Clarifying concerns about doctors' clinical performance: what is the contribution of assessment by the National...

The UK National Clinical Assessment Service (NCAS) provides local NHS bodies with advice and support in relation to concerns about individual doctors and dentists and in some cases also conducts a detailed assessment of practitioner performance. The purpose of this paper is to identify the contribution of NCAS performance assessment to clarifying concerns about clinical performance through comparison of concerns suspected at initial referral with those identified at assessment.

In the paper a sample of 50 NCAS medical cases, performance issues reported at the point of referral to NCAS and those identified at assessment were grouped into five broad domains (clinical care, behaviour, health, education and training, organisation). Concerns identified at assessment were compared with those reported at referral for each domain of concern. Conclusions and recommendations following assessment were also reviewed.

Within each domain, some concerns noted at referral were confirmed; others were challenged or redefined. In all areas, but particularly in respect of the work environment, new concerns were identified for the first time at assessment. In 20 percent of cases, the concerns identified at referral were not borne out at assessment. In 12 percent of cases the issues revealed at assessment were more serious than anticipated.

Findings indicate that the NCAS assessment process provides a more accurate and comprehensive "diagnosis" of performance issues, enabling more appropriate recommendations for "treatment" and helping to differentiate between potentially remediable and more fundamental problems.

There is currently little published evidence about the contribution of this type of performance assessment programme to clarifying performance issues.