Risk-based regulation and reforms to fitness to practise tribunals in the United Kingdom: Serving the public interest?

Abstract

In this paper, I outline recent policy reforms to the General Medical Council (GMC) and how these are designed to promote greater public confidence in its management of the patient complaint and fitness to practise tribunal process. I explore how in spite of a decade of reform, potential for bias remains in relation to how issues of race and ethnicity, disability, age, class, gender and English language proficiency intersect with complaint making and case progression. I draw on reviews of and data from the GMC to examine the key issues surrounding the representativeness of the medical tribunal process, in terms of members’ age, gender and race and ethnicity. I note that, as in other high-income countries, there is a tendency within the United Kingdom (UK) for the risk-focused regulatory system to focus its reforming agenda on the more effective performance management of cost and risk, rather than on inculcating a more diverse patient presence and biographical profile within the day-to-day operation of regulatory regimes. I argue that this might unintentionally lead to the promotion of an optimism bias within risk-focused regulatory systems, potentially leading to a failure to communicate realistic perceptions of medical risk to patients and their families, and in doing so perhaps serving to further exacerbate the situation when instances of medical error and negligence occur. I conclude that current regulatory reforms in the UK are unlikely as a result to as fully promote the public interest and patient safety as they intend.