Identifying and managing concerns about GPs in England: an interview study and case-series analysis.

backgroundUnderperforming doctors have been the focus of sustained interest from the media, policymakers, and researchers. GPs are more likely to be the subject of a complaint than any other type of doctor in the UK, and the management of concerns in primary care needs improvement, yet more is known about how concerns are managed in secondary care.

aimAlthough formal policies for NHS England's management of concerns are clear, little is known about how these are put into practice. This study explores how concerns are identified, investigated, and managed at a regional level. DESIGN AND

settingA qualitative study of the management of concerns in primary care across eight area teams.

methodThe study comprised two main strands: in-depth interviews with NHS England staff; and the analysis of case file data.

resultsThe process for raising concerns was identified as inconsistent and disparate, with potential weaknesses to address. The concerns process was flexible. A trade-off between adaptability and consistency was evident, but the correct balance of the two is difficult to establish. Performance concerns were most common, followed by behaviour. Conduct was the next most frequently raised concern, and a small number of health cases were identified. Outcomes of cases appeared to be dependent on the doctor's engagement and response rather than necessarily the nature of a concern or the consequences of a doctor's actions.

conclusionThe way practices handle complaints and concerns remains unexamined, even though they are a key route for patient complaints.