Two hundred thousand copies of a new handbook which has been approved by ministers, are to be sent out by the General Medical Council this week setting out doctors' responsibility for preserving high standards and telling them when to report colleagues to protect patients from bad practice.
Every hospital and GP practice will also be required to establish procedures to deal with doctors reported by their colleagues. The guide, called Maintaining Good Medical Practice, says doctors must "look after and care for" each other but their first duty is to protect patients.
Sir Donald Irvine, president of the General Medical Council, said there could be no guarantee that the disaster which occurred at the Bristol Royal Infirmary was not happening elsewhere. Two doctors were struck off and a third was banned from operating on children at the end of the council's investigation into 29 baby deaths after the doctors were found to have ignored warnings about their high mortality rate.
Sir Donald said: "I can't say it isn't [happening elsewhere]. I am sufficiently aware from my experience of the health service and the profession to know there are things that need to be done. The priority is to get good local systems in place so that if things do go wrong people know what to do and where to go."
Sir Donald, giving his first interview since the conclusion of the Bristol case, said the eight-month hearing had been traumatic for all concerned and it would be a "dishonour and disservice to the tragedy" if the lessons from it were not learnt. "It was harrowing. It was awful for all of us. I felt for everybody there. Our job was to be objective, to look at the evidence and the evidence was enormously complex."
He said the Bristol case had exposed a hole at the centre of the existing system of self- regulation. It ignored the key role of doctors in monitoring their colleagues. "We used to think regulation was what the GMC and the medical royal colleges did. That misses the point that it starts with the individual doctor, extends to the medical team and to the hospital. The principles of good medical practice have to be embedded in every NHS trust, clinical unit and general practice."
He said the GMC had already been working on extending local regulation when the Bristol case happened, demonstrating in the starkest way why it was essential. "We must not see Bristol as the exception. A lesson would be missed from the tragedy if it were seen in isolation. Bristol has imparted a sense of urgency and realism [to the need for local regulation]. The public are telling the profession it has got to be sorted out and I think that is right."
The guide says colleagues usually know when a doctor's practice is going wrong and that prompt action offers the best chance of avoiding damage.Most cases should be dealt with at the local level but it gives four examples that should trigger a referral to the GMC.
They include a GP who has refused visits, prescribed erratically and kept incomplete notes; a consultant who showed a lack of skill and responded aggressively to expressions of concern; and a surgeon who carried out a series of operations, some of which were done badly and some unnecessarily, but who was aggressive and uncooperative with a local investigation.
It has emerged that the GMC urged the previous government to hold an inquiry into the events at Bristol before its own hearing began.
The council knew that its own investigation, which had to be narrowly based for legal reasons, would be criticised by parents and others affected whose evidence had to be excluded. However, Stephen Dorrell, the then secretary of state for health, announced on 18 March 1997, six weeks before the general election, that the inquiry would follow the GMC case, without consulting the council.
Irvine heals wounds
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