Dr Phil Hammond, broadcaster and GP returner in Bristol

Are you unfit to practise? In a helpful interview with the Guardian newspaper, retired GP and former GMC president Sir Donald Irvine estimated that 11 000 of us out there may be. Alas, he failed to cite the evidence upon which this conclusion is based, other than it’s the bottom 5% of the 230 000 registered doctors.

Still, it could have been worse. In 2001, Chief Medical Officer Sir Liam Donaldson reckoned incompetence could run at 6% whereas the RCGP has put the figure as high as 15%.

Interestingly, the GMC also reckons that 5% of us are addicted to alcohol or other drugs, so maybe that’s where all the incompetents are hiding. Or maybe not, since no one has managed to find evidence of a strong link between addiction among doctors and harm to patients.

All this introspection and bad press was prompted by the fifth report of the Shipman Inquiry. According to BMA News, the actions of the bearded one will reverberate across the entire profession for decades.

Or will they? Far be it from me to question such an august organ but I’m not feeling too much aftershock. True, Dame Janet Smith’s latest report was a touch excoriating, but it didn’t tell us anything we didn’t already know about the GMC.

In 1992, I was the first to expose the Bristol heart scandal. OK, it was under a pseudonym in Private Eye, but I banged on about it for a good few months and called for heart surgeons to have their work independently audited, risk stratified and published.

Some 9 years later, a public inquiry, the profession and the Government all agreed, but to this day it hasn’t happened. Why not? Because, like any other chronically underfunded organisation, the NHS has for years turned a blind eye to absurdly dodgy and dangerous working practices, and we’ve all got far too much dirty linen to wash in public.

Remember those 120-hour weeks as a junior doctor, doing complex procedures for the first time with no senior support in the hospital? Or how about flushing a drip through with potassium because it came in a bottle identical to the one containing saline?

Or covering for the senior consultant with the black eyes who kept “falling over in the potting shed” after his daily bottle of whisky? We all bear scars like this, which is why it’s so hard for any of us to blow the whistle now.

And the brave few who do blow the whistle wonder if it’s worth it. The Government claims to be interested in quality and safety, but the real priorities are targets, throughput and balancing the books.

If we spent 30% of our time in training, like airline pilots or the armed forces, we could surely devise a plan for revalidation that was meaningful and helped protect patients. But it’s all done on the cheap and on the hoof, and we all know it’s just a tick box exercise.

The bottom line for doctors is “would you know if you, or a colleague, were incompetent?” and “would you do anything about it?” Most GPs never observe their colleagues consulting or question their judgement, aside from the odd raised eyebrow in the critical incident meeting.

The best people to regulate doctors are other doctors, but not those with a vested interest in the outcome. Why can’t we have an independent, doctor-led inspectorate in every region investigating complaints swiftly and acting constructively and fairly?

Guidelines in Practice, February 2005, Volume 8(2)
© 2005 MGP Ltd
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