title: Presentation and outcome of clinical poor performance in one health district over a 5-year period: 2002-2007.
abstract: BACKGROUND
  The detection, assessment, and management of primary care poor performance raise difficult issues for all those involved. Guidance has largely focused on managing the most serious cases where patient safety is severely compromised. The management of primary care poor performance has become an increasingly important part of primary care trust (PCT) work, but its modes of presentation and prevalence are not well known.
  
  
  OBJECTIVE
  To report the prevalence, presentation modes, and management of primary care poor performance cases presenting to one PCT over a 5-year period.
  
  
  METHODS
  A retrospective review of primary care poor performance cases in one district.
  
  
  METHODS
  St Helens PCT administered 35 practices with 130 GPs on the performers list, caring for 190 110 patients in North West England, UK.
  
  
  METHODS
  Cases presenting during 2002-2007 were initially reviewed by the chair of the PCT clinical executive committee. Anonymised data were then jointly reviewed by the assessor and another experienced GP advisor.
  
  
  RESULTS
  There were 102 individual presentations (20 per year or one every 2-3 weeks) where clinician performance raised significant cause for concern occurred over the 5-year period. These concerns related to 37 individual clinicians, a range of 1-14 per clinician (mean 2.7). Whistleblowing by professional colleagues on 43 occasions was the most common presentation, of which 26 were from GPs about GPs. Patient complaints (18) were the second most common presentation. Twenty-seven clinicians were GPs, of whom the General Medical Council (GMC) were notified or involved in 13 cases. Clinicians were supported locally, and remedying was exclusively locally managed in 14 cases, and shared with an external organisation (such as the GMC or deanery) in another 12.
  
  
  CONCLUSIONS
  Professional whistleblowing and patient complaints were the most common sources of presentation. Effective PCT teams are needed to manage clinicians whose performance gives cause for concern. Sufficient resources and both formal and informal ways of reporting concerns are essential.
authors.affiliation: Spinney Medical Centre, St Helens, Merseyside. stephen.cox@hsthpct.nhs.uk
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Cox
authors.forename: John D
authors.initials: JD
authors.lastname: Holden
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D054976:Clinical Governance; D004739:England; D005194:Family Practice / Q000592:standards*; D006801:Humans; D019239:Practice Patterns, Dentists' / Q000592:standards*; D028743:Professional Misconduct / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards*; D013997:Time Factors; D035642:Whistleblowing