The Royal College of Physicians says existing ways of regulating the medical profession are no longer good enough, and that the public expects more accountability from doctors and less variation in standards of practice and behaviour.

Its five-point plan follows the launch of proposals for tightening the regulation of doctors announced by the General Medical Council on Monday.

The GMC is proposing to prevent doctors from practising medicine at the highest level if they fail to prove their skills are up to date.

Under the RCP proposals, consultants and specialists will have to prove their competence to a RCP Standards Adviser.

The RCP cannot stop doctors practicing, but it can step in to identify under-performers, and take remedial action to improve standards.

In some cases it has also arranged early retirement for doctors who do not come up to scratch. It can also refer on to the GMC.

The shake-up in the medical profession has been prompted by the inquiry into the deaths of 29 babies and toddlers following heart operations at the Bristol Royal Infirmary.

Three doctors were found guilty of serious professional misconduct in connection with the case. The hospital was found to have a much higher than average rate of death for the heart operations.

The RCP proposals are set out in a new document, 'Physicians Maintaining Good Medical Practice: Clinical Governance and Self-Regulation'.

More than 11,000 consultants from all medical specialities will be covered by the regulations.

The five key components of the plan are:

• Annual, thorough two-way job plan review and appraisal of a doctor's performance with a Clinical or Medical Director;
• The introduction of regular Continuing Medical Education for all doctors based on a personal development plan;
• An audit procedure to monitor clinical outcomes and take action if necessary;
• Introduction of a Royal College of Physicians Standards Adviser for each Trust or group of Trusts to assist in all of the above.
• Piloting of a multi-disciplinary peer assessment service to review the work of clinical teams.

Clear standards

Royal College of Physicians has responded to public opinion

The RCP issued a statement claiming the plan would establish clear standards of acceptable practice, and procedures for identifying and dealing with concerns about particular doctors.

However, the RCP warned the plan would only work if hospital managers were committed to it.

"As individual physicians have a responsibility to strive for the highest standards, so their employers have the responsibility to help them do this, by putting in place adequate resources and manpower to allow clinical governance to bring real benefits to patients," the statement said.

The College will be setting up a new standards committee to lead change and oversee all matters concerning standards of practice.

The committee will develop plans for explicit standards in each clinical specialty, and methods for identifying poor performance in doctors.

It is also proposing to make fellowship of the college dependent on fulfilment of all components of the new plan.

At the moment, once doctors are qualified they do not need to prove any continuing fitness to practice.

Highlighting change

Professor John Ward, RCP vice president, said many of the things that were proposed in the new document were already being done in hospitals nationwide.

"We want to focus attention on the fact that we do these things, and on highlighting the change of culture that is taking place," he said.

"Doctors are no longer turning a blind eye, if somebody is not performing well it is much more likely now days that a colleageu will go to management."

Professor Ward said the RCP and the GMC were intent on achieving the same thing.

He said the RCP had a role to play in identifying and helping underperforming doctors to avoid the necessity for GMC action and possible removal from the medical register.