Surgeons belong to a “profession adrift” that is in urgent need of reform, a leading medical journal has claimed.

An editorial in The Lancet said little progress had been made since the journal raised concerns about the quality of some surgeons’ research and practice a year ago.

A framework of improvements called Ideal (Idea, Development, Exploration, Assessment, Long-term study) was set out and surgeons challenged to transform their field into a “world-class discipline”.

In a special issue today, the Lancet said it had returned to the theme of surgery to see what changes had taken place.

The editorial said: “Recent headlines in the UK suggest not so much a world-class discipline but a profession adrift.”

It cited a recent report on cosmetic surgery in the UK, pointing out that only 47% of 760 eligible centres agreed to participate in the National Confidential Inquiry into Patient Outcome and Death audit.

Among the units that replied, concerns rose over low-volume procedures, inadequately equipped operating theatres, anaesthetic cover, and emergency care provision.

“That such revelations must come from outside the surgical community implies a lack of professionalism and leadership among the surgeons involved,” said The Lancet.

Internationally, a third of the world’s population - those with the greatest burden of surgical disease - were said to have the lowest access to surgical facilities,

The editorial criticised surgeons for not being more pro-active in promoting better standards.

“Surgeons, as patients’ advocates, should be active and united in drawing attention to inadequacies as part of an agenda of reform that promotes professionalism and leadership,” said The Lancet.

“But surgeons are largely absent from the debate, and with one or two notable exceptions… the profession is visibly absent from higher positions in health care.”

The editorial concluded: “Broadening surgical influence effectively requires strong, visible leadership and a commitment to education that develops the core principles and unique skills of the profession; otherwise surgery’s noblest aspirations risk being subsumed by the basest common interests.”

The Royal College of Surgeons hit back, claiming the journal had got its facts wrong.

A spokesman said: “It is curious to read the Lancet decrying surgeons as being absent from the debate of improving healthcare - this is not a description based on fact.

“Surgeons are leading the way in medicine for the collection and reporting of outcome measures. In just the past few weeks alone, the Royal College of Surgeons have helped to widely publicise where reform is needed in access to stroke and obesity surgery and the treatment of hip fractures.

“In the field of education, Medical Education England’s main work to date has been the Temple and Collins reports, both led by surgeons, and in the Department of Health the medical director (Sir Bruce Keogh) and a very recent minister (Lord Darzi) are surgeons.”