The Potemkin doctors

Last year marked the bicentenary of the medical journal The Lancet, first published in October 1823. The Lancet was one of the world’s first medical journals, only outranked by The New England Journal Medicine (which dates from 1812). The first editor of The Lancet, the surgeon Thomas Wakley (later Sir Thomas Wakley) took it upon himself to expose frauds and quackery in medical practice.

Wakley subsequently became a Member of Parliament, and it was at his instigation that the Medical Act of 1858 passed into law, paving the way for the creation of the General Medical Council (GMC). The purpose of the act, set out in the opening sentence of the legislation is to ensure that ‘Persons requiring Medical Aid should be enabled to distinguish qualified from unqualified Practitioners’.

The problem that the Medical Act of 1858 was intended to solve was not a new one. In 1518, King Henry VIII established the Royal College of Physicians, and in its founding charter gave the College the power to determine who could, and who could not, call themselves a physician.

In the last twenty years, successive governments, aware of the relentless increase in workload of the NHS, have promised more doctors. A number of new medical schools have been created, but no one seems to have addressed the unendurable pressure of work, the intolerable conditions of service and declining remuneration. The inevitable result is that doctors retire early, emigrate, choose other careers or move to the private sector. The number of doctors fails to increase.