New powers to suspend incompetent doctors are to be introduced on 1 July under measures signed by Frank Dobson, the Secretary of State for Health, this week.
The sanctions, which will be applied by the General Medical Council, the doctors' disciplinary committee, are intended to weed out well-meaning doctors "doing their inadequate best". They are being introduced three months earlier than planned after arrangements for dealing with the doctors were agreed sooner than expected.
At present, the GMC can only take action against doctors who are found guilty of serious professional misconduct - such as seducing a patient - or are too ill to carry on. It cannot take action against doctors who, while trying hard, are simply not up to the job.
To plug the gap, the NHS Professional Performance Act was introduced in 1995, under which doctors whose competence is questioned can be assessed by the council and made to re-train if necessary.
On Tuesday, Mr Dobson signed the order implementing the Act from 1 July and the first doctors are expected to be assessed in September.
The GMC, which has been working on the arrangements for three years, has established 17 specialist groups covering each area of medical practice, who will judge the competence of doctors referred to them. Health authorities or trusts can lodge complaints which will be assessed by a screener before further action is taken.
A GMC spokesman said the council had moved as swiftly as it could to get the new measures in place. "We recognised this was a gap in our powers and the sooner we could get it up and running the better we could discharge our responsibilities to patients."
About 150 doctors a year are expected to come before the council with perhaps one-third required to undertake re-training. They may be barred from one area of practice or suspended altogether and must be re-assessed after re-training before being re-admitted to practice. The cost of the training could run into thousands of pounds and must be met by the doctor.
The GMC spokesman said: "We are saying that NHS trusts and health authorities should act as responsible employers and assist with re-training and it is open to the doctors concerned to seek help from them."
The heart of the new measures is the definition of "serious deficiency of performance" in each of the 17 areas of practice. Lesley Southgate, Professor of Primary Care at University College, London, who developed the assessment methods, says in a briefing paper for the GMC that this provoked the lengthiest debate.
Errors can occur in any doctor's practice and provided they are infrequent do not usually imply serious deficiency, the paper says. "We are seeking to identify a pattern of performance in which errors are more wide ranging and/or serious than would be expected by the peer group," the paper says.
It adds that experience shows that "it is easier to reach consensus on what is unacceptable than choose one correct way of doing things".