Study identifies poorly performing doctors

"Older doctors are six times more likely to 'pose a risk to patients'," reports The Independent. The news is based on a new study led by the former chief medical officer, Professor Sir Liam Donaldson. It looked at how often doctors were referred to the National Clinical Assessment Service (NCAS) in the UK, and whether there were any common features of the doctors who were referred.

Doctors are referred to the NCAS if there are concerns about their performance. These concerns can include difficulties in how they manage patients, such as poor record keeping or treatment decisions, safety issues, misconduct, behaviour issues, health problems, and personal circumstances.

Over an 11-year period, 6,179 doctors were referred to NCAS (5 per 1,000 doctors per year). Of these:

• doctors in the late stages of their career (aged 55 years or older) were almost six times as likely to be referred compared with doctors in the early stage of their career (under 35 years old)
• doctors who gained their first medical qualification outside the UK were more than twice as likely to be referred compared with UK-qualified doctors
• male doctors were more than twice as likely to be referred compared with female doctors
• doctors working in psychiatry and obstetrics and gynaecology were more likely to be referred than doctors working in other specialities

Further research is needed to determine why there are performance concerns in certain groups of doctors and how best to address these to reduce the risk of harm to patients.

Where did the story come from?

The study was carried out by researchers from Imperial College London and the National Clinical Assessment Service (NCAS), and was conducted as part of the research activities of the Institute of Global Health Innovation, Imperial College London.

It was published in the peer-reviewed journal BMJ Quality and Safety.

The results of the study were well covered by The Independent.

What kind of research was this?

This was an observational study providing an analysis of data collected by NCAS. It aimed to describe how often doctors are referred because of performance-related concerns, and to see if there were common features of the doctors referred.

This sort of study is good for describing the trends and differences between subgroups within the data. It is not intended to explain why these differences might be occurring.

What did the research involve?

The researchers examined data collected by NCAS on the referral of 6,179 doctors between April 2001 and March 2012.

NCAS is a national body that assesses doctors' clinical performance. It was created initially as the National Clinical Assessment Authority following recommendations made in two reports by the chief medical officer for England.

Doctors who feel they are in difficulty can self-refer, or referrals can be made from any healthcare organisation in the NHS.

NCAS gives advice on how to handle the initial situation, such as a patient complaint. If serious enough, NCAS then carries out a full assessment of the doctor to identify options for resolution of the problems encountered.

The service began to operate in England in 2001, in Wales in 2003, in Northern Ireland in 2005, and in Scotland in 2008.

What were the basic results?

The researchers found that:

• five doctors per 1,000 were referred per year
• doctors who gained their first medical qualification outside the UK were more than twice as likely to be referred compared with UK-qualified doctors
• male doctors were more than twice as likely to be referred compared with female doctors
• doctors in the late stages of their career (aged 55 years or older) were almost six times as likely to be referred compared with doctors early in their career (under 35 years old)
• the highest rates of concern were seen in doctors working in psychiatry and obstetrics and gynaecology

How did the researchers interpret the results?

The researchers concluded that, "The UK holds a consistently collected national dataset on performance concerns about doctors. This allows risk groups to be identified so that preventative action and early intervention can be targeted most effectively to reduce harm to patients".

Conclusion

This study analysed data collected by NCAS in the UK from doctors referred because of performance-related concerns.

The results of this study could be used to allow risk groups of doctors to be identified so that poor performance can be targeted, minimising the risk of harm to patients. However, further research is required to determine why there are performance concerns in certain groups of doctors and how best to address these.

For example, it was found that doctors in the late stages of their career (aged 55 years or older) were almost six times as likely to be referred compared with doctors early in their career (under 35 years old). Although it could be that older doctors are less likely to keep up with best clinical practice, it could also be that older, more senior doctors see a greater volume of, or more difficult, cases.

It is also important to note that while doctors from specialties such as obstetrics and gynaecology were more likely to be referred, this is likely to be at least partly explained by the fact that this specialty is known to be "high risk".

In any case, the authors go on to say that, "These data underline the need for regular revalidation of doctors; a step which the UK has now taken".