• L Southgate, J Cox, T David, D Hatch, A Howes, N Johnson, B Jolly, E Macdonald, P McAvoy, P McCrorie, and J Turner.
• Centre for Health Informatics and Medical Education (CHIME), Royal Free and University College Medical School, London, UK. l.southgate@chime.ucl.ac.uk
• Med Educ. 2001 Dec 1;35 Suppl 1:2-8.

BackgroundModernization of medical regulation has included the introduction of the Professional Performance Procedures by the UK General Medical Council in 1995. The Council now has the power to assess any registered practitioner whose performance may be seriously deficient, thus calling registration (licensure) into question. Problems arising from ill health or conduct are dealt with under separate programmes.MethodsThis paper describes the development of the assessment programmes within the overall policy framework determined by the Council. Peer review of performance in the workplace (Phase 1) is followed by tests of competence (Phase 2) to reflect the relationship between clinical competence and performance. The theoretical and research basis for the approach are presented, and the relationship between the qualitative methods in Phase 1 and the quantitative methods in Phase 2 explored.ConclusionsThe approach is feasible, has been implemented and has stood legal challenge. The assessors judge and report all the evidence they collect and may not select from it. All their judgements are included and the voice of the lay assessor is preserved. Taken together, the output from both phases forms an important basis for remediation and training should it be required.

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