Working with doctors Working for patients

Doctors under investigation - performance assessments

This page provides information on performance assessments.

Where the concerns relate to aspects of the doctor's performance, we may require an assessment of the doctor's performance.

A 'performance assessment' may form one part of a wider investigation into a doctor's fitness to practise. 

Concerns about a doctor's performance may arise from information referred by the doctor's employers or from one or more patient complaints. 

What might trigger a performance assessment?

The kinds of concerns that may trigger an assessment of a doctor's performance include:

  • a tendency to use inappropriate or outdated techniques;
  • a basic lack of knowledge/poor judgement;
  • a lack of familiarity with basic clinical/administrative procedures;
  • poor record keeping or failure to keep up-to-date records;
  • inadequate practice arrangements;
  • concerns over referral rates;
  • inadequate hygiene arrangements;
  • poor prescribing.

These are examples only and are not exhaustive.

The assessment process

If we consider that an assessment is required, we will initially write to the doctor asking him/her to confirm some basic details to assist the GMC in arranging the performance assessment. 

The assessment will be carried out by an assessment team appointed by the GMC and comprising:

(a) a team leader, who shall be a medical performance assessor;

(b) one or more additional medical performance assessors; and

(c) one or more non-medical performance assessors.

The assessment team

When selecting the medical performance assessors, the GMC will take account of the area of practice in which the doctor specialises and/or to which the complaint(s) relate. 

In order to help the team understand the circumstances of the doctor's professional practice and plan an assessment which is relevant to his/her particular areas of experience and expertise, the doctor is asked to complete and return to the GMC a portfolio describing different aspects of his/her work. The doctor may wish to ask for advice on completing this portfolio.  

What the assessment will include

The assessment team will adopt such procedures and seek such advice or information as they consider necessary in order to assess the standard of the doctor's performance. 

However, assessments will almost invariably comprise the following elements:

(a) A peer review which may include:

  • a visit to the doctor's place of work;
  • interviews with the doctor;
  • interviews with third parties, including the complainant or complainants in the case;
  • a review of a sample of the doctor's records and practice documents;
  • a case based discussion using a selection of the above cases to explore the doctor's reasoning;
  • observation of the doctor's interaction with patients (where this is practical and the doctor is working). 

(b) Tests of competence comprising formal tests of the basic knowledge and skills required for the particular area of practice in which the doctor is engaged.

At the end of the assessment process, the team will report on the standard of the doctor's professional performance. 

Read more about tests of competence.

You can also view a short video, filmed at our clinical assessment centre, about the Tests of Competence: view the video.

Refusal to undergo assessment

If the doctor refuses to undergo an assessment or fails to cooperate with the assessment process, the doctor may be referred for to the Medical Practitioners Tribunal Service (MPTS) for a medical practitioners tribunal hearing to consider whether action is required on their registration.

Decision by case examiners

Following the performance assessment, the case will be considered by two senior GMC staff known as case examiners (one medical and one non-medical). The case examiners will consider all the evidence that has been gathered during the investigation and not just the contents of the performance assessment report. There are a number of options available to the case examiners at this stage:

  • conclude the case with no further action;
  • refer the case for a medical practitioners tribunal hearing with the MPTS;
  • agree undertakings;
  • issue a warning.