Introduction: The General Medical Council (GMC) regulates British doctors through the Medical Act. The Council comprises doctors (who predominate) and laypeople. It registers doctors for UK practice, sets professional standards, regulates basic medical education, and manages doctors' fitness to practise. The GMC sits uneasily at the interface between the medical profession, the public, Parliament and the National Health Service. Herein lie the seeds of inertia and conflict.
A traditional regulator: The early GMC mainly managed serious complaints against doctors. Reactive, passive and distant from doctors, it was reconstituted in 1979 after it lost their confidence. At this point the public became increasingly impatient with the GMC because it appeared to be too protective of doctors and unwilling to tackle poor practice. When it did respond, its actions were perceived as too little, too late. Public pressure accelerated radical change following the 1990s crisis in paediatric cardiac surgery at Bristol Royal Infirmary.
New professionalism: In the 1990s, the GMC itself set a new direction. There was more public involvement. A statement of professional standards -Good Medical Practice- was agreed between profession and public. The standards are tied to licensure, medical education and workplace clinical governance, and are to be observed by all doctors. The biggest change is the plan to evaluate doctors' practice regularly through revalidation in the form of relicensure.
Conclusion: All patients are entitled to a good doctor. The challenge to the profession and the GMC is to ensure they fulfil this entitlement by implementing professional regulation effectively.