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This chapter outlines recent developments in the fitness to practice hearings where complaints are made against doctors. It traces the introduction of the medical practitioner tribunal service as a separate arm of the general medical council. It outlines how the tribunal service works and discusses its performance over the last decade. As a result, it questions whether recent reforms made have secured the public interest.

The chapter provides a historical policy account of the introduction of medical revalidation in the UK and outlines the limiting structural and cultural factors at play and how these might well hinder its ability to identify poorly performing doctors.

This chapter outlines the aims and objectives of the book and its focus on regulatory reform of the General Medical Council and how it investigates complaints against a doctor’s fitness to practise alongside the introduction of medical revalidation to periodically test professional competence. To set the scene to this analysis in subsequent chapters, the emergence of risk-based approaches to professional regulation are outlined as well as how these have transformed traditional ‘doctors only’ approaches to medical governance.

In light of previous chapters, the final chapter outlines how recent developments in the regulation of doctors are a result of the fluctuating social conditions associated with the emergence of the risk society. It discusses the possible future of risk-based forms of medical regulation and sets out a conceptual and policy-focused research agenda for ascertaining the impact of regulatory reform on both the public and the medical profession.

This chapter considers the issue of how social work programmes can best support students deemed marginal or identified as at risk of failing. Integrity is defined using three Maori words meaning ‘to be right, to take the right action and to always do it with genuineness and heart’ (Appleton, 2010: 82). Using the lens of ‘integrity’ as a conceptual focus, the chapter addresses the context in which ‘fitness to practise’ is determined, together with the processes by which schools of social work may identify, support and manage issues of competence and practice standards. The chapter concludes that such processes are relationally based and supported by assessment practices that in turn demonstrate integrity through the evaluation and development of a student’s knowledge, skills and values. Responsibility for passing or failing marginal students is shared between academic educators, host agencies, the professional staff they appoint as supervisors and most of all by students themselves. Questions that practice educators may use to determine the extent of concerns and options for resolution are applied to a case study while some typical vignettes are offered for the reader to explore.