Restratification and the Hearing of Fitness to Practice Cases

Abstract

This chapter continues the exploration of recent developments in the regulation of the medical profession through the lens of the restratification thesis. As has been discussed in previous chapters, over the last two decades, medical regulation has had to change to become more open and accountable as health-care systems worldwide seek to better performance manage medical work. While at the same time, elite elements of the medical profession are themselves increasingly seeking to performance manage rank-and-file practitioner’s activities as they respond to calls for increased regulatory transparency and accountability. In short, the restratification thesis argues that the medical profession is increasingly dividing into elite and rank-and-file segments as challenges to medical autonomy and self-regulatory privileges play out, and furthermore, medical elites are increasingly exploiting the specialist ‘buffer zone’ provided by their esoteric expertise as they seek to maintain some semblance of medical autonomy through subjecting rank-and-file doctors to greater peer surveillance and control mechanisms. Revalidation is arguably the latest example of this approach. But so are reforms to the hearing of fitness to practice cases. This chapter outlines contemporary developments in the complaint process as well as examines the latest statistical data pertaining to fitness to practice hearings. It highlights how the number of complaints has quadrupled in the last 15 years as well as how it appears that the GMC is adopting a more rigorous and punitive stance towards doctors accused of poor performance and/or unethical behaviour. The chapter also notes that male practitioners are more likely to receive a complaint than female practitioners (although this seems to be changing as more women join the profession). Additionally, older doctors and doctors who qualified outside of the UK are also more likely to come before the GMC fitness to practice panels. In outlining such matters, the chapter discusses how far recent developments in the handling of complaints provide empirical support for the restratification thesis. End-of-chapter self-study tasks are provided so the reader can engage in further study in relation to chapter contents.