Any better? Outcome measures in medical audit.

the legal proceedings over the difference between accreditation within the United Kingdom and specialist certification in the European Community. The joint committee had correctly advised Dr Goldstein that he had fulfilled the training requirements of the medical directives of the European Community, and could apply to the General Medical Council for the certificate of specialist training, a qualification that has no legal standing in the United Kingdom but is recognised as indicating specialist status by other states within the European Community. The judge found it "perverse" that the committee should recommend this while refusing accreditation. The two indicators, however , bear no relation to each other.4 Specialists in other European countries work mainly in free practice outside hospitals, where they do not have the same responsibilities as NHS consultants. Their certificates are a legal requirement for them to be able to claim reimbursement of specialist fees through social security systems but do not indicate suitability for a senior hospital appointment. Accreditation is a purely British phenomenon with no meaning in European Community law and is designed to fulfil a uniquely British need. This distinction is widely misunderstood but is likely to become increasingly important as more doctors migrate within the European Community. The joint committee is at fault in that the relevant guidance in its handbook is confusing. The outcome in this case leaves many questions un-answered, but some conclusions may be drawn. Firstly, bodies acting in the public domain, and therefore subject to judicial review, should be aware of legal pitfalls, and may need to employ legal assessors to avoid them. The procedures and criteria used by the joint committee did not stand up to judicial scrutiny, and better procedures will be needed in future. Secondly, a more rigorous analysis of the criteria applied in accrediting trainees and a more cogent justification of them are needed. Considerations to do with education and manpower have become tangled, and the joint committee must now try to separate them, perhaps by introducing a numbering system for trainees similar to that used in surgery. Lastly, the case has highlighted the unsatisfactory nature of temporary senior registrar appointments. They are an inefficient way of maintaining a clinical service, encourage expectations in the appointee that may not be fulfilled, and are not subject to the same quality controls as substantive posts. In future, such posts should be made available to visiting registrars who may not …