Radical proposals to shake up the regulation of doctors, including what was immediately dubbed a "copper's nark" in every hospital, met with serious opposition from the profession yesterday.
The plans, published by the chief medical officer, Sir Liam Donaldson, include overhauling the General Medical Council, which regulates and disciplines doctors. The self-regulation doctors have enjoyed for decades would be watered down.
At the moment, the GMC investigates, prosecutes and judges errant doctors. Under the Donaldson plans, cases will be decided by an independent tribunal. More doctors could theoretically be struck off because the prosecution will no longer have to establish misconduct beyond reasonable doubt - the criminal standard of proof - but by the easier measure of the balance of probability, as in civil cases.
But it is the proposal to place in every hospital and primary care trust a "GMC affiliate" - a practising doctor who will monitor colleagues and report concerns to the central body - that is expected to disturb doctors most.
In a statement, the British Medical Association council chairman, James Johnson, said the proposal "would place a huge responsibility on one person ... I believe this will be one of the most difficult recommendations to implement".
He said changing the level of proof in GMC cases was likely to attract "huge criticism" from doctors. "It seems wrong to be able to take away a doctor's livelihood because of something found on a balance of probability ... It opens the door to miscarriages of justice which will devastate the lives of doctors and their families."
The BMA also dislikes the proposal to scrap the election of GMC members by doctors and have them appointed by an independent commission.
Sir Liam's report, Good Doctors, Safer Patients, was commissioned by the health minister, Lord Warner, after the inquiry into the murders of up to 250 patients by the GP Harold Shipman. Dame Janet Smith, who chaired the inquiry, levelled heavy criticism at the GMC in December 2004, saying its culture, membership, working methods and governance tended to favour doctors over patients.
Sir Liam's far-reaching reforms, which will cost the NHS, the Department of Health and doctors £70m-80m, would give the GMC a broader role in detecting and helping under-performing doctors early on by devolving some of its powers to the local "affiliates".
The NHS now operates an appraisal system for doctors, but Sir Liam says the quality varies in hospitals, while GPs largely assess themselves. The report proposes assessment led by the GMC. Every few years all doctors will have to seek renewal of their licence to practise, and specialists will be assessed and "recertified" by their medical royal college.
