Q J Med 2001; 94: 567-568
© 2001 Association of Physicians
Correspondence |
Consultant appraisal
Cambridge
Sir,
I find it odd that in his article on consultant appraisal (QJM 2001; 94:235–6) Dr Winearls fails to suggest any role for the Royal Colleges, which were surely established for this very purpose, and are in a better position than either a hospital trust or a consultant's immediate colleagues to carry it out fairly and dispassionately. The lack of any hierarchy within the consultant body makes it difficult to arrange for the kind of appraisal that is now customary within university departments (i.e. appraisal by superiors), while the GMC should surely be the last court of appeal when serious concern is appropriate. Either we should agree to the setting up of a consultant hierarchy, which would have the additional advantage of acknowledging what is already the case, and of enabling at last a squaring of the circle with respect to the numbers of trainees and tenure posts, or the Royal Colleges should bestir themselves to set up standing committees to examine in camera questions of competence raised by concerned colleagues. The need for such scrutiny by disinterested colleagues is underlined by the notorious case of Dr Wendy Savage.
Chairman, Royal College of Physicians Standards, Committee
Registrar, Royal College of Physicians
Sir,
We are responding on behalf of the Royal College of Physicians to Professor Davis's suggestion that we should bestir ourselves in the matter of consultant appraisals. While the College has maintained the highest interest and involvement in the principle of appraisal and how it will sit with revalidation, it believes that its implementation will be inevitably through the employer (usually the NHS Trust and/or University) in the vast majority of cases. We have offered support to Trusts in the process such as in areas of dispute. We do not see the process as being likely to turn up previously unsuspected cases of dysfunctional behaviour or poor performance, but have put together a package offering service reviews, mentoring and retraining opportunities to Trusts. Professor Davis's point about the lack of clear hierarchy is well-taken, but we have to accept that Clinical Directors, who carry responsibility for the delivery of a safe clinical service, must have a key role in the appraisal of consultants within their directorate.
In summary, the College believes that this process is essentially one of local review but the College has a crucial role in providing a framework that will help physicians demonstrate at that review that they are keeping up to date and auditing their practice to the highest national standards. The College can also provide independent advice where there is a breakdown between clinicians and managers. Guidance on the kinds of problems encountered in the case of Dr Wendy Savage should be achieved by this means and thereby recourse to the NCAA and GMC should prove to be infrequent.
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