A vital gap in the governance of GPs could open once primary care trusts are abolished, the head of the National Clinical Assessment Service has warned.

NCAS director Alastair Scotland said vital questions remained unanswered about how GPs with behavioural and performance issues would be identified and managed in future.

The service, part of the National Patient Safety Agency, was established 10 years ago in the wake of high profile medical scandals to identify and tackle disruptive behaviour by doctors, dentists and pharmacists. It receives 1,000-1,200 referrals a year.

Professor Scotland, who is also NCAS medical director, said by far the largest group of clinicians - around 40 per cent - referred to the service each year were GPs. Most of these referrals came from PCTs.

He warned that primary care was the governance area he had most potential concerns about.

He told HSJ he would like to see the present model for PCT governance arrangements - with directors of governance and advisory groups - transferred to commissioning consortia.

However, Professor Scotland said it was unclear how governance would work where the person responsible for GP governance might also be under review.

He also warned potential conflicts of interest in governance arrangements for GPs in senior positions would need to be addressed, as there was a “striking” link between older clinicians and performance issues.

“The most senior people involved in those consortia are the most likely statistically to find their way to someone like NCAS,” he said.

“You are several more times likely to be referred to us as a GP over the age of 60 than if you are less than 40.”