Doctors may face clinical skills test

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POOR doctors who put patients at risk are to be identified by measuring their performance against new professional standards being drawn up by the medical royal colleges.

All hospital specialties are being asked to supply outcome measures against which the performance of individual doctors can be assessed. For some specialties, such as heart surgery, the measure used may be death rates while for others, such as hip replacement surgery, the measure could be revision rates (the proportion of operations that need repeating within a certain period).

The aim is to strengthen self-regulation of the profession to avoid cases coming before the General Medical Council in which doctors' clinical competence is called into question, such as that involving the Bristol heart surgeons currently being heard by the GMC.

Work on developing the system, which is intended to be supportive rather than punitive, was initiated by the British Medical Association and has been taken over by the Academy of Royal Medical Colleges representing all the major hospital disciplines. Similar moves are under way to monitor the work of family doctors.

James Johnson, chairman of the Joint Consultants' Committee of the colleges and the BMA, said: "We are devising a system of appraisal that really will look at doctors' clinical work. We are going to put in place something so that patients can be reassured that their doctor was not just an excellent chap when he qualified 20 years ago but that he is still an excellent chap and has kept up to date."

He said there was no table in any surgical specialty setting out the expected mortality within 30 days of a specific operation or the expected repeat rate. For hernia operations, one of the commonest surgical procedures, there were no figures saying what percentage failed and had to be redone.

"You may hear that surgeon X is pretty bad at repairing hernias. But if you don't have the data it is very difficult to take any action. If, on the other hand, you can show the surgeon that his performance is way outside his colleagues' then you can have a system in which managers can go in and say this won't do, it has got to be sorted out."

For non-surgical specialties outcome measures might be more difficult to devise, but doctors in those specialties were less likely to feature in allegations of incompetence or poor performance, Mr Johnson said.

Dr Sandy Macara, chairman of the BMA said pressure had been growing on the profession to see that incompetent doctors were spotted and brought up to scratch. "We recognised we had to make explicit our commitment to ensuring doctors were fit for the job. But it has to be a supportive mechanism that complements the punitive role of the GMC. It is not a big stick."

Ministers are to announce shortly details of how their own plans for improving clinical performance through the Commission for Health Improvement and the National Institute of Clinical Excellence, heralded in last November's NHS White Paper, will work.