Recognising and dealing with poor performance amongst general medical practitioners: Local arrangements in two English health districts

Primary care trusts (PCTs) in England are required to set in place local arrangements to identify and deal with concerns about general practitioners' (GPs') performance. These arrangements, commonly described as local performance procedures (LPPs), vary widely between PCTs. Gateshead and South Tyneside PCTs have jointly developed local arrangements to deal with concerns about GPs' performance, to protect patients and to support doctors. The structures have strong lay and professional involvement and comprise one supra PCT assessment advisory group (AAG) and one decision making group (DMG) in each PCT. Between 1 April 2002 and 31 March 2003, the AAG dealt with 28 concerns relating to 25 different GPs (23 principals, 1 locum and 1 registrar). In 12 cases, the AAG found no evidence of under-performance but there were performance problems in the remaining 16 instances, six of which were serious enough to involve either the General Medical Council (GMC), National Clinical Assessment Authority (NCAA) or local deanery. The areas of practice that most commonly generated concerns were clinical care, relationships with patients and colleagues, and equipment and buildings. Our LPP arrangements offer a model that other PCTs could build on. Theyprolmote confidentiality, fairness and consistency while making the most of locally scarce expertise. We have also provided valuable information about the number and nature of concerns about general medical practice in two PCTs, which were referred to LPPs. This information gives a quantitative indication of the work-load faced by LPPs and highlights the need for professionals and managers to address interpersonal, management and administrative skills in terms of primary care development.