In a historic vote, the General Medical Council, the profession's disciplinary body, decided that doctors must agree to continuous monitoring of their skills to preserve public confidence and to see off government threats to intervene in their regulation.
The move marks a milestone in the regulation of doctors. Pressure for change has been growing on the GMC and on the royal medical colleges, which have been criticised as cartels protecting the interests of their members, rather than those of the public, and which sharply increased last year following the Bristol heart babies case in which three doctors were found guilty of serious professional conduct after 29 out of 53 babies died.
Yesterday, two weeks before the public inquiry into the tragedy is due to begin hearings, parents of the Bristol babies suffered further distress when it was revealed that they had buried their offspring without their hearts.
The hearts of an estimated 170 babies who died were removed and stored, without their parents' permission, over a 16-year period up to 1995.
The Bristol Royal Infirmary said yesterday it was routine practice to retain organs for "examination and education purposes", and there was no legal requirement on it to obtain consent although it was now standard practice to do so.
Under the measures agreed by the GMC yesterday, every hospital and GP practice will be required to draw up a "profile" of the performance of each doctor which will be continuously updated. This will be backed by regular independent assessment, possibly every five years, with the ultimate sanction that doctors who fail to measure up, or who refuse to co-operate, will be struck off.
Until now, doctors who have completed their training have been free to practise without any further checks on their performance. The new measures mean that for the first time they will have to regularly demonstrate their fitness to practise.
The Government had responded to the growing public disquiet by signalling its intention to intervene unless the GMC put its house in order. The new NHS Bill includes a clause giving ministers powers over regulatory machinery.
A last-minute attempt to water down the proposals was heavily defeated.
Dr Edwin Boorman, former chairman of the junior doctors committee of the British Medical Association said the new measures would be unwieldy, cumbersome and difficult to implement and could open the GMC to a legal challenge by struck-off doctors.
However, Sir Donald Irvine, president of the GMC who has personally driven through the changes, said existing measures were inadequate.
He added that "bloody minded doctors" who refused to co-operate with the assessment could be struck off the register automatically in the same way as those who failed to pay their annual registration fee.
A steering committee of the GMC will now consider how the measures will work in practice and will report back to the full council in May, with a further report in November.
The decision was welcomed yesterday by the medical colleges, the BMA and the Association of Community Health Councils representing patients. But the Bristol Heart Parents Action group said the move still left the checks in the hands of doctors and an independent body was required.
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