Through benchmarking, peer review, appraisal—and management

Professional self regulation has so far been vested in the General Medical Council, which has done much recently to modernise its way of working. The new performance procedures go a long way to plug a major gap in its ability to deal with cases which, though serious, may not be best dealt with by erasure or suspension from the medical register. Each problem dealt with by the GMC, however, represents an issue which has not been adequately addressed locally, and it is locally that major changes are needed if self regulation is to be credible.

Firstly, outcome data for individual treatments are needed to allow doctors to compare their own results with those of colleagues throughout the NHS performing the same procedures. Such benchmarking has been found useful in cardiothoracic surgery 1 2 and lends itself to specialties which produce definite and measurable outcomes and complications but could in principle be adapted to all specialties. Individual doctors' results need to be corrected for case difficulty and comorbidity—which is difficult.

For cardiothoracic surgery Keogh et al have described some of the problems of risk stratification, including the necessity for good data collection.3 …