecessary as well as discriminatory and unfair. The retired should at least be given the chance to demonstrate their competence ‘in their chosen field’.
Before you turn the page to something that seems more relevant, remember that, even if you are not retired, you will be one day. At present, there are some 20 000 of us. If you are in hospital practice the logic of this decision may put you in a similar position before then. Implementation of the GMC's proposal will require primary legislation. It would help the case if some influential doctors in current medical practice lobbied their MP or any medical peer and spoke out against this feeble cop-out of responsibility by our medical representatives on the GMC.