Introduction

The regulation of the medical profession encompasses three interrelated activities:

• • the recognition of achievement of the required standard of education and training by potential doctors;

• • the maintenance of a register of qualified doctors;

• • the removal of doctors from such a register when issues of conduct or capability are found to be incompatible with continued registration.

While the public interest and the interests of the medical profession often coincide, such as in the case of the exclusion of unqualified persons from the register and the practice of medicine, there are times when the activity of regulation may be viewed as unduly lenient by the public or as too severe by the medical profession.

The current regulatory system in the United Kingdom (UK) has evolved over many years and its development has often been in response to crises in the confidence of either the public or elements of the medical profession. An understanding of the current system requires that its history is explored. It is evident that the General Medical Council (GMC), from its very beginnings, has attempted to achieve a balance in responding to concerns expressed by the public and those expressed by the profession. The relative sway of these sometime opposing forces has fluctuated with either being seen as the dominant influence at different times. For this reason, it is germane to consider a series of recent events and reports that have highlighted the expectations of the role of the GMC.

History

The ecclesiastical domination of many aspects of life in the Middle Ages that would be now regarded as secular extended to the recognition of physicians, the majority of whom were in holy orders. Ironically, the initial escape from religious control by the barber-surgeons can be traced to the 18th Canon of the Fourth Lateran Council in 1215, which banned clergy – including sub-deacons, deacons and priests – from being involved in the punitive shedding of blood and the practise of the art of surgery, which involves cauterising and making incisions (Fourth Lateran Council, 1215).

The surgeons proceeded to organise themselves through the guild system; the Barbers’ Company was founded in 1308 and formally recognised in 1376 and the Fellowship of Surgeons was established in 1365 (Colson and Ralley, 2015).