Published: 05/02/2004, Volume II4, No. 5891 Page 8 9

The National Clinical Assessment Authority has said that a 'national collation of primary care trust lists' of GPs would help to track their performance and conduct problems. It has also been suggested that smart cards could be used to hold certain details.

NCAA medical director Dr Alastair Scotland told the inquiry into GP Dr Harold Shipman that PCT lists were 'an invaluable repository' for 'important pieces of information about individual practitioners'.

He said there was no need for a national list of practising GPs, but said information needed to be shared 'in an assured way'.

Dr Scotland offered the idea of smart cards to hold some details, although he conceded that the technology was in its early stages.

'It holds, I think, huge promise if it is possible to introduce it in a way where every doctor - and indeed every employee - in the NHS had a smart card which had the occupational health information.'

Last week's Shipman inquiry seminar on monitoring and disciplinary issues considered improving procedures to deal with conduct, performance and health issues of GPs. In particular, it looked at when to refer to the General Medical Council or who should take responsibility for lesser concerns.

In 1992 a medical services committee investigation into Dr Shipman's conduct criticised his refusal to visit a stroke patient at home who was then admitted to hospital. The patient's husband said he had told Dr Shipman's receptionist about a deterioration in health, but Dr Shipman's notes recorded no such change.

Because of concern that the committee found fault with Dr Shipman's refusal to visit, rather than establishing whether he falsified notes, inquiry leading counsel Caroline Swift QC pressed participants on how 'conflicts of evidence' should be tackled today.

Inquiry chair Dame Janet Smith asked whether cases involving 'a difficult decision' should go direct to the Commission for Healthcare Audit and Inspection, which will be responsible for NHS complaints when it is established in April, rather than to PCTs, after concerns were aired over the expertise of PCTs to handle such complaints.

Dr John Grenville, representing the British Medical Association, said: 'PCTs have their eyes on an awful lot of balls at the moment... I would be worried that complaints were one of the ones they did not have their eye on.'

In tackling referral of cases to the GMC, Dame Janet also looked at case referral to and by the GMC, asking why screeners there did not yet use explicit criteria to 'import fairness, transparency and consistency into their decision-making processes'.

After questioning Council for the Regulation of Healthcare Professionals director Sandy Forrest about its remit, she said it was a 'pity' the council had no jurisdiction to monitor decisions by the GMC's investigations committee, including those not considered serious enough for full hearings.Although referred to the GMC, Dr Shipman's refusal-tovisit case did not progress because of the lack of evidence.