Primary care managers have welcomed the government's white paper on regulation of health professionals.

The NHS Confederation's primary care trust network approved of amendments allowing patients to complain directly to PCTs about their GP. But it warned that the cost of introducing regulation, which requires health professionals to prove fitness to practise every five years, would be a challenge.

The white paper Trust, Assurance and Safety - the regulation of health professionals in the 21st century also states that professional regulators will be independent of government and comprised of a 50:50 split of professionals and members of the public, and that the civil standard of proof 'on the balance of all probability', as opposed to the criminal standard of 'beyond reasonable doubt', should apply in fitness-to-practise cases.

David Stout, director of the NHS Confederation's primary care trust network, said: 'We strongly welcome the amendments that will enable patients to make complaints about their GP direct to their primary care trust.

The British Medical Association said that the proposals add up to the loss of professionally led medical regulation and 'have the potential to muzzle doctors in their role of speaking out for patients'.

BMA chair James Johnson said: 'Doctors recognise the need for change. The BMA supports measures that promote excellence but doctors need to have confidence that the regulatory system will lead to support and retraining if necessary and not be merely punitive.'

A General Medical Council. spokesperson said: 'Regulation is a dynamic process. it should not stand still. It must be scrutinised, challenged and improved.'