Underperforming doctors: a postal survey of the Northern Deanery

BMJ 1998;316:1705-1708 ( 6 June )

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Underperforming doctors: a postal survey of the Northern Deanery

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George Taylor, deputy director general practice.

Postgraduate Institute for Medicine and Dentistry, University of Newcastle, Newcastle upon Tyne NE2 4AB

g.b.taylor{at}ncl.ac.uk

Objectives: To discover the perceived size of pool of doctors considered to be underperforming in general practicein the Northern Deanery and to discover whether these perceptionsare based on formal assessments.
Design: Postal questionnaire.
Setting: Area covered by the Northern Deanery.
Subjects: Seven health authority directors of primary care, seven secretaries of local medical committees, and 14 chief officers of community health councils.
Results: The response rate was 100% for directors of primary care and secretaries of local medical committees and,after one reminder, 92% for chief officers of community healthcouncils. Numbers of doctors perceived to be underperforming rangedfrom none to over 15 in different health authority areas. Mainareas for concern were communication skills, clinical skills,and management skills. Patients' representatives were concernedabout lack of power of patients and health authorities and doctors'lack of accountability. Health authorities were concerned aboutlack of power, identification of underperforming doctors, anddoctors' professional loyalty. Local medical committees were concernedabout the problem of identifying underperformance. A number ofmethods were used for identification, and there was no commonmethod applied.
Conclusions: The number of doctors thought to be underperforming was small. Work still needs to be done on developingtools that can be used in everyday practice to enable doctorsto confirm for themselves, their colleagues, and their patientsthat they are providing an adequate level of care.

Key messages

To quantify the problem of underperforming general practitioners in the Northern Deanery, a postal survey was carried out among representatives of healthcare commissioners, doctors, and patients
A small but not insignificant number of doctors were identified as providing a poor level of performance
Main areas for concern were communication skills, clinical skills, and management skills.
Various methods were used for identifying underperforming doctors, but there was no common method applied
Perceived problems with the present system of dealing with underperforming doctors included identification, lack of power of patients and health authorities, and doctors' professional loyalty and lack of accountability

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