Record number of doctors investigated

Record numbers of NHS doctors are being investigated for poor performance, raising doubts about the safety of medical care.

In the first five months of this year, 317 GPs and hospital specialists were referred to the National Clinical Assessment Authority (NCAA) because of concerns they could be putting patients at risk. Cases include surgeons who have botched operations and doctors accused of bullying colleagues.

The referrals, disclosed at a board meeting of the NCAA, bring to 1,400 the total number of doctors investigated since the authority was set up in April 2001 - more than 1 per cent of the medical workforce. This year the authority is predicting 750 doctors will be referred for investigation, nearly a 50 per cent increase on the 526 referrals in 2003-04. It is doubling the number of case managers from 12 to 25 to cope with the growing workload.

A spokesman said: "It all sounds a bit scary. But we are a new organisation which started from nothing and there has inevitably been an increase in referrals as trusts have become more aware of us."

The NCAA was set up to deal with cases in which a doctor's poor performance is judged to be potentially endangering patients. It is claimed to be the only agency of its kind in the world. It was established after the inquiry into the Bristol children's heart surgery scandal in the 1990s revealed that there was no mechanism to identify poor doctors.

The disclosure of the sharp rise in referrals comes on top of warnings that up to 40,000 NHS patients die each year because of medical errors, ranging from wrongly administered drugs to hospital infections.

The NCAA can carry out a full assessment of a doctor's ability, involving tests and interviews, order retraining or offer simple advice. However, one in eight referrals is considered so serious it is referred to the General Medical Council, which has the power to strike a doctor off the medical register, order a suspension or issue a formal warning.

The spokesman denied that the rising rate of referrals indicated falling standards in the NHS. "It is actually the opposite. The problem in the past was that the NHS was not good at dealing with doctors' and dentists' poor performance. Now people are coming to us early, and that is encouraging because it protects patients and returns doctors to practice."

The Health Foundation, the medical charity which cited the figures last week, called for patients to be involved in keeping a check on medical staff.

Only employers - hospitals or GP practices - and not members of the public can refer doctors to the NCAA, minimising the risk of unsubstantiated or frivolous complaints.

In one case, an otherwise competent surgeon was found to have a high rate of complications with laparascopy, the procedure in which internal organs are examined with a miniature camera inserted by keyhole surgery through the abdomen. Laparoscopy carries a risk of rupture of the internal organs and requires special training to manipulate the instruments safely and accurately. The surgeon was sent for retraining.

Almost a third of referrals reach the "intensive support stage", in which a doctor's performance is monitored, and 6 per cent have a full assessment. "That is reserved for the most intractable cases," the spokesman said.

The authority currently has 370 cases on its books, of which 210 are hospital doctors and the remainder GPs. The annual report shows that the NCAA has cut by 85 per cent the number of doctors who are suspended while allegations are investigated.