Doctors who do not apologise to their patients for mistakes could be struck off under new regulations proposed by the General Medical Council.

The medical regulator has announced it is considering tougher sanctions against doctors who cause harm to their patients or are underperforming, in an effort to improve public trust in the body.

The GMC, which has the power to strike off, suspend and restrict the practice of British doctors, said the sanctions would also mean doctors who had made previous mistakes and had since retrained could be struck off if they showed no improvement. The consultation also proposed that those who refuse to apologise to patients and relatives would be subject to harsher sanctions, and could be banned from practising.

While there are already extensive guidelines in place against doctors' malpractice, the GMC said this was a move to protect patients in a small number of cases where the public have called for the profession to be more strictly held to account for its actions.

Niall Dickson, the chief executive of the GMC, said: "Doctors are among the most trusted professionals, and rightly so. In the vast majority of cases, one-off clinical errors do not merit action by the GMC.

"But if we are to maintain that trust, in the small number of serious cases where doctors fail to listen to concerns they should be held to account for their actions."

Harsher sanctions could also apply to doctors who fail to report their colleagues' mistakes or take action when patients are not being cared for properly.

Dickson said: "There have been occasions when we have been prevented from taking action in cases because the doctor has been able to show that they have subsequently improved their practice. We believe that doctors and patients want stronger action in these serious cases.

"It is also right that patients or their families are told what went wrong and if appropriate they should be given a full apology. We believe this should be taken into account when deciding what, if any, sanction needs to be imposed to protect future patients and uphold the reputation of the profession."

However, Peter Walsh, from the charity Action Against Medical Accidents, said that while the changes were an encouraging sign, he was frustrated that they were not as far-reaching as his charity had previously called for.

Walsh told the BBC: "These measures are a step in the right direction but they are not yet wide enough or comprehensive enough to make it a genuinely patient-centred process."

The GMC said it was calling for input from patients, doctors and other professionals on the consultation, which will run until 14 November. The results will be published next year.