procedure. There have been occasions when both sides have agreed to follow the procedure of the Advisory, Consultation, and Arbitration Service, and it would seem worth while for the Department ofHealth and the profession to give further thought to incorporating this in the guidance. The proposals for increasing self regulation by the profession through "three stern men" would also help for less serious incidents of personal or professional misconduct. Allegations of professional incompetence against junior doctors present real problems and tend to be dealt with informally by not reappointing them or by counselling them towards another specialty. Nevertheless, other NHS employees have felt that "double standards" may exist, and ofcourse theGMC has no powers to consider matters of professional competence, though the council is now reviewing the scope of its disciplinary procedures (14 May, p 1409). Given the increasing number of ways in which a practitioner's performance can be challenged, it is astonishing how little this subject is either taught or understood. The recent guide and theGMC handbook should be read by every doctor because it really could happen to anyone. Meanwhile, NHS management, while recognising that the NHS is to all intents and purposes a monopoly, has also to satisfy mounting public concern over the standards of professional care. We can only hope that the negotiations and the GMC's review are successful. MALCOLM FORSYTHE Regional Medical Officer, South East Thames Regional Health Authority, Bexhill on Sea, East Sussex TN39 3NQ
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