Clarifying concerns about doctors' clinical performance: what is the contribution of assessment by the National Clinical Assessment Service?

PURPOSE: The UK National Clinical Assessment Service (NCAS) provides local NHS bodies with advice and support in relation to concerns about individual doctors and dentists and in some cases also conducts a detailed assessment of practitioner performance. The purpose of this paper is to identify the contribution of NCAS performance assessment to clarifying concerns about clinical performance through comparison of concerns suspected at initial referral with those identified at assessment. DESIGN/METHODOLOGY/APPROACH: In the paper a sample of 50 NCAS medical cases, performance issues reported at the point of referral to NCAS and those identified at assessment were grouped into five broad domains (clinical care, behaviour, health, education and training, organisation). Concerns identified at assessment were compared with those reported at referral for each domain of concern. Conclusions and recommendations following assessment were also reviewed. FINDINGS: Within each domain, some concerns noted at referral were confirmed; others were challenged or redefined. In all areas, but particularly in respect of the work environment, new concerns were identified for the first time at assessment. In 20 percent of cases, the concerns identified at referral were not borne out at assessment. In 12 percent of cases the issues revealed at assessment were more serious than anticipated. PRACTICAL IMPLICATIONS: Findings indicate that the NCAS assessment process provides a more accurate and comprehensive "diagnosis" of performance issues, enabling more appropriate recommendations for "treatment" and helping to differentiate between potentially remediable and more fundamental problems. ORIGINALITY/VALUE: There is currently little published evidence about the contribution of this type of performance assessment programme to clarifying performance issues.

British Gujarati Indian immigrants' and British Caucasians' beliefs about health and illness.

BACKGROUND AND AIMS: This study examined cultural differences in beliefs about health and illness to explore differences in younger and older British Caucasians' and British Gujarati Indian immigrants' beliefs about health and illness. METHODS: This study required a matched group consisting of first- and second-generation Gujarati Indian immigrants and native British Caucasians to complete a questionnaire assessing their beliefs concerning health and illness. RESULTS: Factor analysis of the health beliefs questionnaire identified six clear factors accounting for 36.04% of the variance. Subsequent ANCOVAs conducted on the factor scores, partialling out the demographic differences between the participants, revealed that Gujarati Indian immigrants agreed with items reflecting supernatural explanations of ill health more than indigenous British Caucasian participants. Older Indian immigrants also rated chance-related factors as more important than older Caucasian immigrants. There were no significant differences between the Gujarati Indian immigrants and British Caucasians in terms of attributions made to psychological factors and self-responsibility, social factors and life circumstances, medical treatment and physical vulnerability and the external environment. CONCLUSIONS: Findings are discussed in relation to the model proposed by Helman (2001) and the impact of migration on health beliefs systems; practical implications of the findings are also highlighted.