More than half of the 200,000 doctors in Britain have not yet signed up for a new licence that they need to continue working next year, The Times can reveal.

All doctors will, by November, be required by law to have a new licence to practise medicine as part of the biggest overhaul of medical regulation for 150 years.

The licences, to be issued by the General Medical Council (GMC), are the first practical step towards major reforms in which doctors will face mandatory annual appraisals to ensure they are fit to practise and are maintaining their clinical skills.

However, about 110,000 doctors - 55 per cent of the total - have yet to sign up to the system and the GMC is urging them to do so by the deadline of the end of September.

The wider system of revalidation, prompted by a series of medical scandals such as the Harold Shipman affair, is due to be phased in from 2011 but the announcement of the start date comes amid signs of disquiet among the medical profession, with some doctors saying that the reforms will force them to leave medicine.

A poll carried out for The Times of more than a thousand hospital consultants and GPs found last week that one in six doctors was considering a change in career due to the new regulations, while one in 12 might stop practising medicine altogether.

The GMC says it expects the vast majority of doctors who wish to continue practising to have a new electronic licence by November, but the watchdog is commencing a “reminder” campaign at the end of this month in an attempt make sure anyone currently on the medical register who wishes to be included in the system is not left out.

All those who apply will have to renew their licences every five years, subject to the results of the annual appraisals, which will involve “multi-source feedback” — including the views of colleagues and patients.

Peter Rubin, the new chairman of the GMC, said that the scheme presented the biggest challenge for the regulator since it was founded in 1858 but he sought to reassure doctors that the process would mainly supplement existing procedures and would not tie them up in red tape.

“We are going to introduce revalidation in 2011. The first step is to implement the license to practise, and we’re going to go live with this licence on November 16,” he said. “Change always brings uncertainty and we are very aware of this. We have a job to do to make sure that all doctors know what's expected of them. [But] we are determined that this will not be a cumbersome, intrusive, bureaucratic process.”

In his first interview since taking up his post in April, Professor Rubin said that he expected the vast majority of the 150,000 doctors who are currently actively practising medicine in Britain to sign up. Certain groups — including doctors working overseas, in academia or the pharmaceutical industry — may not require a new licence if they do not intend to treat patients or perform other clinical duties in Britain.

Many NHS trusts already carry out performance-related checks on practitioners but an annual assessment asking doctors to provide evidence that they are keeping their clinical skills up to date and providing good care will become mandatory from 2011.

Some doctors argue that the changes are largely unnecessary, as they would not have caught Shipman, Britain’s most prolific serial killer.

The annual appraisals could cost as much as £16.7 million a year and will be signed off by senior doctors, known locally as “responsible officers”, which the Department of Health is currently recruiting.

Concerns remain, however, about how the assessments will be carried out, particularly for specialists cultivating their own field of research, or for doctors working in isolation rather than in teams.

Pilots are being carried out in some hospitals and primary care trusts, Professor Rubin said, but he emphasised that many details were yet to be worked out and that the process would not be rushed. “I don’t think that revalidation will be implemented in every specialty, every organisation, in every part of the UK, at the same time,” he said. “Those that are ready will start [in 2011] and those that are less ready will come along behind. But we are confident that enough specialties and organisations asre ready for us to start the ball rolling in 2011.”

Jonathan Fielden, chairman of the British Medical Association’s consultants’ committee, said: “Everyone in medicine agrees that we have moved on to a situation where doctors need to positively affirm what good they are doing for patients. The first step towards this is to make sure everyone who wishes to treat patients has a licence to do so. The detail of the wider process has yet to be worked out, but whatever happens it must not increase the bureaucracy for doctors or become a burden that takes them away from treating patients.”

Steve Field, chairman of the Royal College of GPs, said that licences would provide an accurate picture of the number of doctors practising in Britain, as retired doctors can still remain on the medical register.

“We welcome this start date, but doctors need clarity on how appraisals will work. The NHS needs to take this seriously, especially in England.”

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