IT USED to be a defining mark of liberal-democratic societies that their professions were self-governing. Only totalitarian regimes stripped away that right, and in doing so lost more than they could gain.

But as healthcare has become a growing part of the Government’s obligation to its citizens, the balance has shifted. Self-regulation of doctors has come to seem too cosy an option, in which patients’ interests come a poor second, while a body elected by doctors rules on other doctors’ competence.

So defending the General Medical Council has become a lonely occupation, made all the harder by its often peculiar decisions and its inability to defend itself. Its comeuppance has followed the Shipman affair, in which it was guiltless. No system of professional regulation can stop a murdering doctor who has sufficient guile to conceal his activities. If anyone apart from Shipman was guilty, it was his employers, not the GMC.

Sir Liam Donaldson’s proposals tread a careful path between satisfying public anger over Shipman and preserving medicine as a profession, not just a public service. State registration and regulation of doctors would be a step too far: doing nothing was not an option. But the effect would be to turn the GMC into a policeman and a prosecution service. The key decision is to strike off a doctor, and this will become the job of a quasi-judicial tribunal appointed by the NHS.

True, the role of the GMC in nipping poor practice in the bud is strengthened by the idea of “GMC affiliates” — senior narks recruited from the profession to act as local eyes and ears. If doctors can be found to do this job it is a sensible suggestion, as is the proposal to lower the burden of proof in fitness-to-practise cases. But in the end Sir Liam is saying that the profession can no longer be trusted to pick out its bad apples without the help of the legal profession. Responsible as the GMC may be for bringing this upon itself, it is a sad conclusion for believers in liberal values.

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