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Government wants doctors to report unfit colleagues

The working party that produced the report was set up in 1993 after a spate of media reports on poorly performing doctors. It was the case of Dr Carol Starkie, a consultant pathologist from Birmingham who made a series of misdiagnoses of bone cancer, that finally prompted the government to act. Many doctors, it later emerged, had been worried by her performance for years.

Several mechanisms are available--through the NHS and the General Medical Council--for dealing with poorly performing doctors, but the report notes that there is confusion about the relation between the mechanisms, that the NHS procedures are complicated, and that present procedures do not satisfactorily cover all staff, particularly locum staff, private practitioners, and junior staff, who are regularly on the move. The NHS reforms, the report says, have led to a considerable increase in the number of employers and a "diffusion of expertise in handling medical disciplinary issues."

The General Medical Council already requires doctors to take action on poorly performing colleagues, and last year it found an anaesthetist guilty of serious professional misconduct for failing to report a colleague's dangerous practice. The government wants to ensure that all doctors know of the council's guidance, and it proposes legislation to allow the council to implement its proposed mechanism for dealing with doctors who show a pattern of poor performance. That legislation is now passing through parliament. The report also recommends that the General Medical Council should consider reporting to NHS employers allegations that do not fall within its sphere of action but that "may be appropriate for action by the employer." The health departments will issue guidance to employers on when they should inform the council that they are taking action against a doctor.

The working party also recommends that local medical committees be given a formal role in helping family health services authorities (health boards in Scotland) to maintain standards of practice; that employers and professional bodies explore the feasibility of setting up mentoring systems; and that the BMA set up a national helpline to offer confidential, anonymous advice to doctors on all aspects of poor medical performance.

Dr Judy Gilley, a general practitioner and a member of the working party and the General Medical Services Committee, said, "The emphasis must be on prevention, not on shopping doctors who perform poorly. We need to create an environment that's supportive and not competitive, that allows us to offer colleagues a helping hand before the patient is harmed. It's been difficult in the past to admit we've made mistakes."

Dr Mac Armstrong, the secretary of the BMA, welcomed the report but said that there would be tensions in NHS trusts when doctors were discouraged from talking publicly about NHS problems but were required to inform employers about colleagues who are performing poorly.--RICHARD SMITH, BMJ

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