Leading Article: Blowing the medical whistle

What a busy bee Stephen Dorrell has been this summer. The energetic new Health Secretary has been setting out visions for the NHS, promising to "listen more and explain better" and, most recently, describing how patients are to be protected from bad doctors. All of which feels very different from the last, exhausted days of Virginia Bottomley.

This is a bit unfair. It was, after all, under Mrs Bottomley's aegis that the Chief Medical Officer was asked to chair a committee looking into identifying incompetent doctors. It is that committee's recommendations that Mr Dorrell is implementing. Mrs Bottomley also presided over the drafting of the Medical (Professional Performance) Bill which enables the General Medical Council to investigate cases of seriously deficient performance on the part of doctors. At the moment the GMC is restricted to ruling on cases of professional misconduct.

An essential element to the new package is the requirement that doctors blow the whistle on colleagues who are under-performing. Often it is only other doctors who will have the expertise, or who will be in a position to judge, when there is incompetence. There are problems here. If doctors believe their colleagues face dismissal or peremptory action, they are much less likely to tell what they know. So it is vital that the accent should be on improving performance rather than imposing sanctions. Just because hospital managers become aware of a problem does not of itself solve it. Some managers are notoriously bad at dealing with poor performance. Even if doctors complain to management about a colleague, there is no guarantee that managers will act.

Which raises an interesting dilemma. Many trusts enjoin their staff not to leak information to the outside world - for a mixture of commercial and administrative reasons. Staff are often asked to sign "gagging clauses" in their contracts. This sits oddly with the fact that doctors will now be asked to inform on colleagues. Doctors concerned at management inaction over incompetence by other doctors, should be indemnified against disciplinary action if they decide to go public.

Many will also worry about whether the GMC is the right body to preside over cases of professional incompetence. After all, as the profession's own internal regulator, it can hardly be said to be independent - despite increases in its lay membership. Its primary interest is in safeguarding the medical profession rather than achieving the optimum result for patients.

Before we rush to set up OffDoc, however, we ought to see how well this self-regulation works in practice. There are good practical reasons for wanting to avoid the setting up of a professional inspectorate into medical practice - not least because of the danger that such a body would quickly become out of touch with the latest medical and surgical techniques. The GMC itself has strong motives for wanting to convince us that self- regulation will work for doctors, where it has manifestly failed for the legal profession. Nevertheless it must know that, from now on, it is on trial.

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