Dismay among GPs as they are told: You can't decide who is fit to practise

DOCTORS have condemned government plans to strip them of their powers of self-regulation, announced yesterday as part of the biggest shake-up of the rules governing the profession in more than 100 years.

The General Medical Council (GMC) will lose the right to adjudicate in fitness-to-practise cases when complaints are made against doctors.

The GMC will still investigate concerns about doctors, but the final decision on what happens to a doctor is likely to pass to an independent tribunal.

The proposals form a key part of the government's white paper issued in response to the murders by Dr Harold Shipman and other medical scandals.

But doctors yesterday said some of the changes proposed could mean doctors were "forever looking over their shoulders" instead of focusing on patients.

Others welcomed the changes, believed by many to be long overdue.

The plans, which will now come under parliamentary scrutiny, include five-yearly MOT-style checks on doctors to ensure they are fit to practise. Medics who fail the tests will face retraining and supervision or could be struck off.

However, the centrepiece of the plans would result in the regulatory body, the GMC, being stripped of its key power to adjudicate on doctors' fitness to practise. Instead, an independent body will consider whether doctors subject to complaints are fit to continue in their job.

This means that while the GMC will still investigate complaints, it will not make the final decision on doctors' fitness to practise.

These cases will also be judged on a civil standard of proof - on the balance of probability - as opposed to the current criminal standard of beyond all reasonable doubt.

But there will be a sliding scale of proof required depending on the seriousness of the case.

Other changes mean the GMC membership will be made up of half doctors and half lay people, rather than the current profession-led regime.

Bodies governing midwives and dentists will also be subject to change.

The inquiry into the case of Shipman, the Hyde GP who murdered more than 200 people over 23 years, criticised the GMC. Dame Janet Smith, who chaired the inquiry, accused it of being more interested in looking after doctors than protecting patients.

It is hoped that the changes, which follow recommendations made by England's chief medical officer Sir Liam Donaldson, will help change this perception.

But the British Medical Association (BMA), while welcoming regular checks for doctors if they are "fair and workable", expressed concern about the impact of the changes.

James Johnson, BMA chairman, also criticised the effect changing GMC powers could have on doctors, taking away their livelihood purely "on a balance of probabilities".

"Doctors recognise the need for change to reassure patients and the GMC has already greatly changed," he said.

"Sadly, the white paper proposals could lead to a climate of defensive medicine in which doctors are forever looking over their shoulders instead of concentrating on working in the best interests of their patients."

But Scotland's chief medical officer Dr Harry Burns, yesterday said:

"We welcome the recognition in the white paper that the different structures and systems in the devolved administrations will necessarily influence how we implement the new policies. The Scottish Executive will be participating in UK working groups while working with its own stakeholders towards implementation."

Dr Burns has previously criticised some of the proposals.