A patient has his blood pressure taken in this undated file photo

Britain's 150,000 doctors will have to show they are fit to practice once every five years in the nation's biggest change to medical regulation for 150 years.

Doctors falling below standard risk being struck off the medical register unless they improve, under plans published by England's Chief Medical Officer Liam Donaldson on Wednesday.

At present doctors can only be debarred if complaints about their conduct or medical practice are upheld by regulators at the General Medical Council.

Last year the GMC struck off a total of 60 doctors.

Most doctors already undergo annual peer performance reviews, looking at factors such as prescribing habits and how up to date they are on the latest medical advice and research.

Under the new scheme these reviews will be standardized and patients will also be asked for their views on issues such as doctors' communication skills and ability to involve the patient in treatment decisions.

The new appraisals will begin in pilots in late 2009. Doctors will need to be recertified as competent every five years.

"There hasn't been that process before," said a Department of Health spokeswoman. "Once someone was certified they could be a doctor for 50 years, the way the current system works."

GMC President Graeme Catto said the plans were "the biggest change to medical regulation in one hundred and fifty years."