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GP skills gap between best and worst grows

The clinical governance programme ­ aimed at safeguarding high standards ­ has instead created a skills gap between the best- and worst-performing GPs, Government-commission- ed research suggests.

Results from a Primary Care Research and Development Centre study of 400 GPs suggest clinical governance is gradually becoming more acceptable to GPs but reveal that provision is patchy between and within PCTs because many practices lack necessary skills and IT.

Outline findings from the research, carried out in 12 PCTs over a three-year period and published in the centre's annual report, showed GPs had mixed feelings about increased managerial influence on their clinical practice. Others were worried about workload implications, leading to disparities in uptake of clinical governance between practices, the study showed.

A perceived threat to professional self-regulation in the wake of the Shipman case had motivated some GPs to espouse clinical governance, the research suggested.

This had helped create a new minority breed of GP ­ the 'doctor-manager' ­ who had taken the managerial responsibilities of clinical governance on board.

But Dr Mayur Lakhani, RCGP chair elect, who has a special interest in clinical governance, said any change in clinical governance activity had been superficial. 'Clinical governance has not captured the hearts and minds because the approach has been too managerial,' said Dr Lakhani who is due to take over as RCGP chair in November.

Dr Lakhani, who practises in Loughborough, agreed that clinical governance was inconsistent and that GPs need to become more involved. 'There are not enough GP leaders. They have been deserting in droves,' he said.

Study leader Dr Rod Sheaff, senior research fellow at the National Primary Care Research and Development Centre in Manchester, said: 'The message about national service frameworks is slowly being accepted as having an evidence base and good for patients.'

But he added: 'You always get some people who attempt it before the others, creating a gap.'

By Emma Wilkinson

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