BMJ  2004;329:350 (7 August), doi:10.1136/bmj.329.7461.350

Letter

Investigation into GPs with high patient mortality

Monitoring death rates will become increasingly complex

The first 150 words of the full text of this article appear below.

EDITOR—Like Mohammed et al, we investigated several general practitioners (GPs) who signalled as having "unacceptably" high death rates in the study undertaken by Aylin et al.1 2 We also concluded that these higher than expected death rates were explained by a "nursing home effect."

Credit: JOHN GILES/PA

Our methods included calculating standardised mortality ratios for each general practitioner's registered population, and reviewing the case notes of dead patients. The review was conducted by two independent general practitioners using a structured form, based on that used in the original audit of Harold Shipman's practice.3

Identifying a nursing home effect is in itself an inadequate conclusion to an investigation of this type as quality of care may also be poor in this environment. Review of case notes, as a mechanism for formulating an impression of the quality of patients' care, is an essential, albeit resource intensive, adjunct to a purely statistical . . . [Full text of this article]

Julie Billett, specialist trainee in public health

juliebillett@yahoo.co.uk

Nick Kendall, assistant director of public health

Adur, Arun and Worthing Primary Care Trust, Goring by Sea, Worthing BN12 6BT

Peter Old, associate director

National Clinical Assessment Authority, London SW8 5NQ


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An investigation into general practitioners associated with high patient mortality flagged up through the Shipman inquiry: retrospective analysis of routine data
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BMJ 2004 328: 1474-1477. [Abstract] [Full Text] [PDF]

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