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Dr Welsby's belief that GPs are the only people capable of assessing general practitioners is quite correct. For several years in South Africa we in the Cape Town private sector have operated a voluntary and much less labour intensive peer review system with a view to negotiating higher consultation fees in return for reduced costs. Because about 50% of the medical funds' expenditure goes on pharmaceuticals, and because prescribing habits are easy to monitor, we have concentrated on drug costs.
Dr Welsby suggests that his proposed system would have detected much earlier the unprofessional habits of the late unlamented Harold Shipman. I would suggest that the current systems should have exposed him much sooner. I understand that Shipman was murdering his patients using heroin — which he was presumably getting from the local pharmacist or wholesaler. Why did the supplier of the heroin, and the NHS clerk who paid the accounts, not realise that Shipman was using more heroin than all the other area doctors combined?
Some years ago while doing the peer review at one of our emergency departments I spotted a previously unrecognised pethidine addict by the simple process of looking at the dangerous drugs register. He was prescribing more pethidine in a day than the other doctors in a month.