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Performance concerns in psychiatrists referred to the National Clinical Assessment Service

  • Denis O'Leary (a1), Pauline McAvoy (a2) and John Wilson (a1)
Abstract
Aims and method

Relative to workforce numbers, the National Clinical Assessment Service (NCAS) has reported high rates of referrals for performance concerns in psychiatrists. Our aim was to see how these concerns would be distributed across good medical practice (GMP) domains. Such specification would help identify appropriate training and development interventions. Concerns were obtained from consecutive case reports (anonymised) of psychiatrists referred to NCAS between October 2004 and April 2006.

Results

The proportion of psychiatrists with concerns in any domain was highest (just over 50%) in the domains of good clinical care and working with colleagues. Two-thirds had concerns across multiple domains.

Clinical implications

Training and development needs of psychiatrists referred to NCAS are more complex and more prevalent in the GMP domain of good clinical care than previously reported.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Denis O'Leary (denis.o'leary@obmh.nhs.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Department of Health. Assuring the Quality of Medical Practice: Implementing Supporting Doctors, Protecting Patients. Department of Health, 2001.
2 Department of Health. Maintaining High Professional Standards in the Modern NHS. Department of Health, 2004.
3 Berrow, D, Faw, L, Jobanputra, R. Evaluation, Research and Development, Analysis of the First 50 NCAS Assessment Cases. National Clinical Assessment Service, 2005.
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5 National Clinical Assessment Service. Analysis of the First Four Years' Referral Data. National Patient Safety Agency, 2006.
6 National Clinical Assessment Service. NCAS Casework. The First Eight Years. National Patient Safety Agency, 2009.
7 Donaldson, LJ. Doctors with problems in an NHS workforce. BMJ 1994; 308: 1277–82.
8 Morrison, J, Morrison, T. Psychiatrists disciplined by a State Medical Board. Am J Psychiatry 2001; 158: 474–8.
9 Firth-Cozens, J. Improving the health of psychiatrists. Adv Psychiatr Treat 2007; 13: 161–8.
10 Boydell, TH. Identification of Training Needs. British Association of Commercial and Industrial Education, 1983.
11 Buckley, R, Caple, J. The Theory and Practice of Training, 6th edn. Kogan Page, 2004.
12 Palmer, R. The identification of learning needs. In Human Resource Development, 2nd edn (ed Wilson, JP): 7788. Kogan Page, 2005.
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14 General Medical Council. Good Medical Practice. GMC, 2006.
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17 National Clinical Assessment Service. Data Collection and Release Policy. NCAS, 2004.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Performance concerns in psychiatrists referred to the National Clinical Assessment Service

  • Denis O'Leary (a1), Pauline McAvoy (a2) and John Wilson (a1)
Submit a response

eLetters

Psychiatrists behaving badly?

J. S. Bamrah, Director of CPD
08 September 2010

The reason why many of us choose psychiatry as our speciality is thatwe like the human touch of medicine. To a large extent this is our strongest attribute, but as O’Leary et al(1) have demonstrated, quite perversely it is this affinity that also leads to our failing in the areaswe should excel, namely relationships with colleagues/patients as well as good clinical practice. The implications of the numbers of psychiatrists being referred to NCAS should not be under-estimated not least to themselves but also to mental services as a whole. Coupled with the recruitment problems in junior training posts and the relative inability to make our speciality attractive to medical undergraduates(2), we are likely to store further problems of recruitment to consultant posts, something that has dogged our profession for many decades but none more sothan in the 80’s and 90’s. Elsewhere in the journal, Burns(3) articulates his concerns on how the consultant’s role lacks definition, a factor that might well influence ourperformance and our attitude to others, as well as others’ to us. My sense is that we need some creative thinking around how we might promote our speciality, while simultaneously ensuring that our colleagues are supported in the right manner during their stressful years of practice. In this regard, O’Leary’s call for the College to review the CPD programmeis not inappropriate, but as the CPD committee has just set out a new policy(4) it could be sometime before the next policy comes round. There is evidence that those who participate in CPD are less likely to be disciplined than those who don’t and that those who are in mature professional years fare better if they keep up-to-date with modern practice(5). There is scope within the three domains (Clinical, Professional and Academic) of the new CPD policy to cover all speciality developmental issues whilst retaining generic medical and psychiatric skills. These might be further reinforced through peer groups. Each of the College faculties has had the opportunity to influence the policy, but I am in agreement with O’Leary et al that further refinement could take place to reflect the growing need to provide specialist care. It would be my aspiration that the CPD policy will be more electronically based rather than being set in a publication which sits on the shelf for the next 5 years or more without being updated. I would welcome members’ input into how this might be achieved annually, with revision of policy that is in line with their practice.

References1. O'Leary D, McAvoy P, Wilson J. Performance concerns in psychiatrists referred to the National Clinical Assessment Service. The Psychiatrist 2010; 34: 371-375.2. Burns T. The dog that failed to bark. The Psychiatrist (2010) 34: 361-363.3. Selection for Speciality Training (2006).http://www.bma.org.uk/images/SelectionSpecialtyTraining_tcm41-147106.pdf4. Good Psychiatric Practice. Continuing professional development. CollegeReport CR 157, 2010.5. Bamrah J, Bhugra D. CPD and recertification: improving patient outcomes through focused learning. Adv. Psychiatr. Treat., Jan 2009; 15: 2– 6.

Author: J.S. Bamrah, Director of CPD, Royal College of Psychiatrists,17 Belgrave Square, London SW1X 8PG.
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