A major shake-up of the regulation of the medical profession, the first in 150 years, could see large acute and primary care trusts become affiliate outposts of the General Medical Council.

A major shake-up of the regulation of the medical profession, the first in 150 years, could see large acute and primary care trusts become affiliate outposts of the General Medical Council.

Last week, chief medical officer Professor Sir Liam Donaldson delivered the government's long-awaited response to the investigations and public inquiries into mass murderer Dr Harold Shipman and the baby deaths at Bristol Royal Infirmary.

He said his proposals would mean the earlier detection of rogue doctors, faster investigation and increased patient safety.

Sir Liam said he had looked to best practices in industries such as aviation, where safety is paramount. He has made 44 recommendations, including proposals for continuous assessment of doctors' performance via a system of revalidation checks.

The recommendations could double the current cost of medical regulation to over£156m. The Department of Health would bear£19m of the extra costs, the NHS£41m and doctors some£18m.

Over the years the GMC has been criticised for being 'too protective of doctors' as it has the triple role of setting standards of medical practice and being judge and prosecutor where there are concerns over performance or competence.

Instead an independent tribunal system will be set up to adjudicate on fitness to practice matters and the GMC would focus on assessment and investigation of cases.

The GMC would also devolve some of its powers to a network of GMC affiliates working closely with employing NHS organisations. Sir Liam said the exact structures had not been worked out yet, but he speculated that affiliates would be based in each PCT and every large hospital.

He said: 'This would not be a job for someone perhaps near retirement - it would be a prestige professional role.'

Local affiliates would investigate some fitness to practice cases locally and refer more severe cases to the GMC centrally. They would have the power to agree a 'recorded concern' which would be reported to the GMC centrally, but not impose any sanctions. The affiliate would be obliged to inform the doctors' employing or contracting organisation and any complainant when a recorded concern is accepted.

GMC members will no longer be elected but recruited via the NHS Appointments Commission. Revalidation will be a two-tier process with 'generic' medical competence the responsibility of the GMC and 'specialist certification' the realm of the relevant royal college.

NHS Alliance chief officer Mike Sobanja said he was worried that the revalidation exercise could become a 'tick-box exercise'. NHS Employers deputy director Alastair Henderson said it was right that employers' responsibility for ensuring the competency of staff is recognised.

A similar set of recommendations for non-medical healthcare professions was also launched last week. Both sets now go out to four months' consultation.