As the NHS turns 75, MDU chief exec Dr Matthew Lee says that ending the injustices of the regulatory system would be a gift to doctors - and to the health service that depends on them.

An anniversary is a chance to reflect on the people and institutions we care about.

The NHS is 75 years old this July. Like many things that have become a fixture in our lives, it's easy to take it for granted unless we remind ourselves that before 1948, access to healthcare largely depended on a patient's wealth, rather than their need.

On behalf of everyone at the MDU, I want to congratulate the NHS on reaching this important milestone. Along with many of my colleagues, I'm proud to have worked for the NHS, and I know I'll have cause to be grateful for the skill and dedication of its staff during my lifetime. For our part, the MDU will continue to defend and speak up for healthcare professionals.

Recently, we have focused our energies on two aspects of regulation that loom large in the life of every doctor: the GMC's core ethical guidance and its fitness to practise process.

At the time of writing, the new edition of 'Good medical practice' is due very soon, and will set out the professional standards and values that doctors are expected to meet in the coming years.

This is much more than a dry theoretical exercise. A new survey of MDU members shows that 96% of the 600+ respondents had used 'Good medical practice' to deal with an ethical query in their career, and 62% found it helpful in setting standards expected of them. But if we want doctors to reach for the new guidance in the same way, it has to be relevant to their clinical practice as it is - not as we might all like it to be.

In my previous leader, I suggested that some of the wording in the GMC's draft version was potentially too onerous or impractical, and we raised these concerns in our response to the consultation.

For example, we asked the GMC to reconsider the following: "You must not abuse, discriminate against, bully, exploit, or harass anyone, or condone such behaviour by others [our emphasis]. This applies to all interactions, including on social media and networking sites." (para 6).

While we agree with the aim of supporting a support a safe and inclusive workplace culture, we thought the word 'condone' was too difficult to define, especially in the context of social media. If a doctor failed to call out a discriminatory reply to one of their social media posts by a fellow medic, would they be condoning it by implication? And in the real world, what if they were an FY1 who witnessed bullying behaviour by a senior doctor towards one of their peers, or if the victim didn't want to take action?

While the DfHSC continues to say GMC reform is a priority, its inaction speaks louder than words.

I'm pleased to say that the GMC has been receptive to feedback from the MDU (and others), and promised that the final text will better reflect the realities of practice. The word 'condone' is being omitted and there will be more guidance about the kinds of things doctors might do to support colleagues.

We know from our survey that some doctors are worried that major new guidance is being rolled out at a time when they are already under huge pressure. We hope these amends, among others, will help ensure the next edition of 'Good medical practice' meets the needs of its readership.

The GMC's willingness to listen is a positive development but there is another problem. Alleged failure to meet the standards in 'Good medical practice' might prompt a GMC investigation. However, the current fitness to practise process is outdated, stressful and takes far too long.

Proposals for a more proportionate, timely and fair system were set out in the government's consultation, 'Regulating healthcare professionals - protecting the public', along with a commitment to introduce the necessary legislation in 2022. This didn't happen, and we are rapidly running out of time ahead of a likely general election in 2024.

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Following the announcement that substantive reforms of the GMC would be delayed until 2024/25, the MDU marshalled representatives of doctors' trade unions and medical royal colleges to write to the Secretary of State, calling for the Government to keep its promises.

But while the DoHSC continues to say GMC reform is a priority, its inaction speaks louder than words. Introducing new measures to allow the GMC to regulate physician associates (PAs) and anaesthesia associates (AAs) is the right thing to do (with a few caveats, such as that the category of health concerns should be retained to safeguard vulnerable registrants). However, it also paves the way for two tier regulation - at least initially - with PAs and AAs benefiting from a more modern regulatory regime than that applied to all other registered healthcare professionals.

We believe it would be a relatively simple matter to replace 'anaesthesia associates and physician associates' with 'registrants' in a new order that could be swiftly put before parliament. Not only would this mean that everyone is treated with equal fairness, but it would be a more efficient use of the remaining parliamentary time and enable the government to meet its longstanding commitment to doctors.

I started by reflecting on the NHS's 75th birthday and its significance. We know that one of the intractable problems facing the NHS right now is an acute shortage of doctors and other clinical staff. Pay and conditions are major factors, but ending the injustices of the regulatory system would be one way for the government to show it values our doctors, as well as a gift for the health service that depends on them.

The MDU will be campaigning for this change in the coming months in the interests of members and I'd urge you to join us and make your voices heard. We will be sharing more details with you about how precisely you can do that.

This page was correct at publication on 10/07/2023. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.