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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 8; 335(7618): 465.
PMCID: PMC1971186
Unholy Trinity

Sticking to standards, not together

Caroline Mawer, general practitioner and Douglas Russell, medical director

If the profession continues to turn a blind eye to underperformimg doctors we should not be surprised if the government takes action.1

We have used locum doctors as part of the salvage process for a high health need, inner city practice over the past six months. Some of them missed potential red flags; had poor record keeping, prescribing, and referral practices; and proposed out of date management of chronic conditions. Some from elsewhere in Europe do not know how the NHS works, or how to work in the NHS. Perhaps not surprisingly—since locums are generally unsupervised and unsupported—most do not seem to reflect systematically on their clinical practice.

So far, in this one practice over the past few months, we have referred one doctor to the National Clinical Assessment Service and another for formal investigation. Dozens of others have been referred to their host primary care trusts.

We are unusual in having an assertive quality process, routinely reviewing the day to day work of all our clinicians. And it takes up time and resources which we would rather spend on our patients.

Perhaps this explains why no one else has picked up these issues and these doctors. We think that there is widespread collusion between employers (often general practitioners, sometimes primary care trusts) who want holidays and other staff gaps filled; locum agencies that are apparently oblivious; and other doctors who seem to be in denial about poor performance even when they notice it.

Jones calls for professional unity.2 Surely this means sticking to standards rather than together?


Competing interests: None declared.


1. Delamothe T. Why this unholy trinity? Editor's choice. BMJ 2007;335 doi: 10.1136/bmj.39308.477870.BD
2. Jones R. The future of the medical profession. BMJ 2007;335:53 (14 July.) [PMC free article] [PubMed]

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