EDITOR, - Liam J Donaldson discusses dealing with problem doctors in a region.1 Regional responses to medical disciplinary problems have often been remote, cosy, and ineffective, lacking in urgency and understanding of local situations; regions have not inspired confidence in hospital managers and clinicians who wish to bring forward serious allegations. Local knowledge of the personal and professional conduct of individual doctors should enable medical directors of hospital trusts to assess problems more rapidly and deal with them more effectively at an earlier stage. NHS trusts are less likely to tolerate personal …