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Underperforming doctors in general practice: a survey of referrals to UK Deaneries.

BACKGROUND
National Health Service Executive guidelines for rehabilitation of general practitioners (GPs) who require professional support state that these GPs should be advised to contact the Director of Postgraduate General Practice Education in their Deanery. There has been concern about how the needs of these GPs can be met without additional resources.


AIM
To monitor and describe the process and outcome of these referrals over a two-year period to assess the size of the problem, to share good practice, and to identify any deficiencies in the system.


DESIGN OF STUDY
Quarterly postal questionnaires.


SETTING
Deaneries in the United Kingdom, which are geographically-based organisational units for the management of general practice education.


METHODS
Three postal questionnaires were devised to cover General Medical Council (GMC) referrals to Deaneries, health authority referrals, and referrals made by Deaneries to the GMC Non-responders were contacted by telephone.


RESULTS
Twenty-seven GPs were referred by the GMC, 72 were referred by health authorities, and 18 referrals were made by Deaneries to the GMC. The information provided to Deaneries by the GMC was timely in just over half the cases, and was left to be appropriate in two-thirds of cases. Information provided by health authorities was almost always timely, detailed, and appropriate. The action required by the GMC was felt to be inappropriate in five cases, and not feasible in eight cases. No extra resources were available in the majority of cases. Information about outcome for the GP was either unavailable or unclear in over half the cases.


CONCLUSION
This monitoring exercise has revealed several deficiencies in the system for dealing with the educational needs of underperforming GPs. There is a needfor a clear national protocol for referral of GPs to Deaneries and for the support that Deaneries can be expected to provide.