Joesbury H, Mathers N, Lane P
Institute of General Practice and Primary Care, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S5 7AU, UK.
Fam Pract. 2001 Apr;18(2):123-30. doi: 10.1093/fampra/18.2.123.
The North Trent scheme to address the problem of GPs whose performance gives cause for concern was implemented in 1997. This paper describes the structure and process of the scheme and evaluates the main outcomes.
We used non-participant observation and semi-structured interviews with representatives of the seven Health Authorities (HAs) of North Trent including medical and prescribing advisors and senior primary care managers. Twenty-one GPs who were members of the Performance Review Quartets (PRQs) were also interviewed. Qualitative data were analysed using a constant comparative method to identify emergent themes.
Performance indicators were agreed between HAs and the profession in the seven North Trent localities. The scheme identified 18 GPs whose performance gave cause for concern, of whom 15 GPs in six practices received a formal visit. Educational plans were agreed and implemented with three GPs. The remaining 12 received administrative and clinical support. Three of the 18 GPs initially refused to co-operate with the scheme. Two of these have since agreed a practice visit following a visit by a senior local medical committee representative. The performance indicators used in the scheme have not been specific to individual GPs except those in single-handed practices. Some indicators used by PRQs related to cost effectiveness rather than quality of care for individual patients. Current resources were adequate for the small number of underperforming GPs identified by the scheme.
The North Trent scheme has identified a number of underperforming GPs, 83% of whom have been willing to participate in a supportive intervention. The scheme will need some modification with the advent of primary care trusts and the proposed assessment and support centres.
北特伦特计划旨在解决那些表现令人担忧的全科医生问题，该计划于1997年实施。本文描述了该计划的结构和流程，并评估了主要成果。
我们对北特伦特七个卫生当局（HA）的代表进行了非参与式观察和半结构化访谈，其中包括医学和处方顾问以及初级保健高级管理人员。还采访了21名绩效审查四重奏（PRQ）成员的全科医生。使用持续比较法对定性数据进行分析，以确定新出现的主题。
北特伦特七个地区的卫生当局和专业人士就绩效指标达成了一致。该计划识别出18名表现令人担忧的全科医生，其中六个诊所的15名全科医生接受了正式访问。与三名全科医生商定并实施了教育计划。其余12名获得了行政和临床支持。18名全科医生中有三名最初拒绝与该计划合作。其中两人在当地医学委员会高级代表访问后同意进行诊所访问。该计划中使用的绩效指标除了单人执业的情况外，并非针对个别全科医生。PRQ使用的一些指标与成本效益有关，而不是针对个体患者的护理质量。现有资源足以应对该计划识别出的少数表现不佳的全科医生。
北特伦特计划识别出了一些表现不佳的全科医生，其中83%愿意参与支持性干预。随着初级保健信托基金的出现以及拟议的评估和支持中心的建立，该计划需要进行一些修改。
