Writing in the Psychiatric Bulletin, Robert Kendell says the royal medical colleges are "widely regarded, even by some of their own members and fellows, as rather pompous, self-satisfied and inordinately wealthy organisations with arcane rituals, fancy gowns and a surfeit of elaborate dinners and ponderous speeches".

He says that, until recently, their position was "unassailable".

But changes in the way the medical profession operates - particularly the introduction of a range of new techniques - means that specialists who qualify at 32 are not necessarily going to remain competent for the next 32 years.

Public confidence

The recent series of medical scandals, including the Bristol heart operation deaths, have undermined public confidence in the medical profession and exposed the medical colleges' limitations, says Dr Kendell.

He says psychiatry has escaped public censure, but probably only because it is difficult to audit and mistakes are rarely life-threatening.

Protests over the Bristol babies case have undermined public confidence in doctors

However, he says surveys by his college of electroconvulsive therapy (ECT) show "serious deficiencies" in the way ECT clinics are supervised, the way junior doctors are trained and in the equipment itself.

Dr Kendell believes these failures have been used by "doctrinaire" ECT opponents.

He adds that the medical colleges have little scope for punishing members who are incompetent or unfit.

They can expel them, but this does not affect their ability to keep working.

The colleges have even less influence on doctors who are not their members or fellows.

Stark choice

Dr Kendell says medical colleges face a stark choice:

Either they should limit themselves to postgraduate training, and so lose influence, or they should make more vigorous attempts to monitor and uphold clinical standards.

The RCP has already opted for the latter course. Dr Kendell says the solution to raising clinical standards is to enter into an alliance with NHS employers.

This would involve hospital managers being held responsible for clinical quality standards, which would be set by the colleges.

The colleges could step in after trust services had failed and offer advice on how to improve the situation.

There could also be regular monitoring of some services by colleges, for example, the RCP has agreed to inspect ECT services in the course of regular inspections of training programmes.

Dr Kendell also calls for regular revalidation of specialists' competence every five to seven years.

Five-yearly check-ups for specialists was proposed by the Senate of Surgery in October as part of its response to the Bristol baby case.

Feasibility

Speaking to BBC News Online, Dr Kendell said: "There is wide agreement in the medical profession that it is highly desirable [to have the check-ups], but there are concerns about their feasibility.

"There are 57 different kinds of specialist and many people's jobs are very much more specialised than that.

The Bristol case and others have led to a huge review of clinical practice

"A surgeon may have been appointed to a consultant post in general surgery and end up working on the pancreas and not much more.

"It is a very specific job and it is very complicated and difficult to test his or her competence," he said.

The medical profession is still talking about how it can be done and the General Medical Council, doctors' regulatory body, is holding a big meeting on it in February.

Dr Kendell says any decision to strike off a consultant for being incompetent would be bound to be challenged in the courts so the colleges' competency tests would have to be legally defensible.

Dr Kendell added that it was not yet clear that NHS trust managers were interested in routinely allowing royal colleges to give them advice when services were failing.

But he thought this might change when the legislation making trusts responsible for the clinical performance of their services comes in next year.

The article in Psychiatric Bulletin was discussed with the presidents of other medical colleges.

"We all see the issues in much the same way," said Dr Kendell.