Managers are calling for stronger guidance from the General Medical Council on the ethical duties of doctors who work as managers.

A draft document prepared by the GMC in response to the Bristol tragedy 'doesn't go far enough' according to the NHS Confederation. Associate policy director Cathy Hamlyn welcomed the guidance, but warned that advice to record objections to decisions that could affect patient safety was 'too limited'.

'The document talks about the duty to make your views known if there is a 'need to protect the public',' she said. 'The bit that is missing is any action as a result.'

Ms Hamlyn, former chief executive of Sheffield health authority, said the guidance should spell out how managers could approach the Commission for Health Improvement 'which has a right to interfere' or 'take the matter further in the NHS hierarchy' before going public with their views.

The GMC has agreed to publish the paper in the spring, following consultation with 'interested organisations'. Copies will be sent to clinical and medical directors, directors of public health and other doctors with 'direct management responsibilities'.

GMC standards committee chair Sir Cyril Chantler - ex-chief executive of Guy's Hospital in London - told HSJ: 'We have tried to give some guidance but it is not something where you can provide an obvious solution.'

The GMC had 'tried to set out a framework', he added. 'If there is a complaint you should be able to demonstrate that you have taken action.'

Concern about the role of doctors working in management was sparked by the case of former United Bristol Healthcare trust chief executive John Roylance, one of two doctors struck off the GMC register in the wake of the Bristol babies tragedy.

The guidance was drawn up by a committee including Institute of Health Services Management director Karen Caines and Jenny Simpson, chief executive of the British Association of Medical Managers.

It says doctors in management 'have a duty' to 'make their views known' to chief executives, clinical or medical directors if they believe that 'patients' health or safety is being put at risk' by 'unsatisfactory' staffing levels or 'inadequate equipment or facilities'.

Doctors who sit on trust boards must ensure that objections to any decisions they believe 'would put patients at risk' are 'known and recorded'.

'It is your responsibility to decide whether to take further action, for example by making your concerns known publicly or to patients', the GMC warns.