Sir Donald Irvine
Family doctor who as head of the GMC tried to tackle the ‘club’ culture of the medical profession
SIR DONALD IRVINE, who has died aged 83, was an outstanding general practitioner who throughout his career fought to change the relationship between the public and their doctors.
The only GP to become president of the doctors’ regulatory body, the General Medical Council (1995-2002), he was responsible for a seismic change in that body’s philosophy, from one of protecting doctors to that of protecting patients.
In the early years of the NHS, general practice was the poor relation: Churchill’s doctor, Lord Moran, said in 1958 that it was the place doctors landed when they fell off the hospital ladder. This stung young Irvine, who had grown up with a GP as his father.
Donald Hamilton Irvine was born at Ashington, Northumberland, on June 2 1935, the son of Andrew and Dorothy Irvine. His father’s surgery was attached to the house, and so Donald had early exposure to many aspects of medicine.
He recalled in his memoir, Medical Professionalism and the Public Interest, that the practice was part of the family’s life and that everything fitted around the patients.
At the age of 10 he developed rheumatic fever while on holiday in Edinburgh and spent almost a year in hospital there, 100 miles from home. The one thing that stuck in his mind from this time was the trust he had in the doctor who was looking after him, because his manner and way of talking made young Donald believe in everything he said.
He went to King Edward VI Grammar School in Morpeth and thence to Durham University, where he qualified in Medicine in 1958. In spite of encouragement to specialise, he was determined to join his father in his practice, and he was a family doctor in Ashington from 1960 to 1995.
The recognition that standards needed to improve in general practice was partly behind the formation in 1952 of the College of General Practitioners (of which Irvine’s father was a founder-member).
Aged 33 Donald Irvine found himself secretary to the College, and from that time he built a base from which he could fulfil his dream of making general practice an equal partner in the delivery of modern medicine.
In those postwar years, which saw the beginning of the NHS, a doctor could enter general practice after only one year of hospital posts and with no requirement for further training.
Professor John Walker of Newcastle University Medical School, who had worked hard to establish general practice in the undergraduate medical curriculum, turned his hand to postgraduate education, and worked with Irvine.
A three-year vocational training for GPS was led by what had become the Royal College of General Practitioners, with Irvine at the forefront. It was organised on a regional basis, and he led it in the north of England with his GP colleague, Mike Mckendrick.
An essential element was to have recognised training practices and a curriculum for young doctors to follow.
He became Chairman of the Council of the RCGP and was able to develop his ideas around improving professionalism, but it was on the wider stage of the GMC that he was to have most influence.
He met Sir Ian Kennedy, who had antagonised the medical establishment with his 1980 Reith lectures, “Unmasking Medicine”.
For Irvine the lectures had been a breath of fresh air, particularly their call to make the patient the centre of care rather than the doctor. Kennedy joined a group with Irvine to revise the doctors’ code of practice.
The crucial insight was to talk about what the “Good Doctor” should do. At a stroke this shifted a cultural approach which had been geared to telling doctors what they should not do, to one which told them what they should do. The result was Good Medical Practice, which still guides doctors.
The GMC at that time had around 110 members, most of whom were elected, with only 11 lay members. The British Medical Association had a large influence on those who were elected, so there was considerable hostility to these changes. That there was any change at all was down to Irvine’s commitment, helped by his toughness and charm.
His cause was helped by several high-profile medical scandals involving individuals, and then the Bristol case. It became known through a whistleblower that the results for children’s heart surgery in Bristol were substantially worse than they should have been. Three doctors were suspended. Irvine chaired the disciplinary panel, which found them guilty; two were struck off.
There was considerable media and public attention, which led to an inquiry led by Sir Ian Kennedy. Irvine gave evidence, not about the specific issues thrown up by Bristol but about the prevailing paternalistic culture among the medical profession and what changes might be called for.
Kennedy recalled feeling that Irvine was weighed down by the burden of what Bristol had exposed: a “club” culture, the stifling of unwelcome views, bullying and oppressive management, all of which he felt both responsible for and affronted by.
Irvine’s strongly expressed ideas were influential in the direction the Kennedy report took about education and training.
The GMC remained hostile to change, but the appointment of a new chief executive, Finlay Scott, and threats that if the Council did not reform it would be abolished, were sufficient to precipitate reform. Irvine’s tenure as chairman was a bruising time and he had to survive a vote of no confidence and a challenge to his leadership, leaving one year earlier than he might have done.
His presidency was also an unhappy period and not the pinnacle of his career that it should have been; most of his predecessors had been elevated to the House of Lords. His book, The Doctor’s Tale (2003), records this period of his life.
He remembered 2000 as an annus horribilis for the GMC, with highprofile conduct proceedings, tensions within and between medical tribes and pressure from government.
Not surprisingly his book received a mixed reception from the medical profession but the public was more favourable.
The overall result has been an independent GMC which still exists, but now has a clear focus on protecting patients as well as on the education and training of doctors.
It is slimmed down, with more lay representation and much strengthened misconduct procedures. A move to doctors having to undergo revalidation is a result of the change of culture started by Irvine.
He was a pioneer not only in the UK but also in the US, through his work with the Picker Institute, whose executive director, Loie Hanscomb, recalled that Irvine had a deep understanding of the importance of the relationship between patient and physician.
In 2017 the American Board of Medical Specialties awarded him the ABMS Health Care Quality and Safety Award. He was appointed OBE in 1979, CBE in 1987 and knighted in 1994. He received honorary doctorates from seven universities.
He was tall, always immaculately dressed, unceasingly polite and described as a true gentleman. He enjoyed gardening, for which he would wear kid gloves, as well as birdwatching and walking in the Northumberland countryside.
Donald Irvine married, first, Margaret Mcguckin in 1960; they had a daughter and two sons but divorced in 1983. In 1986 he married Sally Fountain; they divorced in 2004. In 2007 he married Cynthia Rickett, who survives him with the children.
Donald Irvine, born June 2 1935, died November 19 2018