The recommendation follows alarming cases in which family health service authorities have felt forced to appoint a family doctor to a single- doctor practice, even where they have believed that none of the candidates was suitable.
In at least one case, the GP was subsequently struck off by the General Medical Council.
Mary Leigh, chairman of the Medical Practices Committee, which helps to oversee GP appointments, said she was "delighted" at the recommendation. Some Family Health Service authorities have flouted the law and refused to appoint where all the candidates were unsuitable, she said, and others have made appointments they regretted.
The requirement - which affects only single-handed doctors who tend to be concentrated in inner cities - dates back to the National Health Service's establishment in 1948, when GPs feared being placed under a "state civil service" and insisted that if they were qualified they should be entitled to appointment. It meant that legally a doctor should be appointed, however unsuitable.
The Department of Health said it would take the recommendation forward as soon as possible. Dr Calman's call came as Stephen Dorrell, the Secretary of State for Health, formally announced plans for a new condition to be written into doctors' terms and conditions of service requiring them to report colleagues whose performance they believe is suspect.
Mr Dorrell said the plan was not "a shop-a-doc scheme" but a reinforcement of doctors' traditional duty "to put the interests of patients first, even when that leads to a difficult conflict of loyalties with their professional colleagues".
Mr Dorrell, whose move was broadly supported by British Medical Association and the medical Royal Colleges, added that it was "not a witch-hunt, it is a welfare watch" aimed at picking up problems early and putting them right before disciplinary action was needed.
Dr Calman's report also calls for a string of other improvements in general practice, including the possibility that GPs be given "mentors" - another doctor to advise and watch over them as an effective means of pinpointing deficiencies in knowledge and skills - and recently trained doctors should not be appointed to general practice without an objective assessment of their skills. The report makes 15 recommen- dations to fulfil its title of Maintaining Medical Excellence; Mr Dorrell said he was asking for quarterly reports on progress.
t Doctors should be trained an tested in their communication skills with patients - although nearly half of GPs admit that they do not allocate enough time for consultations, according to a survey in Which? Way to Health, writes Celia Hall.
While 40 per cent of GPs wanted to spend longer with each patient, "giving more time" came only 13th on the list of priorities. Patients found that getting to see a doctor, at all, was their major problem with general practice.
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