Managers have came under fire from both sides in a debate on the future of professional self-regulation for failing to deal with incompetent or improperly behaved health professionals.

Speakers shifted the blame for failings by the General Medical Council and the UK Central Council for Nursing, Midwifery and Health Visiting onto managers.

Celia Davies, professor of healthcare at the Open University, said: 'Regulatory bodies must be the very last resort. What we need is better management.'

Managers were quick to refer nurses to the UKCC but reluctant to take the same action for doctors, even when complaints arose from poor teamwork, she said. The result was resentment between the professions and lack of confidence by the public in complaint mechanisms.

Her opponent Bob Nicholls, a health management consultant and lay member of the GMC, said that 85 per cent of patient complaints arose from errors in management or teamwork. Only 15 per cent involved an error by an individual.

He said: 'The GMC hears 4,000 complaints a year and the vast proportion are nothing we can do anything about.

These cases should have been dealt with at a different level.'

The debate was organised by the King's Fund, with an audience invited to discuss whether professional selfregulation could maintain public confidence and meet the government's need to control the professions. Over half the 75-strong audience felt it could.

It came as the GMC opened a high profile hearing against a doctor who was struck off the register in his native Canada in 1985 but continued to practise in the UK until last year.

Contributors called for better lay representation on regulatory bodies and better accountability, but agreed that self-regulation should remain in place. More emphasis should be put on education and standard-setting, rather than disciplinary procedures.