Where we started from
Antibiotics were decades from discovery and the NHS a distant dream when we formed in 1858.
Before we were formed under the Medical Act, there were 19 bodies regulating the UK medical profession. And all these bodies used different tests for competence. Even the Archbishop of Canterbury had a right to issue a licence to practise. Well, in theory anyway.
1841 Census estimates suggest a third of all doctors in England were unqualified. And back then professional titles were usually local. This meant a doctor from Glasgow may not be able to practise elsewhere. In short, there was no single way of saying who was a doctor in the UK (including Ireland at that time) and who was not. That's where we came in.
We were established as the General Council of Medical Education and Registration of the United Kingdom. It was our role to take charge of registration and medical education across the UK as well as the publication of a pharmacopoeia. This would list available drugs and directions for use.
Putting together the first medical register was no easy feat. Thousands scrambled to apply in the last days of 1858, delaying publication by six months.
Richard Organ was the first doctor to be removed from the register for being unqualified in 1860.
In 1899, the council held its first hearing with a doctor facing a conviction for ‘drunkenness’.
An evolving model of regulation
Our original Council – our governing body – had 24 members. And all but six of them were from the royal colleges and universities.
The Right Honourable Edward Hilton Young, DSO, DSC, was the first non-medical member of our Council. He was appointed by the king as a Crown member (as many members were in years gone by).
Suffragette Christine Murrell was our Council’s first female member in 1933. She sadly died before she could take an active role. Our next female member would be Dame Hilda Nora Lloyd. She was nominated by the Royal College of Obstetrics and Gynaecology in 1950.
During this period of our history, we were the guardian of self-regulation. This was a model that allowed doctors to decide what was best for patients. We would exercise our disciplinary powers in cases of criminal behaviour or poor professional conduct.
A lot has changed since we were founded. But the biggest reforms would occur from the 1970s.
The results of an inquiry commissioned by the UK government in 1972 led to a raft of changes for us.
The Merrison Committee’s report recommended a restructure of the disciplinary process including procedures for doctors with serious mental or other ill health the development of specialist and GP registration, a new committee to coordinate all stages of medical education and that the majority of the council’s members be professionally elected.
These changes were enshrined in a new Medical Act in 1978.
In 1995 we published the first edition of Good medical practice. This was the first positive statement about the standards of care patients should expect and doctors should work towards.
At the turn of the millennium we faced criticism for not striking off more doctors. This came after hearings about serious failings at Bristol Royal Infirmary and the Harold Shipman case.
The public inquiries into Bristol and Shipman were watershed moments for us. They catalysed dramatic reforms to redirect our focus on patient safety
Self-regulation was replaced with professional regulation. We would hold doctors to one set of standards which underpin periodic revalidation. We also became responsible for all stages of medical education and practice. This would cover from entry to medical school to retirement.
2003 saw our biggest reform since being established, when membership of our Council reduced from 104 members to 35 and the proportion of lay members rose to 40%. (It's now 50% lay, with six lay and six registrant members.) We would also see the election of medical members by the profession replaced with appointment by the Privy Council.
In 2012, we introduced revalidation. This makes sure doctors reflect on and improve their practice throughout their careers.
In 2013, we published the current version of Good medical practice.
We're now adopting a more proactive approach to regulation. And we're reducing fitness to practise investigations and building more supportive programmes.
While so much in medicine and society has changed since 1858, our purpose would still be recognisable to one of our founding members. We protect the public by ensuring good standards of medical education and practice. Or as we said it back then, so that ‘Persons requiring medical aid should be enabled to distinguish qualified from unqualified practitioners’.