I am amazed at the government's top-down prescription for dealing with doctors who are believed to be dangerous.

The problem is first that GPs as 'independent contractors' are not supervised and do not have normal contracts of employment, accountability structures or audit arrangement with the local health authority or primary care trust.

To ensure that GPs practise in an acceptable way, and are accountable to their patients and community, their independent contractor status must be abolished and local accountability, monitoring and management arrangements introduced.

Second, the watered-down local complaints procedure for GPs introduced in 1996 ensured they had little to fear from patients who had suffered at the hands of a bad doctor. The poorly performing General Medical Council has ensured that only the most grievous cases ever came to book. Will the government now regularise the employment of GPs and introduce powerful local complaints procedures? Not on your life.

Malcolm Alexander Chief officer Southwark CHC