Doctors face duty to report deficient colleagues

NICHOLAS TIMMINS

Public Policy Editor

A new duty is to be placed on doctors to "whistle-blow" on incompetent colleagues under plans to be announced today by Stephen Dorrell, the Secretary of State for Health. The move follows a string of cases where doctors have mistreated or misdiagnosed patients, but where colleagues have failed to report them despite, in some cases, being long aware of problems.

A working party chaired by Dr Kenneth Calman, the Chief Medical Officer, was asked in 1993 to review guidance on doctors' performance. This follows the case of Dr Carol Starkie, a consultant pathologist at Selly Oak Hospital, Birmingham, where patients with cancer were missed while children without cancer underwent unnecessary chemotherapy. It later emerged that some doctors had been unhappy with her performance for years.

Dr Calman's report, Maintaining Medical Excellence, makes a string of recommendations, some of which Mr Dorrell has accepted and others of which he will consult on. One of the latter is understood to be a recommendation that health professionals should have a contractual obligation to report concerns about a colleague's performance.

Dr Mac Armstrong, secretary of the British Medical Association, yesterday stressed that the number of incompetent doctors was small, but believed the profession would go along with the plan. He said: "Anything which improves patient care has to be accepted, however unwelcome the implications may be.

"No doctor will like drawing to the attention of clinical management that a colleague is not performing as well as he or she might, but it sometimes has to be done."

The General Medical Council - the doctors' disciplinary body - has already adopted that stance. Last year, it found a consultant anaesthetist guilty of serious professional misconduct for failing to report a colleague's dangerous practice. The council warned all doctors that "they must take action if they believe colleagues' professional performance to be deficient". In addition, Dr Armstrong said that NHS employers were increasingly "seeking to make employees responsible for the quality of their workmates' work". That presented a new face to the "whistle-blowing" argument, he said. On the one hand, Trusts were trying to prevent staff from talking publicly about NHS problems. On the other, "they are requiring them to inform employers if they suspect that colleagues are not up to the mark."

Mr Dorrell, speaking on BBC TV's Breakfast With Frost, said he hoped the proposals "will give extra teeth to what had already been the commitment of the medical profession ... to improving medical excellence".

Doctors whose performance is below par will be offered retraining. But Trusts may find it cheaper to dismiss them, even though retraining may be in the public interest given the investment made in their skills.

On the same programme yesterday, Mr Dorrell said the pay review bodies for doctors and nurses will survive, despite the introduction of local pay.

Doctor watch, page 13