Surgeons to be tested for competence

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ALL CONSULTANT surgeons should be subject to regular checks throughout their careers to ensure their skills are up to standard, the Senate of Surgery of Great Britain and Ireland said yesterday.

In its first formal response to the Bristol heart-surgery deaths inquiry, the Senate, which represents the 10,000 most senior surgeons in the country, said the protection of patients was paramount and the "public must be reassured we provide a safe and appropriate service".

In addition to checks on consultant performance, it made further recommendations, including monitoring success rates of operations and the establishment of rapid-response teams to deal with hospitals within 48 hours of a threat to patient safety coming to light.

The response by the Senate, which represents the royal colleges of Surgeons of England, Glasgow, Edinburgh and Ireland, is in marked contrast to the initial reaction to the Bristol case by the former president of the English royal college.

Speaking the day after the final verdicts were delivered last June, which resulted in two senior doctors from the Bristol Royal Infirmary being struck off and one banned from operating on children for three years, Sir Rodney Sweetnam said the Bristol case had resulted from a "failure of local auditing procedures."

Pressure since from the Government and the public, fuelled by a string of cases at other hospitals where surgeons have been alleged - and in some cases, proved - to have been at fault, have forced a rethink. Yesterday the new president of the English college, Barry Jackson, said the profession accepted the principle of self-regulation was under threat and that the Government might step in and take control if doctors did not set their house in order.

"We recognise there is a problem that needs to be addressed. But we would like to stress that more than four million operations are carried out each year and the overwhelming majority to a high standard. We believe mechanisms need to be put in place to reassure the public unequivocally that the standard of operations they are going to receive should be uniformly high throughout the country."

However, Arnold Maran, president of the Edinburgh college, said even regular checks on performance would be unlikely to prevent another Bristol; what was needed was a change of attitude. "If revalidation had come in I doubt if it would have changed the Bristol scene. What will have changed it is the fact that Bristol occurred. It has resulted in a professional change of culture. It was not seen by my generation as so terrible but it was identified by the younger generation immediately as an incorrect way of practising. There was an obvious problem at Bristol but it was a problem we didn't react to."

The General Medical Council, which is responsible for maintaining medical standards, is to consider regular checks for consultants at its next meeting on 3 November.

Its president, Sir Donald Irvine, said: "It is crucial that doctors are able to demonstrate their fitness to practise throughout their careers."