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Thursday, October 22, 1998 Published at 13:12 GMT

Tough new rules for surgeons

Surgeons face tough new monitoring regulations

Surgeons will have to undergo regular check ups on their skills if they are to continue practising, according to proposals put forward by the leaders of the medical profession.

BBC Health Correspondent Fergus Walsh reports from Bristol
The proposals come in response to the deaths of 29 babies and toddlers following heart surgery at Bristol Royal Infirmary.

A report by the Senate of Surgery, which represents all surgeons in the UK, said surgeons should undergo regular assessments of their competence.

The Bristol Heart Babies
It also called for rapid response teams of specialists to be sent in to take over at hospitals where patient safety is at risk.

The senate recommends high national standards for the future regulation of the medical profession. In addition to five yearly MOTs for doctors and rapid response teams, these include:

  • A proposal for individual doctors to take responsibility for the actions of their team;
  • A confidential reporting system for staff and patients to make their fears known;
  • A more effective system of drawing attention to concerns about patient safety and acting on them;
  • No doctor to perform an operation unless they have long experience of the procedure under supervision of a senior doctor;
  • Improved collection of data relating to the success of surgical procedures;
  • Improved facilities for re-training failing doctors;
  • Better communication with patients.

Radical change

Mr Barry Jackson, president of the Royal College of Surgeons of England, said the measures represented a culture change in the medical profession.

Mr Barry Jackson discusses the measures
He said: "It is not just among the leaders of the profession, but throughout the profession as a whole."

[ image: Mr Barry Jackson:
Mr Barry Jackson: "Culture change"
He said that he hoped the doctors' regulatory body, the General Medical Council, would adopt the proposals for regular re-accreditation of doctors.

Such a process would focus on doctors' clinical performance rather than their medical knowledge, he said.

For this reason it would take the form of appraisal by doctors from other hospitals and analysis of a doctor's results.

GMC president Sir Donald Irvine said: "I am delighted that the Senate of Surgery has responded quickly and positively to the issues raised by the GMC at the conclusion of the Bristol case.

"I am particularly encouraged to see that they have decided to develop a process of revalidation for surgeons, and we look forward to working with them to achieve this.

"We must be able to reassure patients that registration within the GMC means not only that doctors are fit to practise medicine at the beginning of their careers - which is what happens at present - but in future throughout their working lives."

The Senate of Surgery started a working party following the GMC ruling on heart surgery cases at Bristol Royal Infirmary.

Monitoring performance

Mr Tony Giddings, chairman of the working party, said the senate had to respond to ensure that doctors continued to regulate their own profession.

Mr Tony Giddings: "Surgery is a complex art"
He said: "Surgery is a complex discipline which requires the ability to be scientific about one's work, to communicate well with patients and above all to work well in a team where we are prepared to share information openly and monitor our results.

[ image: Mr Tony Giddings:
Mr Tony Giddings: "Future of self-regulation"
"In the past the fact that consultants have been independent practitioners has in some instances not helped that culture.

"It is time to revisit those issues, to build teamworking and to develop those other skills, and to validate those skills on which the public depends for its service."

He added that the process of developing openness had been going on for 15 years.

The report is published as the Institute of Health Services Management launched a toolkit to help hospital managers monitor doctors' performance.

It contains clinical and legal guidelines, a checklist, sources of evidence of clinical and cost effectiveness and useful contacts.

The British Medical Association gave its "full backing" to the senate's measures.

Dr Peter Hawker, chairman of the association's consultants' committee, said: "These are important initiatives which will strengthen the efforts being made by the whole profession to make sure that patient safety is protected and problems are detected early."

Baby deaths

The GMC found three BRI doctors guilty of serious professional misconduct in June.

[ image: Mr James Wisheart was banned from practising]
Mr James Wisheart was banned from practising
It barred surgeon Mr James Wisheart and manager Dr John Roylance from working and barred surgeon Mr Janardan Dhasmana from operating on children for three years.

As well as making recommendations, the senate criticised the Department of Health's role in the Bristol case.

Even when the department was aware of problems in Bristol, it failed to act swiftly, the senate said.

It also warned that political projects such as waiting list initiatives put patient safety at risk.

They put undue pressure on doctors and prevented them from keeping up to date with training, it said.

A public inquiry into the Bristol case begins next week.

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