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Wednesday, February 10, 1999 Published at 11:03 GMT


Radical shake-up for doctors

Doctors will have to prove that their skills are up to date

By BBC Health Correspondent Richard Hannaford

The proposals before the GMC are truly radical. Up until now no doctor in the UK has ever had to undergo any form of test to ensure he or she is competent to continue treating patients, or even prove they're safe.

Once they passed their medical exams and were registered they could continue to practise indefinitely.

The old saying had it that doctors could kill as many patients as they liked - as long as they didn't get caught having sex with them, as that would get them into trouble.

In fact the principle - that as part of a condition of their continued registration on the roll of medical practitioners, all doctors must undergo some form of regular assessment of their skills - is likely to find few opponents at today's meeting of the General Medical Council.

But what is contentious is how that assessment is carried out, and how often.

Monitoring skills and habits

Recent proposals passed by the Royal College of General Practitioners suggested that all family doctors should undergo a form of self-assessment on a five yearly basis.

It would include them not only monitoring their own prescribing habits and listing the outcomes of various diagnoses, but also providing evidence of communication skills with patients.

There would also be a team of inspectors, including patients, who would examine one in ten GP's every year.

Those that were under performing would be given special help, while those that were considered a danger to their patients would be automatically referred to the General Medical Council to decide whether they should be struck off.

Of course self-assessment allows doctors to monitor themselves. But many doctors argue that any other system would be costly and cumbersome.

Can you imagine, they say, all the thousands of inspectors, presumably medically trained, you would need to monitor the work of the doctors - let alone how much it would cost.

Who carries the can?

But some patients groups have already criticised the idea that doctors should only be tested every five years. They want to see it done much more often. And by outside independent bodies.

[ image: Rodney Ledward practised for years with his skills unchecked]
Rodney Ledward practised for years with his skills unchecked
And that is what is at stake for the doctors - the ability to regulate their own profession: to ensure standards and discipline members who transgress.

Despite the tragedy of the Bristol Heart Babies, and the scandal surrounding the Gynaecologist Rodney Ledward - who operated for years on women, causing immense damage - the Government does not want to have to interfere with the idea of the doctors (and nurses) regulating and disciplining their own profession.

These proposals today could also link in very well with the government's own proposals for a Commission for Health Improvement - a sort of NHS Inspectorate.

However if the medical profession gets too bogged down in arguments about how these assessments should be carried out, the government will impose a system of its own. This is the last chance for the doctors.

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