underperforming doctors

Seven health authorities in Trent region are piloting a scheme developed by Sheffield University's school of health and related research to identify and tackle poor performance by GPs. This entails setting up a 'performance review quartet' - a panel representing the HA, local medical committee, medical audit advisory group and people involved in continuing medical education.

The panel investigates concerns about individual GPs by examining information readily available to HAs, including data on prescribing, referrals, immunisation, training and demography. Complaints by patients are not always a reliable indicator, says Dr Helen Joesbury, a GP overseeing the project. 'A nice GP who is incompetent might not get complaints, whereas a crotchety GP might be very competent,' she says.

She estimates that between 1 and 2 per cent of GPs have a real problem, although no minimum standards exist.

If the panel confirms the problems it arranges an assessment visit. If the problems are severe and do not respond to remedial measures, it will refer to the GMC or trigger disciplinary procedures. Otherwise, the panel considers how to help the GP improve practice.

GPs usually respond in one of three ways, says Dr Joesbury. Some are surprised at the concerns and co-operate well. Some confess a catalogue of personal and health problems. Others are completely hostile and refuse help.

Often there are many factors contributing to the problems, she says. GPs with problems may be isolated, out of touch and suffer physical or personal stress. Support can include training, either for the GP or their practice staff, which should be tailor-made to the circumstances. Some doctors need help to sort out personal or financial problems. For others, simply recognising the problems changes behaviour.

'Some inevitably see it as punitive, but it is not intended to be,' Dr Joesbury says. 'The whole point is it is intended to be supportive.'