Managing the clinical performance of doctors

A coherent response to an intractable problem

News p 1319

The last few years have seen a progression of “rogue doctors” and health care scandals through the media.1 Now, unsurprisingly, we have a series of proposals that attempt to guarantee to patients that the doctors treating them are up to standard. Public confidence must be restored, or trust in the National Health Service will be destroyed. Three weeks ago the prime minister launched the Commission on Health Improvement (CHI), which will inspect health services in England and Wales and respond to services in trouble.2 Two weeks ago the General Medical Council discussed its proposals for revalidation for every doctor in the United Kingdom.3 Now the chief medical officer of England has issued his proposals on how poor clinical performance among doctors will be prevented, recognised, and dealt with.4 The old system—based on an expectation that professionals would keep up to date and do something about poorly performing colleagues combined with some half hearted systems of self regulation—is dead.

Nobody can deny that there is a problem. “Bristol”—the case of poor performance in paediatric cardiothoracic services—heads the list and, I have argued, changed everything.5 But there have been several other episodes, and chillingly the chief medical officer seems to accept there are more to come: “We expect that over the …