The use of "undercover" monitors to carry out random checks on GPs and specialists is one option under consideration as the medical profession moves to tighten self-regulation. Another possibility is the introduction of formal tests to assess doctors' knowledge of medical developments.
The General Medical Council (GMC) is considering whether to introduce performance checks every five years for each doctor, a move that could be approved at its conference next month.
Its attempts to restore public confidence in the profession without giving up doctors' rights of self-regulation follow the outcry over the deaths of 29 children in the Bristol heart surgery disaster.
Last June, Bristol surgeons James Wisheart and Janardan Dhasmana, and the former chief executive of their governing NHS Trust, John Roylance, were found guilty of serious professional misconduct for allowing operations on babies to continue despite evidence of the high death rate.
However, while the need for more rigorous monitoring is widely recognised, many fear that undercover assessment would be a step too far.
Jean Robinson, a former lay member of the GMC and visiting professor at Ulster University's health sciences department, said such a system would be open to abuse.
"I am not in favour of subterfuge, it fosters an atmosphere of fear and suspicion in a place where team work is essential," she said.
"It should be perfectly possible to monitor a doctor's work openly and honestly and above board. If there is a suspicion that there is a problem with their standard of work you present them with the information and discuss it."
Professor Robinson said it was wrong for doctors to be registered for life and called for regular assessments. She also wanted more attention to be paid to patients' experiences. "There are doctors who publish impressive papers but if you look at the kind of effect they have on their patients, they are not very impressive at all," she said.
Other critics of the GMC proposals have called for an independent body to be set up to monitor the profession. A spokesman for the BMA said the need for a revalidation scheme had been accepted and the details would be discussed at theconference next month, although it would be two years before any changes could be introduced.
Late last year, despite pressure from the Department of Health for more external checks and balances, the GMC pulled back from ordering regular competence checks on senior doctors. However, its members fear that if the profession is not seen to be taking the lead in monitoring itself, new systems will be imposed by the Government.
In June, the GMC updated its guide, Maintaining Good Medical Practice, which spells out the duty on doctors to report colleagues who put patients at risk.
After the Bristol inquiry, the Senate of Surgery of Great Britain and Ireland also said that all consultant surgeons should be subject to regular checks.Reuse content