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Appraisals could be used to 'name and shame' GPs over cancer referrals, local leaders say

Exclusive GPs have been warned against participating in an initiative for them to submit cancer cases they have worked on for their revalidation, for fear that it will be used to ‘name and shame’ them, in line with the health secretary’s proposals to improve delayed diagnoses.

NHS England (London)’s appraisal team has asked all doctors to include at least one study of a cancer case as a significant event analysis in this year’s appraisal, to contribute to a ‘collective investigation’ into problems in cancer pathways in the UK.

But local leaders have ‘strongly advised’ GPs against taking part because the letter says that the information could be used for ‘other purposes’, including ‘naming and shaming’ GP practices, they said.

The GPC and RCGP are set to release statements expressing their concerns about the use of appraisal for this investigation, warning that this was an ‘inappropriate’ use of the process.

The responsible officers at NHS England (London) said the initiative is voluntary and insist it will not be used to target individual doctors.

It follows plans by health secretary Jeremy Hunt to give a ‘red flag’ warning to individual GPs who fail to send cancer patients to hospital, which were criticised by GP groups for being a ‘crude’ system that ‘does not tell the full story’.

In a letter send out by the three London appraisal teams, responsible officers have invited GPs to consider including a recent cancer case and ‘share thoughts on anything that with hindsight might have made a difference to the subsequent outcome’.

The letter continues: ‘This will include personal and practice learning or development needs of course, but patient factors also delay presentation, as does GP access to diagnostic tools.’

But Londonwide LMCs medical director Dr Tony Grewal said there was no guarantee the information would not used by area teams for other purposes outside of the study’s aims and warned GPs it could lead to performance management in line with the Government’s ‘name and shame’ agenda to publicly identify individual GPs who fail to refer enough patients with a ‘red flag’.

Dr Grewal said: ‘[The appraisal teams] approached me about it initially and I thought it seemed like a good idea. But when the actual template came out it asked for far more than simply encouraging GPs to reflect and it also required the GPs to identify themselves and also give permission for those data to be used for purposes other than appraisal.’

However, he has heard reports ‘that some appraisers are actually instructing appraisees to fill in this reflection rather than simply offering it to them as a possible tool’, and that he was aware that ‘appraisers are being trained to assess them’.

He added: ‘It’s moving very rapidly from appraisal in confidence to performance management and name and shame. I’m afraid that area teams have shown before that what starts off as something informative and supportive, very rapidly becomes summative and punitive.’

He added: ‘My strong advice would be to avoid this completely and to remember as we have advised practices that this is entirely voluntary and any inappropriate pressure from appraisers who make appraisees fill this in should be resisted and reported to the LMC.’

Dr Dean Marshall, the GPC lead on revalidation, said the BMA would be taking action on the scheme, which is an ‘inappropriate’ use of the appraisal process.

He said: ‘It’s been discussed and ourselves and the RCGP are going to be putting a statement on it.’

‘The bottom line is this is not appropriate for appraisal – the appraisal is for an individual doctor, for them to present to their appraiser, to show the range of work and how they have reflected on things.’

‘This is an attempt to try and force GPs to do it in an inappropriate way – if they want to do that kind of study it should be agreed with the LMC and funded appropriately.’

However, Dr John Sanfey, the GP appraisal lead in North West London who initiated the scheme, said the study would put GPs at the forefront of identifying areas for improvement and ‘driving change’ and insisted the information will not be used against individuals who take part.

Dr Sanfey said: ‘All GPs obviously have to be appraised and revalidated – the college recommends two case studies per year for significant events. So what we’ve suggested is, because cancer outcomes in the UK are quite poor compared with equivalent countries, if doctors can study cancer cases in numbers there is an opportunity to put those thoughts together and make a lot of changes.

‘It puts us on the front foot, instead of being pressed upon by initiatives and various well-meaning protocols and tasks from outside, suddenly we have the agenda in our control, we are using clinical reflection to drive the changes that need to be made in the health service.’

Dr Sanfey added: ‘This is nothing to do with naming and shaming – this is part of the GP profession fighting back against that whole naming and shaming culture. This is doctors solving a problem that needs to be solved and reclaiming the agenda for clinical change within general practice. And the Government will fall behind that, they are not going to attack GPs for improving cancer outcomes.’

NB: Please note, the second paragraph has been changed at 10:18am on 15 August to make clear that the local area team is asking for a ‘significant case analysis’

Readers' comments (16)

  • Just submit successful cases! Idiotic approach to data collection - they need to assess all patients diagnosed with cancer and review their pathways.
    Ultimately, GPs are human, no human system is infallible. Worse having an overburdened NHS with inadequate resources being wasted on the worried well and trivial illnesses. I'd much rather have the time and resource to spend with patients that warrant professional assessment and divert minor illness to Pharmacies or nurses.

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  • Hi - thanks for the comment and that is a good point. The story has been changed to make clear that GPs are being asked to submit a 'significant case analysis', meaning they cannot simply pick a successful case.

  • ditto, just submit two successful cases, make sure you get extra funding for this :), what a moron idea

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  • *blip*

    Did anyone else here that?

    Ah yes, that was the threshold for possible cancer referrals dropping even further...

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  • Jeremy Hunt has committed a "moral crime against society" with his relentless and "criminal" attacks on General practice. This shameful individual will hopefully leave politics altogether to focus on more multi-millionaire personal money-making schemes.

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  • Definitely a "crude piece of work . Just started looking at our data locally and appears; 2WW referal and subsequently Dx as cancer rates vary from 30% to 100% for individual practices. Note this appears to be retrospective data trawled out from death certificates and records.

    Additionally "conversion rates" vary (between practices and areas) so which is better 10% conversion rate or 100% conversion rate of all the referals you make?

    Far more to this than just name and shame.

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  • This is not rocket science. The reason cancer outcomes are poorer than our competitors is simply that we invest less of our GDP in the NHS. They are however improving so it's grossly unfair of the government to shame GPs in order to cover up the effects of their failing polices. Confidence in revalidation is already rock bottom with little accountability for these abuses of power.

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  • discussing individual cases and then allowing our names to be used would suggest a high degree of trust in the Area Team, so this is unlikely to go ahead

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  • interesting ...

    Stack the odds against GPs making it inevitable they will fail.

    Once they fail drag them through various disciplinary processes from re-education to being struck off. All whilst there is a funding and recruitment crisis.

    what is the ultimate purpose? Is it to improve standards or is it for control and to spread fear? Either which way it sends a powerful message to drs who may want to be GPs - the job is too risky.

    the bankers may have been too big to fail but lowly GPs are to small to save!

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  • bottom line lower your threshold for cancer referrals, inundate the hospitals, patients happy, jeremey happy, daily mail happy, poor hospitals will suffer and be investigated and given warnings from cqc and eventually put into special measures, then nowhere to refer patients to.....everything goes private. It really does not take anything from my time except for a lot more referrals , and in fact just makes my life easier as I take a zero risk attitude to any patient that presents with anything that might even vaguely be a cancer.

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  • This sounds very much like a research project, not merely evaluation or audit.

    Does it have ethical approval from an appropriate research ethics committee?

    If it is a research project and doesn't have ethical approval, then any doctor who participates in this study is risking their GMC registration.

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