Leading article: Doctors fit for the purpose

All patients about to go under the knife or be dosed with powerful drugs want to be certain that the doctor treating them is competent to do the job, in the same way that every airline passenger wants to know that the pilot is fit to fly the plane. Yet while checks on pilots' fitness have been routine for decades, there are no rules to ensure doctors are up to scratch.

From the Bristol babies' heart surgery disaster in the late 1990s, to the Harold Shipman murders, a series of scandals has exposed the remarkable fact that from the moment doctors qualify to the moment they hang up their stethoscopes some 40 years later, there may be no checks on their performance.

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Now, the Chief Medical Officer, Sir Liam Donaldson, has published new proposals for five-yearly MOTs, backed by annual appraisals, for all Britain's 150,000 doctors. This is not exactly a first. The proposals have been debated for at least a decade, were fiercely opposed by the medical profession (leading to a bruising row with the General Medical Council), and were originally due to be implemented in 2005.

Those plans were holed below the waterline by Dame Janet Smith in her final report from the Shipman Inquiry in 2004. She said that they had been so watered down – to accommodate opposition from the profession – that they were useless. To compare them to the MOT for cars was, she said, a travesty.

So it was back to the drawing board and an extended period of frosty relations between the Chief Medical Officer, the GMC and the British Medical Association as they sought to thrash out the new set of proposals that are published today. This time, all three organisations have signed up to them, indicating that a compromise has been reached, designed to satisfy critics such as Dame Janet, but which is also acceptable to the profession as a whole. The unanswered question, though, is whether the tests will be tough enough to protect patients.

No system could guarantee to detect a Shipman, a man who was bent on murder. What it must do is provide early warning of problems, in time for them to be remedied by training or monitoring. Critics complain that this will simply add to bureaucracy. The argument goes that if doctors spend too much time checking up on each other, rather than their patients, we will all be the losers.

This is a counsel of despair from those who have not got the message about patient safety. No passenger would be interested in flying with an airline that had not been subject to the proper checks. It is part of what we pay for. Similarly, no patient should tolerate treatment from a doctor who has been subject to anything less than rigorous checks of their performance.