Continuous, risk-based, consultation peer review in out-of-hours general practice: a qualitative interview study of the benefits and limitations

Ian Bennett-Britton*, Jonathan Banks, Andrew Carson-Stevens, Chris Salisbury

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)
57 Downloads (Pure)


BACKGROUND: Systems to detect and minimise unwarranted variation in clinician practice are crucial to ensure increasingly multidisciplinary healthcare workforces are supported to practice to their full potential. Such systems are limited in English general practice settings, with implications for the efficiency and safety of care.

AIM: To evaluate the benefits and limitations of a continuous, risk-based, consultation peer-review system used for 10 years by an out-of-hours general practice service in Bristol, UK.

DESIGN AND SETTING: A qualitative interview study in South-West England.

METHOD: Semi-structured interviews with intervention users (clinicians, peer-reviewers and clinical management), analysed by inductive thematic analysis and integrated into a programme theory.

RESULTS: 20 clinicians were interviewed between September 2018 - January 2019. Interviewees indicated the intervention supported clinician learning through improved peer-feedback; highlighting learning needs and validating practice. It was compared favourably with existing structures of ensuring clinician competence; supporting standardisation of supervision, clinical governance and learning culture. These benefits were potentially limited by intervention factors such as differential feedback quality between clinician groups, the efficiency of methods to identify learning needs, and limitations of assessments based on written clinical notes. Contextual factors such as clinician experience, motivation and organisational learning culture influenced the perception of the intervention as a support or stressor.

CONCLUSION: Our findings demonstrate the potential of this methodology to support clinicians in an increasingly multidisciplinary general practice workforce to efficiently and safely practice to their full potential. Our programme theory provides a theoretical basis to maximise its benefits and accommodate its potential limitations.

Original languageEnglish
Article numberBJGP.2021.0076
Pages (from-to)E797-E805
Number of pages25
JournalThe British journal of general practice : the journal of the Royal College of General Practitioners
Issue number711
Early online date11 May 2021
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information:
This study is based on independent research. Funding bodies and organisations involved in this research had no influence over this study or the content of the manuscript. Ian Bennett-Britton’s time was funded by the National Institute for Health Research (NIHR) School of Primary Care Research (GP Progression Fellowship) and Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (RCF 19/20-64E). Study costs were in-part supported by the Scientific Foundation Board of the Royal College of General Practitioners (grant reference: SFB 2018 – 28). Jonathan Banks’s time is supported by the NIHR Applied Research Collaboration West (NIHR ARC West). Chris Salisbury is partly supported by the NIHR ARC West and by Bristol Clinical Commissioning Group. Andrew Carson-Stevens is partly supported by the Health and Care Research Wales funded Primary and Emergency Care Research Centre (PRIME Centre Wales).

Publisher Copyright:
© 2021 Royal College of General Practitioners. All rights reserved.

Structured keywords

  • Centre for Academic Primary Care


  • General Practice
  • Primary Health Care
  • Peer Review
  • Patient Safety
  • Feedback
  • Quality of Health Care


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