Clarifying concerns about doctors' clinical performance: what is the contribution of assessment by the National Clinical Assessment Service?
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.


CONCLUSIONS
There is currently little published evidence about the contribution of this type of performance assessment programme to clarifying performance issues.
Berrow
Diane
D
National Clinical Assessment Service, National Patient Safety Agency, London, UK. Diane.Berrow@ncas.npsa.nhs.uk
Humphrey
Charlotte
C
Field
Rosemary
R
Jobanputra
Rena
R
Faw
Leyla
L
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004650:Employee Performance Appraisal; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010820:Physicians / Q000592:standards*; D013222:State Medicine; D006113:United Kingdom