Valuing the National Clinical Assessment Service

The UK’s National Clinical Assessment Service (NCAS) provides advice to NHS managers about handling performance issues involving doctors, pharmacists and dentists. This post summarises an OHE research project meant to establish how much NHS managers value the NCAS’s services and the relative value placed on different attributes and types of service.

The UK appears to be unique in its National Clinical Assessment Service (NCAS), intended specifically to help health care providers in the NHS deal with problem clinicians. Established in 2001, the NCAS provides support, on request, to all NHS organisations employing or contracting with doctors, pharmacists, and dentists. Currently, the NCAS is financed from central NHS funds, not from charges to NHS organisations. By 2013, however, the NCAS is to become self-funding (a decision made after completion of the research summarised below).

OHE’s latest Research Paper reports on a project meant to establish how much referrers in the NHS value NCAS’s services and the relative value placed on different attributes and types of service. Funded by an unrestricted grant from the NCAS, the project used a mix of qualitative and quantitative methods to elicit information from potential referrers, including a discrete choice experiment (DCE) that provided estimates of relative values and willingness to pay.

The qualitative aspects of the study included a literature review, semi-structured interviews with six senior NCAS staff members and with the medical, dental and pharmacy professions (BMA, BDA and RPS), and discussion groups with a total of 23 senior medical and other NHS managers in each of the four UK nations. The quantitative DCE elicited responses from 450 senior NHS managers responsible for managing clinical performance concerns that could be referred to the NCAS.

The DCE results suggest that the senior NHS managers who participated in the research valued a full package of support at £161.56 per year for each whole-time-equivalent doctor, dentist or pharmacist. Approximately 200,000 such health professionals currently are employed by or under contract to the NHS, making the value of a full package of services covering them all over £32 million per year. Currently, the NCAS provides all these services at an annual cost of £9 million (2008/09).

The paper discusses in some detail the nuances that were revealed by the research — for example, the determinants of variations in preferences for particular packages and in willingness to pay – and factors that may affect changes in demand for NCAS's services over time.

Download Watson, V., Sussex, J., Tetteh, E. and Ryan, M. (2011) Managing poorly performing clinicians: The value of independent help. OHE Research Paper 11/01. London: Office of Health Economics.