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Teaching GPs to say ‘no’

I’d like to clarify a couple of points raised by your article, ‘”Agreeable” GPs should face disciplinary action, says NHS watchdog’ (11 June).

The National Clinical Assessment Service (NCAS) is not a watchdog but exists to provide advice and support to healthcare managers, doctors and GPs who are concerned about the performance of a colleague. We provide a similar service for pharmacists and dentists. Our new good practice guide, Handling concerns about a practitioner’s behaviour and conduct, is designed to assist this and our advice is always to act quickly so that any problems can be addressed and resolved early on.

In regards to “agreeability”, it’s self-evidently a good thing for GPs to listen to patients carefully and treat them with respect and kindness. But, of course, that sometimes includes saying “no” to a patient’s request, if it’s not in their best clinical interest. In our experience, there’s only a small number of doctors who won’t say “no” because they dislike confrontation but this can lead to problems, for example, the over-prescription of antibiotics. It’s this kind of “agreeability” that we want to help GPs avoid.

The starting point for our advice, which is free to the NHS, is always to support practitioners back to safe practice through training where possible. Our 11 years of experience has shown that the overwhelming majority of GPs who get this help are able to make change and provide better, safer services as a result.


We are here to help. If you are worried about the performance of a colleague, please contact us. Our short publication, What to do if you have concerns about a colleague’s performance provides more information.

Dr Pauline McAvoy, Interim Medical Director, National Clinical Assessment Service