Sir, Your article “All doctors to face annual test of their competence” (July 23) reflects an issue that has wider application across UK industry; that of effective and consistent performance appraisal and how it is used. Everyone at work is appraised every day; colleagues, patients and their carers form impressions about a doctor’s competence based on their interactions and experiences. The big question is how does one collect this data and how does one use it?

Many progressive hospitals are already using multi-source feedback surveys (usually referred to as “360-feedback”), with doctors receiving structured, confidential feedback from their peer group, from doctors in training, from other health professionals and from patients. Because the feedback is confidential, survey respondents “tell it like it is”. The feedback — usually based on the GMC professional standards — is used by the doctors to enhance their performance. There are always things that can be done better, regardless of experience or seniority.

Yes, the process can pick up underperformers, but shouldn’t the whole appraisal process be about helping doctors continuously to improve, rather than using it as a big stick?

To quote a consultant at a local hospital where appraisal processes and 360 were introduced more than five years ago: “I have been in this job for nearly 15 years, and no one has ever said anything this positive about the way I work. Before , we only normally heard about complaints.”

Harvey Bennett
Poole, Dorset

Sir, With about 250 working days per year and 150,000 doctors practising in the UK, this means 600 reviews to be achieved every day. I sense a Civil Service employment bonanza ahead.

Dr David Wood
Durham

Sir, As a nurse, I have to prove my fitness to practise and show that I am an up-to-date practitioner. Doctors have more responsibility and autonomy than nurses, so why should this not apply to them?

The current system is woefully inadequate and if doctors are practising safely then they have nothing to worry about. The current system allows doctors to continue to uphold their mystique as some kind of deity, beyond reproach.

Undoubtedly, doctors do a hard job, often in difficult circumstances and they save lives, but in all professions there are good and bad practitioners. At least with an annual review the bad will no longer be able to hide, and will be filtered out for the safety of patients and for the good of the profession. Surely doctors cannot be against this?

Julie Phillips
Telford, Shropshire

Sir, These proposals are unwieldy and bureaucratic. They will increase NHS costs, reduce frontline services and do little to improve standards. Most doctors work in practices or teams led by a senior partner or consultant. Hospital consultants are in turn led by medical directors of the various specialisms. Medical competence is effectively assessed continually by such senior medical staff, most taking their mentoring and teaching responsibilities very seriously.

The simple solution to maintaining standards is to incorporate full responsibility for assessing and maintaining the competence of practice or team members in the employment contracts of senior doctors. This would leave only the most senior practitioners to be assessed by the BMA or other appointed body.

George Garside
Benllech, Anglesey

Explore Letters

• Feedback