General practitioner reaccreditation: use of performance indicators.

There has been increasing debate about reaccreditation of general practitioners over the last few years with contributions from the General Medical Services Committee, the Royal College of General Practitioners and the National Association of Health Authorities and Trusts. The implications of proposals in terms of cost, logistics and organization are discussed in this paper, in light of experience with the introduction of summative assessment for general practitioner registrars (trainees) and a programme of training practice visits in West Midlands Region. A model for reaccreditation for all general practitioners is proposed which is professionally led and sensitive to the needs of patients and health service managers. The basic proposition is that publicly owned family health services authority data could be used as initial performance indicators for professional competence. The model is dependent on the rebuttal of the null hypothesis: there is no link between the competence of a general practitioner and his or her achievements in the suggested performance indicators. If the performance indicators (educational commitments, prescribing data, health promotion activity and immunization targets, and service elements) can be shown to correlate with possession of the attributes for independent practice as defined by the General Medical Council, then a relatively inexpensive and simple system of reaccreditation could be envisaged. General practitioners who are recorded as achieving set performance indicator targets would be accorded automatic reaccreditation. Only substandard practitioners would be required to be assessed further by a visiting team of local general practitioner peers and, if appropriate, a remedial education strategy introduced. This method would complement the General Medical Council scheme for assessing an individual doctor's persistent poor performance, which could then be invoked as a last resort.