The performance of doctors. II: Maintaining good practice, protecting patients from poor performance

Introduction

The public now seeks assurances that doctors remain capable and safe throughout their practising lives. For the profession this means refocusing self regulation on fully established doctors.1 For the General Medical Council it means that all doctors on the register working in Britain must maintain an appropriate standard of practice. Where doctors do not, the GMC must ensure that action is taken, either locally or by itself. The first concern is to protect patients. The second is to find out what has gone wrong and to establish the cause. The third, wherever possible, is to help doctors recover their fitness for normal practice.

Practising safely

The principle that doctors should be able to show that they practise safely is unarguable. Unfortunately, discussion of the means tends to be contentious because of the threat of “recertification,” implying the regular testing of all career doctors. Yet there must be considerable doubt about whether, in our current state of knowledge, a formal national programme of periodic recertification would achieve the results that its advocates claim. There is no consensus on method, and the benefits would be small when measured against the cost of assessing large numbers of doctors already considered to be performing well. Given these uncertainties, a different approach may be more constructive.

Interests of the public and the profession may best be served by the development and implementation of a coherent, properly paced, and well balanced strategy of quality assured, professional self regulation based on the principle of management by exception.1 This would allow flexibility through strategies tailored to differing needs and circumstances. Practitioners who were …