Cox Stephen J, Holden John D
Spinney Medical Centre, St Helens, Merseyside.
Br J Gen Pract. 2009 May;59(562):344-8. doi: 10.3399/bjgp09X420527.
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.
To report the prevalence, presentation modes, and management of primary care poor performance cases presenting to one PCT over a 5-year period.
A retrospective review of primary care poor performance cases in one district.
St Helens PCT administered 35 practices with 130 GPs on the performers list, caring for 190 110 patients in North West England, UK.
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.
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.
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.
初级医疗服务表现不佳的检测、评估和管理给所有相关人员带来了难题。指导意见主要集中在管理患者安全受到严重损害的最严重案例上。初级医疗服务表现不佳的管理已成为初级医疗信托机构（PCT）工作中日益重要的一部分，但其呈现方式和发生率尚不为人所知。
报告在5年期间向一个初级医疗信托机构呈报的初级医疗服务表现不佳案例的发生率、呈现方式及管理情况。
对一个地区初级医疗服务表现不佳案例进行回顾性研究。
圣海伦斯初级医疗信托机构管理着35家诊所，有130名全科医生在绩效名单上，为英国英格兰西北部的190110名患者提供服务。
2002年至2007年期间呈报的案例最初由初级医疗信托机构临床执行委员会主席进行审查。然后，评估人员和另一位经验丰富的全科医生顾问共同审查匿名数据。
在5年期间，有102次个人呈报（每年20次或每2至3周1次），其中临床医生的表现引发了重大担忧。这些担忧涉及37名临床医生，每位临床医生涉及1至14次（平均2.7次）。专业同事举报43次是最常见的呈报方式，其中26次是全科医生举报全科医生。患者投诉（18次）是第二常见的呈报方式。27名临床医生是全科医生，其中向英国医学总会（GMC）通报或涉入的有13例。临床医生在当地得到支持，14例仅在当地进行补救管理，另外12例与外部组织（如英国医学总会或医学院）共同管理。
专业举报和患者投诉是最常见的呈报来源。需要有效的初级医疗信托机构团队来管理表现令人担忧的临床医生。充足的资源以及正式和非正式的举报途径至关重要。
