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Performance best judged by local clinical governance

Local clinical governance is best placed to define whether a GP is performing adequately, a primary care academic has argued.

Dr Malcolm Lewis, director of postgraduate GP education for Wales, said that in establishing the boundaries between acceptable and poor practice for relicensing doctors, local clinical governance systems would get the best results.

He said: 'I'm not sure that conceptually the college is in a position to be able to say where the line is and to know how to identify it. You're more likely to get that through local clinical governance processes.'

Dr Lewis said appraisal should be about sustaining, improving and assuring the professional standards of the overwhelming majority.

But rather than the RCGP creating a 'package' to allow people to demonstrate high standards in certain areas, he advocated the use of clinical governance systems which employed local information including self-reporting and sampling.

He said where local governance systems had flagged up problems, appraisers and medical directors were already deferring their decisions, demonstrating that appraisal works as part of the clinical governance spectrum.

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