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Less than 1% of doctors a year prompt performance concerns, study finds

Just five in every thousand NHS doctors prompt concerns about their performance each year, although doctors in the late stages of their career are six times more likely to be referred for remedial help, a study has found.

A study published in BMJ Quality & Safety found that less than 1% of NHS doctors were referred to the National Clinical Assessment Service (NCAS) between April 2001, when it was set up, and March 2012.

NCAS receives referrals from any healthcare organisation in the NHS and gives advice on how to handle the situation. If serious enough, it carries out a full assessment of the doctor to identify options for resolution of the problems encountered.

Originally the service only covered England, but extended to cover the other devolved nations in subsequent years: Wales (2003), Northern Ireland (2005) and Scotland (2008).

The study found that over the 11 years, 6,179 doctors from all specialties and types of employment were referred to the complaints service. The annual rate worked out at five referrals per 1,000 working doctors, though it fluctuated in the first few years after it was set up.

For the 3,467 doctors for whom information on concerns was available, 6,192 top-level concerns were identified; an average of 1.8 per doctor. These included clinical difficulties, governance and safety issues, misconduct, behaviour issues, health problems such as suicide misuse, work environment influences such as workload issues and personal circumstances.

Based on eight years of data (5,271 doctors), to exclude the fluctuations of the first three start-up years, the figures consistently showed that doctors who qualified overseas and male doctors were more than twice as likely to be referred to the service compared with UK-qualified doctors and women doctors.

The study said: ‘The annual referral rate was five per 1,000 doctors. Doctors whose first medical qualification was gained outside the UK were more than twice as likely to be referred as UK-qualified doctors; male doctors were more than twice as likely to be referred as women doctors; and doctors in the late stages of their career were nearly six times as likely to be referred as early career doctors.’

The specialties prompting the highest rates of concern were psychiatry and obstetrics and gynaecology. Doctors working in these specialties were more than 3.5 times as likely to be referred as those working in the specialties with the lowest referral rates— public health, cancer, and general medicine.

The variation in results led the authors to welcome the introduction of revalidation. The report said: ‘These data underlie the need for regular revalidation of doctors; a step which the UK has now taken. Revalidation should allow employers to better understand the histories of doctors they appoint and allow doctors whose practice is causing concern to be identified earlier.’