Journal of Evaluation in Clinical Practice, 12, 6, 622–629 doi:10.1111/j.1365-2753.2005.00630.x 622 © 2006 Blackwell Publishing Ltd Blackwell Science, LtdOxford, UKJEPJournal of Evaluation in Clinical Practice1356-1294Blackwell Publishing Ltd 200512 6622629Original ArticleVariations in the ability of GPs to apply auditJ. McKay et al. Correspondence Dr John McKay NHS Education for Scotland 2 Central Quay 89 Hydepark Street Glasgow G3 8BW UK E-mail: john.mckay@nes.scot.nhs.uk Keywords: audit, general practitioners, peer review, SEA Accepted for publication: 27 April 2005 Variations in the ability of general medical practitioners to apply two methods of clinical audit: a five-year study of assessment by peer review John McKay BSc (Hons) FRCGP, 1 Paul Bowie BA PgDip 1 and Murray Lough MD FRCGP 2 1 Associate Adviser, 2 Assistant Director, Department of Postgraduate Medical Education, University of Glasgow, Glasgow, UK Abstract Introduction Clinical audit has a central role in the NHS clinical gover- nance agenda and the professional appraisal of medical practitioners in the UK. However, concerns have been raised about the poor design and impact of clinical audit studies and the ability of practitioners to apply audit meth- ods. One method of making informed judgements on audit performance is by peer review. In the west of Scotland a voluntary peer review model has been open to general practitioners since 1999, while general practice train- ees are compelled to participate as part of summative assessment. The study aimed to compare the outcomes of peer review for two methods of audit undertaken by different professional and academic groups of doctors. Methods Participants submitted a criterion audit or significant event anal- ysis in standard formats for review by two informed general practitioners (GPs) using appropriate instruments. Peer review outcome data and the professional status of doctors participating were generated by computer search. Differences in proportions of those gaining a satisfactory peer review for each group were calculated. Results Of 1002 criterion audit submissions, 552 (55%) were judged to be satisfactory. GP registrars were significantly more likely than GP trainers ( P < 0.001) and other established GP groups ( P < 0.001) to gain a satisfactory peer review. GPs in non- training practices were less likely to achieve a satisfactory review than reg- istrars ( P < 0.001) and colleagues in training practices ( P < 0.001). Of 883 SEA submissions, 541 (65%) were judged as satisfactory, with all groups gaining a similar proportion of satisfactory assessments, although GP reg- istrars may have outperformed non-training practice GPs ( P = 0.05). Conclusion A significant proportion of GPs may be unable to adequately apply audit methods, potentially raising serious questions about the effec- tiveness of clinical audit as a health care improvement policy in general medical practice. Introduction Criterion-based clinical audit is a widely accepted method for monitoring, assessing and improving the quality of health care (Shaw 1990). A relatively new qualitative approach to audit, significant event anal- ysis (SEA), is increasingly being accepted as a sur- rogate for an individual practitioner or health care team to reflect on and enhance the safety and qual- ity of care (Pringle et al . 1995; Harrison et al . 2002).