Endorsement of peer review

Editor – We read with interest the paper by Roberts et al (Clin Med June 2010 pp 223–7) describing their positive qualitative experience of peer review in respiratory medicine. We would like to further endorse the peer-review process based on our experiences in rheumatology.

In rheumatology, peer-review programmes are encouraged on a regional basis, using a nationally agreed proforma developed by the British Society for Rheumatology and the British Health Professionals in Rheumatology based on evidence-based clinical guidelines. Within the West Midlands region the cycle of multidisciplinary peer review visits occur over a five-year period. Analysis of this programme demonstrated many qualitative benefits, including perceptions that peer review helped obtain more consultant posts, secure day case facilities, set strategies for the next five years, focus managerial requirements and foster a positive learning environment where strengths could be transferred between units. Quantitative analysis revealed many of the recommendations of the peer-review reports had been implemented. It was agreed that peer review was a worthwhile and constructive component of continuing professional development.¹ For some units there was a five-year interval between their peer review and our study which may explain why we were able to detect improvements in staffing and facilities; we agree with Roberts et al that their 12-month follow-up period may have been too short to capture changes in their respiratory services.

Roberts et al describe difficulties in recruiting patients into peer-review teams. In our most recent cycle of 11 peer-review visits we were able to recruit a lay person (patient or carer) onto each reviewing team but only seven visits went ahead with lay involvement, due to unexpected ill health of the lay person or their family (data unpublished).

Roberts et al raised the issue of the cost-effectiveness of peer review. We would suggest that our regional approach over a longer period minimises the organisation required, and that a one-day visit every five years may be a relatively low cost exercise for staff for a clinical governance activity which may yield significant potential benefits including multidisciplinary education, revalidation, and improving patient care.

• Royal College of Physicians