GENERAL-PRACTITIONER REACCREDITATION - USE OF PERFORMANCE INDICATORS

There has been increasing debate about reaccreditation of general prac titioners 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 im plications of proposals in terms of cost, logistics and organization a re discussed in this paper, in light of experience with the introducti on of summative assessment for general practitioner registrars (traine es) and a programme of training practice visits in West Midlands Regio n. A model for reaccreditation for all general practitioners is propos ed which is professionally led and sensitive to the needs of patients and health service managers. The basic proposition is that publicly ow ned family health services authority data could be used as initial per formance indicators for professional competence. The model is dependen t on the rebuttal of the null hypothesis: there is no link between the competence of a general practitioner and his or her achievements in t he suggested performance indicators. If the performance indicators (ed ucational 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 sim ple system of reaccreditation could be envisaged. General practitioner s who are recorded as achieving set performance indicator targets woul d be accorded automatic reaccreditation. Only substandard practitioner s 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 pe rformance, which could then be invoked as a last resort.