title: Can a district hospital assess its doctors for re-licensure?
abstract: BACKGROUND
  The Chief Medical Officer's recommendations on medical regulation in the UK suggest that National Health Service (NHS) trusts should assess their doctors and confirm whether they remain fit to practise medicine.
  
  
  OBJECTIVE
  We set out to evaluate the utility of hospital trust-based assessment in a 'best-case scenario' within existing resources.
  
  
  METHODS
  We carried out a generalisability analysis, and feasibility and validity evaluation, based on an assessment process for 137 career-grade doctors at Chesterfield Royal Hospital, Chesterfield, UK, using validated multi-source feedback (MSF) and patient rating (PR) instruments.
  
  
  RESULTS
  Uptake and response rates were good for MSF (91% and 85%, respectively). However, only 6% of non-clinical doctors and anaesthetists, and 48% of clinical doctors, obtained sufficient PR ratings. Aggregate scores were acceptably reliable. Nine combined MSF ratings and 15 PR ratings produce standard errors of measurement of 0.19 on a 6-point scale and 0.15 on a 5-point scale, respectively. Overall aggregate scores did not identify any doctor as unsatisfactory, but 6 doctors were scored as unsatisfactory by 2 or more colleagues or patients. These performance concerns appear to merit further investigation. Patients rated female doctors better than male doctors (4.61 versus 4.46; P < 0.05). Colleagues rated UK graduates better than non-UK graduates (5.31 versus 5.15; P < 0.05).
  
  
  CONCLUSIONS
  This study shows that the commissioning of professional services makes the implementation of an assessment process linked to appraisal feasible. However, trust-based assessment requires significant development: developmental appraisal needs protection; new instruments are needed for non-clinical specialties; PR requires specific administrative support, and guidance is required over concern thresholds and demographic effects. Disaggregated assessment data may help identify doctors with potential performance problems.
authors.affiliation: Academic Unit of Medical Education, University of Sheffield, Sheffield, UK. j.crossley@sheffield.ac.uk
authors.forename: Jim
authors.initials: J
authors.lastname: Crossley
authors.forename: John
authors.initials: J
authors.lastname: McDonnell
authors.forename: Charlie
authors.initials: C
authors.lastname: Cooper
authors.forename: Pauline
authors.initials: P
authors.lastname: McAvoy
authors.forename: Julian
authors.initials: J
authors.lastname: Archer
authors.forename: Helena
authors.initials: H
authors.lastname: Davies
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003253:Consultants; D005240:Feasibility Studies; D006767:Hospitals, District; D008004:Licensure; D008505:Medical Staff, Hospital / Q000592:standards*; D006113:United Kingdom