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At the heart of general practice since 1960

GPs are urged to be more suspicious of each other

The academic who uncovered the scale of Harold Shipman's crimes has called for far stricter checks on GPs' clinical performance and for GPs to trust each other less.

In a report for the Shipman Inquiry, Professor Richard Baker, director of the Clinical Governance Research and

Development unit at the

University of Leicester, laun-ched an attack on GP appraisal and revalidation.

The report, Monitoring, proposed wholesale changes in assessment of GPs and argued the GMC's revalidation plans 'would not deserve public confidence' unless they could detect another Shipman.

Professor Baker also said GP appraisal 'cannot be regarded as a searching assessment of competence or performance' and should not be the basis for revalidation.

He called for an additional system on top of appraisal and revalidation to monitor GPs' clinical performance and for lay people to watch GP consultations as part of appraisal.

His report, which informs the fourth stage of the Shipman Inquiry, argued GPs must trust each other less to ensure poor-performing colleagues are uncovered.

It also proposes a central register of all complaints against GPs, closer monitoring of GPs' records and for PCOs to investigate practices that do not refer many complaints.

GPs warned the proposals would be a knee-jerk reaction that would demoralise the profession.

GPC negotiator Dr Laurence Buckman said the recommendations were inappropriate: 'GPs won't tolerate being policed in this way. It's demoralising.'

In evidence to the Shipman Inquiry last week, GPC chair Dr John Chisholm said appraisal evidence was not enough on its own for revalidation, but warned against extra bureaucracy.

But Dr Chisholm added revalidation and appraisal were 'not the tools to prevent a recurrence of the Shipman tragedy'.

Some of Professor Baker's

recommendations:

lAppraisal and revalidation should include more objective performance reviews and checks of a sample of dead patients' records.

lNurses should be trained to screen patient records and refer those causing concern.

lCHI, NPSA and NCAA are not robust enough to detect poor-performing GPs.

lPCOs should investigate practices that report few compla;ints

lGPs and defence bodies should tell PCTs about convictions, pending civil cases and report deaths in the practice.

lA central register of complaints should be kept, possibly by the NCAA.

lGPs should be more willing to discuss treatment options with patients, rather than acting 'paternally' and telling them what is going to happen.

lGPs should not always trust each others' explanations for unusual events.

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