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National Patient Safety Agency

Largest UK study of medical and dental performance concerns released

22 September 2009


The largest study of medical and dental performance concerns ever carried out in the UK has today been released by the National Clinical Assessment Service (NCAS).


NCAS casework – The first eight years report analyses cases referred to NCAS since 2001 (a total of almost 5,000). It identifies which groups of practitioners are more likely to be referred to NCAS and what can be learnt from these referral patterns. The report also examines episodes of suspension and exclusion of individual practitioners. And, for more than 1,400 cases dealt with by NCAS since the end of 2007, it analyses the nature of concerns which led to referral.


Professor Alastair Scotland, Medical Director of NCAS, said: “The first eight years is a central part of our work in supporting the highest standards of patient care. The great majority of practitioners work hard to provide excellent care, but in those uncommon situations where concerns do arise about individual practice, we work closely with health services and with practitioners to ensure not only that those concerns are understood and resolved as quickly and as fairly as they can be, but also that this meets our paramount duty of protecting patients and the public.


“The heart of NCAS’ service is its case work with health services, the insights this gives us to the reasons that we are contacted for help and what lies behind those concerns. We use these insights to share what we learn with healthcare professions and with health services, so concerns can be identified much earlier and more accurately, and can be resolved more quickly and more fairly, enabling us to meet our first priority of protecting patients and the public.”


Dr Peter Old and Ms Diana Scarrott, who led the work of producing this report said: “The first eight years report shows some striking findings and some consistent differences between groups.


a         NCAS referrals come from all parts of the UK and across all sectors, whether in hospital or in general practice;

b         Two referrals in three are about clinical skills but behavioural concerns are also common, seen in more than half the cases analysed;

c         The average duration of exclusions of doctors in the hospital and community sector has fallen by over a third since 2003, which directly addresses concerns raised over the past two decades about prolonged exclusion from work;

d         Amongst 144 of our cases where the most serious concerns have been raised, two thirds were back in work after remediation – rather than being lost to the service;

e         Certain groups of practitioners are more likely than others to be referred to NCAS, for example men and older practitioners. The same groups are also more likely to experience exclusion or suspension from work;

f           The report also examines the part played by ethnicity and place of qualification in the likelihood of referral of practitioners in hospital and community services. It shows that non-white practitioners qualifying outside the UK are more likely to be referred to NCAS, but that neither referral nor suspension or exclusion from practice is any higher among non-white practitioners qualifying within the UK.”


Dr Old and Ms Scarrott added: “We want this report to be used by health services and the professions that look to NCAS for a service to think about the arrangements they have in place to predict, to prevent, to identify and to manage performance concerns.  


“We also want to work with them to understand more about the patterns of referral and what lies behind them. Our latest analyses of some of our most difficult cases show that most of the practitioners whose performance caused concern were able to resume safe and valued practice. That has to be the best outcome we can aim for.”


The full report (60 pages) and a 12 page summary can be viewed at: www.ncas.npsa.nhs.uk/resources/publications/caseworkanalyses/




Notes for Editors


The National Clinical Assessment Service (NCAS) was set up in 2001 and, since 2005, has been a division of the National Patient Safety Agency, along with the National Research Ethics Service (NRES) and the National Reporting and Learning Service (NRLS).


NCAS provides advice, support and formal assessment in respect of doctors, dentists and, since April 2009 following recommendations in the White Paper Trust, Assurance and Safety, pharmacists.


NCAS provides its services to healthcare throughout the United Kingdom, to the NHS, the independent sector and Defence Medical Services, and to the Isle of Man, Channel Islands and Gibraltar.



Media enquiries to the NPSA Press Office:

Simon Morgan – 020 7927 9580 / 07750 224 240 simon.morgan@npsa.nhs.uk