MEDICAL SELF -REGULATION ANDTHEMEDICAL ROYAL COLLEGES

been a profound change in the way doctors are perceived by the general public and by regulatory authorities. Until recently it was generally accepted that doctors who had completed an accredited examination and were working in a senior capacity were competent at their jobs and cared for their patients appropriately. The greater knowledge of patients about medical matters, together with the development of lobby groups and their influence on medical policy decisions, has challenged the traditional self-regulation procedures of the medical establishment. These were rocked fundamentally by the ‘earthquake’ affecting British medicine (Klein, 1998; Smith, 1998) following the report of the Bristol heart surgery inquiry. The state had to take action, the need for clinical governance became imperative (National Health Service Executive, 1999) and the effects of the new procedures on the regulation of the work of doctors is now apparent to all working in Britain today.