Introduction

The GMC proceeded with redefining how overseas-trained doctors gained access to the register at a moment of political crisis within British medicine. On November 23, 1972, Secretary of State for Health and Social Security Sir Keith Joseph announced in Parliament the appointment of a committee of inquiry into the regulation of the medical profession. The committee, chaired by Sir Alec Merrison, was created to follow up on a pledge by Joseph's predecessor, Richard Crossman, in March 1969, during the continuing dispute between the BMA and the GMC over the retention fee. Crossman had urged the association leadership to find common ground with Lord Cohen to resolve differences over the governance structure and functions of the GMC. Working groups had reached consensus on a host of items—including the centrality of an independent body to regulate the medical profession—prior to Secretary Joseph's announcement. But the hardening of opposition to the fee among a core element within the BMA membership, together with the intention of the GMC to remove nonpayers from the register, effectively doomed compromise. The specter of an apparent breakdown in the regulation of the profession was not without liabilities for the government. While the number of doctors to be potentially removed was not definitively known, even the possibility carried the threat of a contraction in the supply of registered doctors and a possible interruption in the delivery of health care to the public. At a minimum, the appointment of the Merrison Committee was a means to defuse a crisis while grounding any proposed changes to the regulation of the profession in the judgment of a nonpartisan body that represented a cross section of the public and the profession, but neither the GMC nor BMA.

The inquiry was unprecedented in the longer than 150–year history of the GMC. Although the GMC would be subject to prolonged scrutiny, council president Lord Cohen and his successor, Sir Richardson, welcomed the inquiry. This was not simply a matter of putting on a brave face in a difficult situation. However much the GMC and the BMA were at odds about governance and oversight functions, there was broad agreement on at least two principles.