Why are psychiatrists more likely to get into trouble with the NCAS?

The National Clinical Assessment Service (NCAS) was established in 2001 to help the NHS address concerns about the performance of doctors. It was extended to include dentists in 2003. They publish reports on their activity every couple of years or so; the most recent one being published in 2009.

Unfortunately, it seems as though it's difficult to access from outside of the NHS. However, there is a copy here: NCAS Casework: The first eight years. There are some interesting findings.

One is that psychiatrists are over-represented in specialties referred to the NCAS. Between 2001/02 and 2008/09, 541 psychiatrists were assessed out of a total of 4,508 doctors (12%). The majority, 341/ 541 (63%) were consultant psychiatrists.

This might not be that interesting were it not for the fact that more psychiatrists were assessed than might be expected from their overall number of doctors. Psychiatrists make up between 6-7% of the workforce, but contribute 12% of all assessments. This is shown below:

Why might this be? Well, the NCAS has tried to determine the factors that might be contributing to this finding (which is consistent year-on-year). They found that, "The specialties are ranked in order of proportions non-white and qualifying outside the UK (column 2). O&G [Obstetrics and Gynaecology] and psychiatry rank highest (36 per cent and 33 per cent compared with 25 per cent for medical specialties together). They also have the lowest proportions white and UK-qualified (37 per cent and 40 per cent in column 5). Their share of UK-qualified non-white practitioners is below average (column 3) and white non-UK qualified practitioners have an above average share (column 4). Chart 2.1 may therefore be showing, for psychiatrists, the effect of ethnicity and place of qualification alongside specialty."

This appears to suggest that being non-British and qualifying outside of the UK has a bigger effect on psychiatry than other specialties because psychiatry has a higher relative proportion of these groups. They add that, "There is no evidence that non-white UK-qualified practitioners are being referred or excluded disproportionately." I think that it is important to not speculate too much as these are potentially sensitive areas. NCAS are keen to point out that, "NCAS is not trying to produce a determinist explanation of referral patterns".

What about reasons for referral to NCAS? Well, individual specialty data are not available from the report, but the most common reasons for doctors to get into trouble are: "Clinical Difficulties", followed by "Governance/ Safety Issues", followed by "Misconduct". This is shown in the graph below:

Of the clinical difficulties, the most common reasons were: Critical Incident (21%); Diagnosis Skills (20%); Record Keeping (18%); Consultation Skills (18%). Other reasons are broken down by speciality in the table below. Only the figures in bold were found to be statistically significant.

The whole report can be found at the link above.