Toby Sealy: "The Bristol baby scandal has prompted action"

The proposals were published on Monday by the General Medical Council, which regulates doctors.

They suggest that revalidation - also known as MOTs for doctors - could be linked to a doctor's place on the register that determines whether or not they have a legal right to practise.

Doctors must be on the specialist register if they wish to practise as a consultant. There is due to be a similar register for GPs introduced in the near future.

Doctors who fail to prove that their skills are adequate could be removed from the register under the proposals.

The GMC will vote on whether to accept the measures on 10 February.

Coverage

The proposals will cover hospital specialists and principal GPs initially, but eventually will cover all doctors.

The GMC first examined the issue at a meeting in November last year.

The council agreed that doctors should be able to prove on a regular basis that their skills are up to date, and set up a steering group to examine how this could be done.

However, they did not agree on how this process should be linked to the specialist register or the proposed register for GPs.

Proposals

Monday's proposals, the culmination of a report by the steering group, say:

• Specialists and GPs must be able to demonstrate that they remain fit to practice, and this is best achieved by linking procedures to registration;
• GMC performance measures should be adequate to provide a basis for reviewing registration in the event of "seriously deficient performance";
• In consultation with other patients, managers, doctors and government, the steering group should have a model for revalidation ready for implementation within two years.

If a doctor performed poorly in a revalidation assessment, the first step would be local mediation. The doctor could also be referred to the GMC's performance procedures.

If the GMC was not satisfied that the doctor was fit to practise, it could review his or her place on the register.

Ongoing issue

The GMC's president, Sir Donald Irvine, rejected suggestions that the proposals were flawed because they involved self-regulation.

Sir Donald Irvine denies the proposals are flawed

He said: "You have to remember that the GMC is 25% made up of members of the public.

"In assessments carried out by us of a doctor's practice one in three of the assessors are members of the public. There is a very, very strong public involvement in the GMC's activities."

There has been growing pressure for regular reassessment of doctors' skills following the Bristol Heart Babies case.

Two surgeons were revealed to have dangerously inadequate abilities yet they were allowed to perform complex surgery on young babies.

Twenty-nine babies and toddlers died following heart surgery at Bristol Royal Infirmary.

The surgical royal colleges published their own proposals for reaccredidation in October.

How the registers work

The specialist register was set up under European legislation. It was designed to provide uniformity of training standards throughout the European Union.

To appear on the register, doctors must hold a certificate of completion of specialist training, or CCST.

To appear on the proposed GP register, doctors will have to hold a certificate of completion of vocational training.