The review of ‘The problem surgical colleague’ by Mr John Mosley is both timely and relevant. All surgeons are naturally concerned about the mechanisms in place, both locally and through the General Medical Council (GMC) to deal with fitness-to-practise issues. It is inevitable that criticisms, often unfounded, are voiced by the profession. Most surgeons welcome a fair and transparent system to deal with such matters whilst maintaining the principle of self-regulation. We must accept that there are a small number of surgeons whose practice is impaired to such a degree that they represent a serious patient-safety risk and they must be dealt with appropriately.

As a GMC medical case examiner since 2003, and having dealt with over 600 fitness-to-practise cases, I wish to comment on some of the important issues raised by Mr Mosley, specifically in relation to the surgeon and his or her practice. In doing so, I will set out the investigative process to be followed when fitness-to-practise concerns are brought to the attention of the GMC.

By means of a postal questionnaire to all members of the Association of Surgeons of Great Britain and Ireland, attitudes to the importance, timing, and assessment of research activity in surgical training were obtained. There was a 71% response rate. Most believe that a period of research is desirable, highly desirable or essential, irrespective of whether a University/Teaching or DGH consultant. The implications of incorporation of research into training programmes are discussed.

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