A major shake-up in the way doctors are regulated in the UK is to be outlined by ministers.
Doctors are to lose the power to regulate themselves and senior medics will face regular MOT-style checks under a planned shake-up of regulation.
The government is acting after Chief Medical Officer Sir Liam Donaldson made the case for reform last year.
The overhaul, which will now be debated by parliament, has been announced by ministers following the Shipman murders and other medical scandals.
Ministers are expected to accept his call for doctors to face MOT-style tests, while stricter checking of death certificates will also be put forward.
A stricter system of death certification is also to be introduced.
It comes after the inquiry into killer GP Harold Shipman criticised the way doctors were regulated.
The General Medical Council is set to lose its power to adjudicate on fitness-to-practise cases.
Shipman, from Hyde in Greater Manchester, murdered more than 200 people over a period of 23 years.
Patient safety is the overriding concern Andy BurnhamHealth Minister
Let's hope the government will at last deliver where the medical establishment, left to itself, has so far failed us Roger Goss, of Patient Concern
The GMC will also have to change its membership to 50% doctors, 50% lay people in a move away from the much criticised profession-led regime.
Similar systems are being introduced for the other eight health professional regulatory bodies, covering the likes of dentists, pharmacists and nurses.
Rogue doctors
The proposals - the biggest overhaul of regulation in a generation - have been made by the government in a white paper and response to recent cases where patients have been harmed by doctors.
Dr Harold Shipman, from Hyde in Greater Manchester, murdered more than 200 people over a period of 23 years.
Dame Janet Smith, who chaired the inquiry into the case, accused the GMC regulatory body in her 2004 report of being more interested in looking after doctors than protecting patients.
Dame Janet Smith, who chaired the inquiry into the case, accused the GMC regulatory body in her 2004 report of being more interested in looking after doctors than protecting patients.
She did not blame the GMC for failing to detect Shipman's killing spree but said the culture in the medical profession was to focus on doctors' interests.
She did not blame the GMC for failing to detect Shipman's killing spree but said the culture in the medical profession was to focus on doctors' interests.
The MOT-style checks, or revalidation as it is also called, will be carried out every five years, ending the situation where once doctors qualify as GPs or consultants they no longer face formal reassessment.
The medical profession has also come under fire following other scandals, such as Clifford Ayling, a Sussex GP who sexually abused patients.
Death certificates will also need to be signed off by someone appointed by the local NHS trust as well as the relevant doctor.
The proposals include:
Senior doctors such as GPs and consultants are to face five-yearly MOT-style checks, known as revalidation.
Medics who fail the tests will have to undergo retraining and supervision and may even be struck off the medical register.
The GMC is to lose its power to adjudicate on fitness-to-practice cases, which will be considered by an independent body.
Such cases will also be judged on a civil standard of proof - on the balance of probability - albeit with a sliding scale depending on the seriousness of the allegations. At present, they are based on the criminal standard - beyond all reasonable doubt.
The GMC will be left to concentrate on investigating complaints against doctors.
However, the GMC will be allowed to keep control of undergraduate education - despite Chief Medical Officer Sir Liam Donaldson calling last year for it to lose that responsibility.
All regulators will be expected to move towards at least a 50:50 split between lay and professional members.
NHS trusts will have to appoint a "medical examiner" to sign off all death certificates filed by doctors. At the moment, this only happens routinely for cremations.
Health minister Andy Burnham said he hoped the proposals would settle once and for all the controversies over doctor regulation.
HAVE YOUR SAY The proposals will provide lots of jobs for administrators and increase registration fees Dr B Green, Cheadle Send us your comments
HAVE YOUR SAY The proposals will provide lots of jobs for administrators and increase registration fees Dr B Green, Cheadle Send us your comments
The government's white paper, Trust, Assurance and Safety: The Regulation of Health Professionals in the 21st Century, will also deal with other recommendations raised by Sir Liam.
"Patient safety is the overriding concern. It is crucial to ensure the systems we are imposing ensure the confidence of patients and the wider public and command professional confidence."
He proposed handing adjudication of fit to practise cases to an independent body, leaving the GMC to investigate complaints.
Sir Liam said MOT-style checks would correct the situation where doctors can go their whole career without facing assessment whereas an airline pilot can expect 100 checks over the same period of time.
And he said the burden of proof in these cases should be changed to "on the balance of probability" rather than "beyond reasonable doubt" as it is now.
He said: "I am confident that the proposals will set out a framework through which patients, the public, professions and government secure a new settlement that assures the safety of patients."
He also suggested moving undergraduate medical education from the GMC to the Postgraduate Medical Education and Training Board.
Professor Ian Gilmore, president of the Royal College of Physicians, welcomed the proposals.
Burden of proof
"Patients need to know that their doctor can treat them safely and to a high clinical standard - the new national framework will give both doctors and patients more confidence in the regulatory system."
When he launched the report, Sir Liam said: "Patients put their trust in doctors often at a major moment in their lives.
"They are right to do so, but my review has shown that the public and doctors think that this trust must be underpinned by a strong system to assure good practice and safe care."
The British Medical Association, the doctor's trade union body, has objected to lowering the burden of proof, while GMC officials have said they want to keep responsibility for education and adjudication.
Neither body has objected in principle to the so-called MOTs of doctors.
But Dr Hamish Meldrum, chairman of the BMA's GPs committee, said it would depend on the practicalities and he would not want to see half of doctors "charging around the country appraising the other half".
Roger Goss, co-director of Patient Concern, said they were hoping for a strong response in the white paper not only for those affected by Shipman but in answer to other medical scandals.
"Victims and survivors deserve the lasting memorial of an effective system for spotting and stopping people like them before they have inflicted horrendous harm on lots of patients.
"Let's hope the government will at last deliver where the medical establishment, left to itself, has so far failed us."
