Only five in 1,000 doctors referred over performance concerns

ONLY five in every 1,000 NHS doctors in England are referred for investigation over performance-related concerns, according to a new study.

Doctors who qualified outside the UK are more than twice as likely to prompt concerns while those in the later stages of their career are six times as likely to be referred.

The figures published in BMJ Quality & Safety relate to referrals made to the National Clinical Assessment Service (NCAS) between April 2001 and March 2012. During that time, 6,179 referrals were made to the service, whose aim is to determine whether a doctor is able to do their job.

The study focused on eight years of data (concerning 5,271 doctors) in order to exclude the fluctuations of the initial three years.

The study revealed doctors working in the specialties of psychiatry and obstetrics and gynaecology sparked the highest rates of concern and were 3.5 times as likely to be referred as those working in the specialties of public health, cancer and general medicine.

Overall, men were more than twice as likely to be referred than women.

Among the most serious concerns raised regarding doctors’ performance were clinical difficulties (such as poor diagnostic and treatment decisions), governance/safety issues, behavioural problems (such as aggression), and misconduct (including financial irregularities and inappropriate sexual behaviour).

Health problems including drug/alcohol misuse were also common, as were concerns over work-related stress and personal issues such as marital breakdown or bereavement.

Clinical difficulties were more commonly experienced by doctors later in their career while behavioural issues were more common early in doctors’ careers. Men were more likely to be accused of misconduct while women were most likely to experience behavioural issues, the figures showed.

Almost a third of those referred to NCAS had health problems, the authors said, adding that organisations should focus more on the mental wellbeing of staff.

The researchers, led by Professor Sir Liam Donaldson, also welcomed the introduction of revalidation, stating: “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.”