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The National Cancer Peer Review Programme is undertaken by peer reviewers and user reviewers resulting in assessments on the quality of cancer services for NHS patients in England.1 2 Throughout 2004–2007 the peer review process has been taking place across England. Responding to some disquiet at the benefits of peer review in its current format, the BTS Lung Cancer and Mesothelioma Specialist Advisory Group decided to carry out a survey of lead lung cancer clinicians in all trusts in England who were undergoing peer review. The methodology of the survey is detailed in the online Appendix.
A total of 94 responses were received from approximately 150 lung cancer leads (all consultant physicians). Responses were obtained from consultants in all cancer networks in England (fig 1). The majority (93%) had been personally involved in self-assessment; 59% felt that self-assessment had been a useful process, but there was significant impact upon clinical activities (in 36%) and management activities (in 49%). Respondents were asked to estimate the time spent on self-assessment; a wide range of answers was received, ranging from no time to 168 h with a mean of 19 h and a total of 1606 h (67 days). To attend the peer review interview, 62% of consultants had to cancel clinical sessions and 27% reported difficulties in getting colleagues to attend; 82% of respondents felt that the membership of the interview panel was appropriate. However, the format of the interview was overall felt to concentrate on the wrong aspects by 65%; 24% felt that the interview concentrated on outcomes whereas 91% felt that process and paper evidence were the main focus. Overall, 72% felt that the final report was a fair assessment of their lung cancer service.
The final questions asked for overall feelings about the peer review process (fig 2). There appeared to be mixed feelings about whether peer review had benefited patients, with only 55% giving a positive opinion. Approximately one-third agreed that peer review concentrated on the right aspects, but nearly 50% felt it did not. Similar responses were obtained to the question of whether peer review was an effective way of improving cancer care. Finally, 95% of respondents felt that the results of the survey should be fed back to those with responsibility for the peer review process.
We re-analysed the results according to seniority of the consultants, splitting them into those who were >10 years in post (n = 48) and those <10 years in post (n = 46). The results were similar in the two groups. However, the younger consultants were more likely to look upon self-assessment as a useful exercise (70% vs 56%) and were more likely to feel that peer review had benefited patients (61% vs 52%).
The survey questions allowed space for free text comments and many were made (see online Appendix).
One criticism of the results might be the rather low response rate of 61%. However, some 20% of the trusts that did not respond had valid reasons—for example, their lead clinician had since retired or moved to a different post. The survey has revealed strong feelings among lead clinicians regarding cancer peer review, and the overwhelming message of the survey is that clinicians feel that peer review is assessing the wrong things, concentrating on paper evidence of compliance with measures which may not be evidence-based and which may not reflect the quality of the lung cancer service. There is a wish for teams to be assessed less on these elements of process and more on outcomes. Measuring outcomes and comparing them between units is a longer term aim of the LUCADA audit. However, some respondents did acknowledge that peer review was an evolving process and many of the measures reflected good practice.
The results of this survey will be fed back to the National Peer Review team and hopefully the comments will inform further rounds of the peer review process, thereby engaging clinicians and ensuring that all patients with lung cancer have access to high quality services.
Competing interests: None.
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