Prescribing rights and retired doctors

The GMC has made it clear in a communication to this Society that it has decided to withdraw prescribing rights from, by definition the most experienced, albeit retired, registered medical practitioners even for themselves, their families and friends, with effect from January 2005. There is no precedent for such proposed interdict as far as we are aware in the annals of the GMC's history. Neither are we aware of any evidence base suggesting harmful or irresponsible prescribing from this considerable group of practitioners and wonder if this issue has been driven by blunderbuss CPD/revalidation considerations. The latter in turn appears to have been generated by political pressure and the previous GMC president's repeated yet mistaken belief that the wider public has, since Bristol (primarily an NHS systems failure) and Shipman (a uniquely evil individual amongst the current and historic corpus of medical practitioners), lost confidence in the profession. Public survey after survey has continued to show the contrary.

Recently there appears to be a reluctance to mention 'self regulation' of the profession. Are we, as registered medical practitioners, now self regulated or not?  Forgive our confusion.  When Sir Graeme Catto was asked in an interview last February about doctors possibly exchanging self regulation for regulation by government and thereby saving money, he answered "whosoever regulates doctors will charge them.  We prefer to talk about professionally led (our italics) regulation in partnership with the public".  Isn't self regulation the spade we have had since 1858. Even then government regulation for control of medical standards was still unacceptable to the average citizen.

Sir Graeme indeed reminds us that 'when independent regulation [of the medical profession] has been removed in other countries, patients have seen a fall in standards'. Quite so.  Concern here is that with already so much government diktat about how doctors should deliver services (various 'targets' are just one manifestation), patient care by doctors has been predictably undermined.  The way ahead, as defined by politicians seems likely to entrench further this trend.

We wonder who on earth any such proposal seeks to placate.  We cannot imagine its having emerged from any substantial group of doctors who have given serious thought to it.  What about prescribing rights of doctors in public health, those who are full-time advisers to, say, pharmaceutical and other public companies such as in the insurance industry; senior full-time office holders (doctors) of bodies such as the BMA, GMC, medical defence organisations; specialties such as radiology, pathology, forensic medicine. This list is surely not exhaustive. Yet with all those specialties prescribing has been a marginal, but responsibly exercised, benign function.

Remarkably, it has been during these recent times also, that there has been politically driven discussion of extending prescribing rights to some professions allied to medicine where education and training in basic sciences, in anatomy, physiology, pathology, pharmacology, diagnosis and therapeutics is not and has not been at all a comparable feature in their training. It has also seen the emergence of NHS Direct, a body of non-doctors, and therefore persons not trained in clinical examination and diagnosis, which dispense distance advice (telephone) on a wide variety of patient problems. The general public to are being encouraged to purchase OTCs  e.g. H2 blockers which up to recently were prescription-only medications.

It beggars belief that this proposal has somehow emanated from the governing body of what is still supposedly a self regulated medical profession funded via GMC subscription by its member practitioners. Any such move represents a potential breach, without provocation, of longstanding custom and practise.  There are related ageist and other infringement issues of natural justice and rules of evidence. Before proceeding further in any arbitrary withdrawal of prescribing rights for this considerable number of responsible doctors, albeit retired, (who thus incidentally reduce demand on already hard pressed family doctors' time), we would submit that all registered medical practitioners should be offered a vote on this issue.

Either we are self regulated or we are not.  It could be a foolishness for the profession to pay for government driven faux self regulation which devalues what practitioners do, whatever their specialty. The profession protests at each new turn-of-the-screw directive, which effectively erodes any remaining genuine self regulation. Voices warn that by doing so risks losing that self regulation which government strips away as it increases empowerment of its NHS managerial bureaucracy. Patients' and profession's greater risk lies in our failing to protest robustly in protecting proper self regulation.

If, as a profession, we still have any shred of real self regulation left we should roundly reject the GMC proposal related to retired doctors prescribing and insist on its repeal. If necessary the GMC should invite each registered medical practitioner to vote on the issue.

Dr Dermot J Ward  FRCPI FRCPsych

Deputy Chairman, Society of Clinical Psychiatrists.