Quis custodiet ipsos custodes?

“Who shall guard the guards?” —Juvenal, Satires

The Witch Doctor, in her excellent blog, often refers to the concept of “creep” – a form of social engineering by stealth.

The obersturmführers and apparatchiks of the Party know that radical change will meet resistance. So, to effect the change they desire, they adopt a stealth approach. Changes are small and incremental. Boundaries are nudged. And – every now and then – a stiletto flashes in a quiet corner to silence the lone dissenter.

Because the individual changes are small, and the knifings done quietly, few notice. But the changes are not happening in isolation: they are incremental and, taken together, effect great change.

This is exactly what is happening with the General Medical Council. Over the last few years they have:

• removed elected members from the Council. All members are now appointed by an organisation – the Appointments Commission - that is directly accountable to the DoH
• introduced the Interim Orders Panel: a panel that can order a doctor be immediately suspended or constructively suspended (by the imposition of work blocking sanctions) pending a full Fitness to Practice hearing. The IOP sits in private, and accepts flimsy evidence. At any one time some three to four hundred doctors will be subject to such an order (388 in December 2008)
• extended their remit to cover medical students. Gone are the care-free days of medical student fun: nowadays even students have to be fit to practice
• lowered the standard of proof in Fitness to Practice hearings from the criminal standard (“beyond reasonable doubt”) to the civil standard (“on the balance of probabilities”)

and over next few years they will:

• introduce revalidation: a regulatory approach that assumes incompetence until proved otherwise. All doctors will need to be revalidated if they are to practice
• introduce a network of local apparatchiks and spies to monitor individual doctors (the so-called “responsible officers” and “GMC affiliates”)
• take over the functions PMETB (Postgraduate Medical Education and Training Board), which oversees junior doctors’ training and controls entry on to the specialist registers.

Taken together, these changes in medical regulation are draconian. They invade every aspect of a doctor's life, from the first day at medical school to his or her last breath. They trample on concepts of decency, fairness and trust. They are untried, unwanted and unnecessary. In the process of adopting these changes, the GMC has become less accountable, more opaque and less just in its dealings with the profession.

And so the question arises: who shall guard the guards? It is the people, of course, and in the case of the medical profession that means the profession at large. For, as Burke is said to have said, all that is necessary for the triumph of evil is that good men do nothing.