GMC champions compassionate regulation amid calls for reform and trust-building

In a keynote speech at the International Association of Medical Regulatory Authorities (IAMRA) conference, Professor Dame Carrie MacEwen, Chair of the General Medical Council (GMC), outlined a vision for compassionate leadership in medical regulation. She emphasized the importance of trust, fairness, and reform in shaping the GMC’s role as a modern regulator. MacEwen acknowledged that regulation is often perceived as punitive or fear-inducing, particularly among doctors, and argued that fear undermines safety, transparency, and learning. She stressed that trust from both the public and the profession is essential to effective oversight.

Addressing misconceptions about the GMC’s fitness to practise procedures, MacEwen noted that most doctors never encounter these investigations. Of the 250 cases concluded by the Medical Practitioners Tribunal Service in 2023, only five involved clinical performance alone. Nearly 78 percent were related to misconduct, such as falsifying credentials or engaging in violent or sexually motivated behavior. While regulatory action is necessary in such cases, MacEwen highlighted the emotional toll and misinformation that often distort perceptions of the process.

The GMC continues to operate under the outdated 1983 Medical Act, which requires full assessment of every complaint, regardless of its likelihood to meet fitness to practise thresholds. With nearly 11,000 complaints annually, this legal rigidity has strained resources and prolonged investigations. The UK government has committed to legislative reform, which the GMC hopes will allow for more proportionate, timely, and compassionate responses.

MacEwen also addressed systemic inequities in referral patterns. Research from the GMC’s 2019 “Fair to Refer” report revealed that international medical graduates and ethnic minority doctors are disproportionately referred by employers, often without resulting in regulatory action. In response, the GMC has set a target to eliminate disproportionate referrals by 2026 and has expanded outreach efforts to encourage local resolution of concerns.

To reduce fear and foster respect, the GMC has revised its communication practices, removing dense legal language and adopting a more human tone. It has also created specialist teams to support vulnerable doctors and commissioned the British Medical Association to run an independent Doctor Support Service.

Recent GMC research shows that nearly 30 percent of UK doctors are struggling, with one in five at high risk of burnout. These conditions directly affect patient safety, with 40 percent of doctors reporting compromised care in 2024, up from 32 percent in 2019. The GMC is using this data to inform employers and policymakers, reinforcing its commitment to upstream regulation that supports doctors before issues escalate.

MacEwen concluded that the GMC’s mission is not only to enforce standards but to cultivate environments where doctors can thrive and patients can trust. Compassionate regulation, she argued, is not soft regulation—it is smart, fair, and essential to safer care.

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