Over 1,50,000 practising doctors in Britain will have to undergo annual reviews to weed out poor performers, under the most radical reform of medical regulation for 150 years, announced by the Government which consulted the General Medical Council (GMC) and other medical organisations.
Family doctors, hospital consultants and private practitioners will have to apply to renew their licences every five years, according to plans published by the Chief Medical Officer.
The report by Sir Liam Donaldson, Medical Revalidation: Principles and Next Steps, outlines how senior doctors will be appointed to assess the competence of general practitioners (GPs) and hospital consultants in their area to ensure that patients’ lives are not being put at risk.
The medical colleges, which represent different clinical specialties, will have to develop tests to check that doctors are keeping abreast of advances.
The system — the first of its kind in the world — is designed to identify doctors who repeatedly make poor clinical decisions, according to the Times. Inspectors are to use evidence from patients’ questionnaires and feedback from colleagues. Doctors “unable to remedy significant shortfalls in their standards of practice” risk being removed from the medical register, the report says.
Trials will begin within two years. At the moment doctors face no formal reassessments of their competence, clinical skills or performance between entering independent practice as a GP or consultant and retiring. An airline pilot would be assessed about 100 times over a similar period. The new regime will make annual reviews mandatory. They will cover the full range of performance factors, including prescribing habits, interaction with patients and personal problems such as alcohol or drug misuse.
A senior doctor of Indian-origin Shiv Pande, the only Indian to have become treasurer of the GMC while talking to the Hindustan Times welcomed the scheme. “This should be a wake-up call for the Indian Medical Council. Do Indian masses not deserve a better health services like the one proposed here for the British citizens,” he said.
But, the opinion of doctors about such a change is divided. Critics said that it would mean doctors spending less time with patients and practising “defensive medicine”. Many doctors are concerned about bureaucracy diverting them from patient care. But the report emphasises that the system will be “focused on raising standards, not a disciplinary mechanism to deal with the small proportion of doctors who may cause concern”.
Sir Graeme Catto, President of the General Medical Council, said that it had dealt with 5,168 complaints about doctors last year — 1,300 more than in 2000 — but only about one in three led to an investigation, and fewer than five per cent to a hearing. A total of 60 were struck off. Describing the report as a “wake-up call” for doctors and local NHS organisations, he told the Times: “We have been recommending a system of revalidation for ten years.” He denied that the reforms would lead to a culture of “defensive medicine”, with doctors worried about the consequences of their actions.