Patients will be at greater risk of poor treatment if proposals to change the regulation of doctors are approved, the British Medical Association was told yesterday.

After a passionate debate, the BMA put itself on a collision course with the Government by rejecting its proposals for changes to the General Medical Council – and threatening to withhold subscriptions to the GMC if its demands are not met.

The BMA conference passed two motions condemning changes to the make-up of the GMC and the standards of proof required in fitness-to-practice cases, both inspired by reports written by Sir Liam Donaldson, the Chief Medical Officer. If adopted, the changes would eliminate the medical majority on the GMC, which the BMA asserts will mean the end of professional self-regulation, and will alter the scale of proof required in GMC investigations, with the most serious cases requiring “beyond reasonable doubt” and more minor ones being decided on the civil standard of the balance of probabilities.

Doctors who spoke in the debate argued that the whole profession was being blamed for the sins of a murderer, Harold Shipman, who happened to be a doctor. “I have been appalled, incensed and disgusted that the profession has taken this lying down,” said Ian Jessiman, from Bromley, southeast London, in the debate about the composition of the GMC. “We should have risen as one and said we won’t have it. We have been bamboozled into impotence, but it hasn’t taken a lot of bamboozling,” he said, accusing the GMC of having rolled over, the royal colleges of trying to ignore the issue, and the BMA of being slow to act.

BMA officeholders denied the charge of inaction while agreeing with Dr Jessiman’s sentiments. Hamish Meldrum, chairman of the BMA GPs’ committee, said that, far from simply regretting the proposal, as the resolution read, he had been “appalled, shocked, horror-struck and aghast” at it.

And Lawrence Buckman, who is responsible for the BMA’s relations with the GMC, said that the BMA had been consistent and determined in opposing the proposals. “We’ve said no from the very beginning,” he said.

Dr Buckman added that changes to the burden of proof would put doctors under such threat that they would become more conservative in their treatments. “They [doctors] would order more tests, and adopt more risk-averse behaviour. “That is going to cost more, and put patients through things simply in order to protect doctors,” he said.

The GMC argues – most recently in a letter from its President, Sir Graeme Catto in yesterday’s Times – that a sliding scale will be used, with cases likely to involve striking off still requiring criminal standards of proof. But his argument did not impress the BMA. Both Dr Buckman and Sam Everingham, acting chairman, argued that a scale that could change during a hearing, as evidence emerged, was absolutely unfair.

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