UNDERPERFORMING DOCTORS - A POSTAL SURVEY OF THE NORTHERN DEANERY

Objectives: To discover the perceived size of pool of doctors consider ed to be underperforming in general practice in the Northern Deanery a nd to discover whether these perceptions are based on formal assessmen ts. Design: Postal questionnaire. Setting: Area covered by the Norther n Deanery. Subjects: Seven health authority directors of primary care, seven secretaries of local medical committees, and 14 chief officers of community health councils. Results: The response rate was 100% for directors of primary care and secretaries of local medical committees and, after one reminder, 92% for chief officers of community health co uncils. Numbers of doctors perceived to be underperforming ranged from none to over 15 in different health authority areas. Main areas for c oncern were communication skills, clinical skills, and management skil ls. Patients' representatives were concerned about lack of power of pa tients and health authorities and doctors' lack of accountability. Hea lth authorities were concerned about lack of power, identification of underperforming doctors, and doctors' professional loyalty. Local medi cal committees were concerned about the problem of identifying underpe rformance. A number of methods were used for identification, and there was no common method applied. Conclusions: The number of doctors thou ght to be underperforming was small. Work still needs to be done on de veloping tools that can be used in everyday practice to enable doctors to confirm for themselves, their colleagues, and their patients that they are providing an adequate level of care.