The hearing dubbed the General Medical Council's 'case of the decade' must be sending shivers up the spines of health service managers who happen to be doctors.

One of three doctors charged with serious professional misconduct is John Roylance, former chief executive of United Bristol Healthcare trust and the first chief executive to face charges before the GMC.

An important issue in the case is whether the GMC's remit extends to the conduct of doctors acting as managers rather than as doctors. Dr Roylance is accused of letting heart operations on babies and children go ahead notwithstanding figures considerably higher than the national average for brain damage and death.

Two surgeons are accused of carrying out operations beyond their technical competence although they were aware of concerns about their results.

The hearing resumes on 12 January and is set to go on until April.

In a dramatic twist just before it adjourned in December, lawyers for all three doctors, with the support of the Medical Defence Union and Medical Protection Society, made an application - unprecedented before the GMC - for the committee to stand down on the grounds of bias.

They alleged that questioning of witnesses by the chair, GMC president Sir Donald Irvine, showed that he had made up his mind in advance.

The committee decided to stand its ground and go on with the hearing.

One lesson likely to come out of the case is the need for a recognised mechanism within trusts for raising concerns about colleagues' competence.