Published: 13/06/2002, Volume II2, No.5809 Page 20

A toothless code of conduct will have no impact on the behaviour of those senior managers who are ethically challenged and are not highly principled ('Crisp launches code of conduct for managers', news, 23 May).

The major threat to doctors is that of erasure from the General Medical Council register, a career-terminating event which undoubtedly impacts on the behaviour of some of the potential bad apples in the medical profession.

For NHS chief executive Nigel Crisp to liken the proposed code to the professional code of conduct for doctors because it 'reads across with the GMC one' misses the point of regulation and accountability. A code without a register and consistent, enforceable sanctions for code breaches remains words to aspire to and nothing more.

The Department of Health should act like the GMC and hold a central register of all directors, as well as board level executives and non-executives, and take responsibility for standards and discipline at senior managerial levels within the health service.

To do less is to abrogate responsibility and does nothing to strengthen public belief that the NHS is being run to high ethical standards. The draft code should be applauded, but it should be given proper teeth.

Dr Nigel Dudley Consultant in elderly medicine St James's University Hospital Leeds