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But as with any large workforce it is inevitable that problems will occur with a minority. Over most of its history, the NHS has found great difficulty in addressing such problems - albeit involving a small minority of the medical workforce - in a way which gives priority to protecting patients, whilst at the same time recognising that disciplinary solutions are not always the fairest and most appropriate way of dealing with doctors who have genuine problems in their practice.

A new approach was agreed in 2000 based on early identification of problems and rapid objective assessment of the doctor concerned by a National Clinical Assessment Authority.

Problems with the suspension of doctors have continued, highlighted by the recent report from the National Audit Office, The Management of Suspensions of Clinical Staff in NHS Hospital and Ambulance Trusts in England.

CMO's Annual Report 2002 called for urgent action to replace the existing guidance on suspension of doctors and dentists and this has now been provided by the publication of HSC 2003/012 Maintaining High Professional Standards in the Modern NHS: a framework for the initial handling of concerns about doctors and dentists in the NHS which will be implemented by the Restriction of Practice and Exclusion from Work Directions 2003.

• The Management of Suspensions of Clinical Staff in NHS Hospital and Ambulance Trusts in England (opens new window)
• Annual report of the Chief Medical Officer 2002
• HSC 2003/012 - Maintaining high professional standards in the modern NHS: a framework for the initial handling of concerns about doctors and dentists in the NHS