NHS Forth Valley
Department of Human Resources
Guidance for Managing Issues Regarding the
Conduct and Competence of Consultant and Other Career Grade
Doctors and Dentists
Warning - Document uncontrolled when printed
Policy Reference:
Date of Issue:
22nd August 2012
Prepared by: As Page 2
Date of Review:
21st July 2012
Lead Reviewer (Policy Owner):
Version: 1
Authorised by:
Forth Valley NHS Board and Local
Negotiating Committee
Date: 22nd August 2012
Distribution
All Consultants, General Managers, Service Managers
Method
CD Rom
E-mail √
Paper
Intranet √
AGREEMENT BETWEEN FORTH VALLEY NHS BOARD AND
THE LOCAL NEGOTIATING COMMITTEE
This Guidance has been negotiated by Forth Valley NHS Board and the Local
Negotiating Committee (LNC):
Signed on behalf of NHS
Forth Valley
Iain Wallace, Medical Director
Date:
Signed on behalf of NHS
Forth Valley LNC
Brian Kennedy, Staff Side Chair of LNC
Date:
Signed on behalf of NHS
Forth Valley HR Department :
Helen Kelly, HR Director
Date:
1. Background
This guidance paper has been produced to help to define the roles and responsibilities of key
stakeholders when the conduct, performance, capability or health of a career grade doctor /
dentist is called into question.
i) Change in Culture
Over the last few years a number of initiatives have been put in place which aim to create a
culture of accountability for doctors with emphasis on the delivery of a quality service to patients.
Central to this is the issue of how to deal with poorly performing doctors / dentists, the overarching principle being that prevention is better than cure.
ii) Contractual and Legal Framework
All Doctors / Dentists employed by the Board:
o
o
o
o
have a contract of employment with the Board;
are covered by the Disciplinary Process outlined in NHS Circular 1990 (PCS) 8, 1990
(PCS) 32, PCS (DD) 1994/11, PCS (DD) 1997/7, PCS (DD) 2001/9 and local process
are subject to Board Policies and Procedures governing all aspects of their employment;
are covered by the provisions of the Equality Act 2010, as well as Data Protection
provisions.
In addition, all Doctors/Dentists are subject to statutory regulation by the General Medical Council
(GMC) and / or the General Dental Council (GDC) as appropriate.
iii) Supporting Career Grade Doctors/Dentists
Structures are in place to ensure that all career grade doctors are appraised annually. The
process is outlined in “Policy for Appraisal and Revalidation of Doctors in Primary and Secondary
Care”.
The Board should ensure that structures are in place to deliver the following for all career grade
doctors/dentists:
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quality induction
clearly defined supervisory arrangements where appropriate for non-Consultant career
grade doctors/dentists
an annual job plan review
annual appraisal
the availability of a mentor if requested
pastoral support for doctors/dentists in difficulty
By ensuring that the above structures are in place, competence and performance issues will be
identified at an early stage. Many may be adequately dealt with in the first instance on an informal
basis, locally by the Clinical Lead. Options available, which are not exhaustive, are included in
Appendix 2.
Salaried and Community Dental Practitioners are not covered by the “Policy for Appraisal and
Revalidation of Doctors in Primary and Secondary Care”. Separate arrangements for Dentists
apply.
2. Dealing With Clinical Performance Issues
i) Introduction
In every profession, it is recognised that on occasion, employees may encounter difficulties
during their career. These may manifest themselves in many ways, in terms of conduct,
competency, poor performance or ill health.
Within the medical and dental professions, it is recognised that the cost of training clinicians is
high. Retention of doctors/dentists within the system is therefore cost effective to the service but
cannot be at the expense of patient safety, which is of paramount importance.
The management of performance is a continuous process which will identify problems at an early
stage. Numerous ways now exist in which concerns about a practitioner’s performance can be
identified, facilitating remedial and supportive action before problems become serious or patients
are harmed. Where appropriate, such early intervention may avoid the need to resort to the use
of formal investigation or use of the formal disciplinary process.
Concerns about a doctor’s/dentist’s conduct or capability can come to light in a wide variety of
ways, including for example:
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concerns expressed by other clinicians, NHS professionals, health care managers,
students and non-clinical staff
review of performance against job plans, annual appraisal and revalidation
monitoring of data on performance and quality of care
clinical governance, clinical audit and other quality improvement activities, including the
patient safety initiative
complaints about care by patients, carers or relatives of patients
litigation following allegations of negligence
information from the police or Procurator Fiscal
court judgements
Complaints made by patients, relatives or carers, or concerns raised by colleagues, must be
properly investigated to establish and verify the facts. Unfounded and/or malicious allegations
can cause lasting damage to a doctor’s/dentist’s reputation and career prospects.
A serious concern about capability will arise where the practitioner’s actions may adversely affect
patient care or have already done so.
ii) Procedures
When information is received or an allegation made of sufficient concern to require potential
action and which cannot be dealt with informally by the Clinical Lead, it should be referred to the
appropriate Associate Medical Director (AMD), who will instigate a preliminary enquiry to
determine the appropriate course of action. The AMD will inform the relevant General Manager
that this course of action has been initiated. The appropriate Human Resources Manager will
also be informed and will support the processes set out below.
iii) Preliminary Enquiry (PE)
The preliminary enquiry is not a formal investigation; while it may inform the direction and scope
of any subsequent formal process, its substance should not be used as part a formal investigation
to avoid the risk of prejudicing the outcome.
The AMD may choose to conduct the PE or delegate it to the Clinical Lead responsible for the
doctor/dentist in question. The aim of the PE is to provide sufficient preliminary information to the
AMD to enable him/her to decide which of the range of options for dealing with a potential
problem will be pursued.
It is important, since the PE is not a formal investigation, that its scope is limited to gathering the
information necessary to enable the AMD to make a decision on the future progress of the
matter. This is also necessary to ensure that it is undertaken swiftly and to avoid prejudicing any
formal investigation. A PE should normally be completed in no more than 2 weeks.
Whist the PE it is not a formal process, it will always include discussion with the doctor / dentist
concerned. It is recognised that practitioners may wish to draw upon the support, advice and
representation of the relevant organisation, for example, the BMA or relevant Defence Body.
iv) Options
The AMD has the following options to deal with any matters raised under these procedures, once
a PE is complete. In advance of making a decision about what course of action to follow (other
than a) the AMD should discuss the matter with the appropriate General Manager and alert the
Medical Director.
a.
b.
c.
d.
e.
f.
g.
h.
i.
there is no substance in the allegations and therefore no further action is necessary;
the case is one which the AMD considers suitable to be dealt with outwith the formal
disciplinary process;
the procedures for sick doctors set out in NHS Circular 1982 will apply;
the allegation is of personal misconduct, in which case the disciplinary provisions set out
in the Board’s Disciplinary Policy and Procedure will apply;
the case is appropriate to be dealt with under the Professional Review Machinery (1990
(PCS) 8, Annex A);
the case involves less serious allegations about professional misconduct or competence
and is suitable for the intermediate procedure (1990 (PCS) 8, Annex B; or
the case involves allegations concerning serious professional conduct or competence
and should be dealt with in terms of (1990 (PCS) 8, Annex C);
involvement of the relevant Royal College External Advisory Team (ECAT) as set out in
PCS 9DD) 1999/7 or another agreed College process.
involvement of the National Clinical Assessment Service (NCAS);
In considering whether d, f or g above is appropriate, the Associate Medical Director will have
regard to the content of NHS Circular PCS 2011 (DD) 9 in determining the classification of
conduct and will notify the practitioner accordingly. If the practitioner is dissatisfied with the
decision they may appeal to the Medical Director within seven days of receipt of the formal
notification of classification. The Medical Director The Medical Director will be responsible for
convening a Classification Appeal Committee as specified in the aforementioned circular.
If a decision is taken by the AMD to deal with the concerns outwith the formal disciplinary
process, the outcome of this approach should be communicated to the appropriate General
Manager and Medical Director. A range of options, which is not exhaustive, is listed in Appendix
2.
An Occupational Health referral should be considered in cases where options b – i above are
being pursued.
If there is ongoing concern about a doctor’s professional conduct or performance, no matter what
option is being pursued, the relevant Associate Medical Director and General Manager should
ensure that appropriate arrangements are put in place for further monitoring of the practitioner
until the matter is fully resolved.
3. Terms and Conditions Context
The Board has an agreed Management of Employee Conduct Policy and procedure for dealing
with disciplinary procedures involving personal conduct issues.
For matters relating to professional competence and conduct, the processes are set down
nationally, as laid out NHS Circular 1990 (PCS) 8, 1990 (PCS) 32, PCS (DD) 1994/11, PCS (DD)
1997/7, PCS (DD) 2001/9.
4. Poorly Performing Doctor/Dentists, NCAS and the GMC
If a decision is made to make a referral to NCAS on professional competence grounds (not ill
health) this must only follow a PE as referred to above. If performance remains a serious
concern or there are immediate issues affecting patient safety, it may be appropriate to contact
the GMC/GDC. Any referral to NCAS or the GMC/GDC should only be taken by an AMD after
discussion with the Board Medical Director. The decision to refer will be discussed with the
doctor / dentist concerned in advance of the referral being made.
5. Suspension
Guidance on the conduct of Medical and Dental suspension is laid out in PCS (DD) 1994/11, later
modified by PCS 9DD) 1999/7. The procedure set out in Appendix 1 must be followed in relation
to any suspension of medical/dental staff.
In all cases, suspension should only be considered once all other options have been fully
explored.
6. Right to Representation
At all stages of the procedure referred to above, the doctor/dentist will have the right to be
represented by his/her Trade Union, Professional Association or Defence Body.
Appendix 1
Procedure for Dealing With the Suspension of Medical/Dental Staff
This procedure should be used in respect of the suspension of medical/dental staff on any
grounds, including both personal and professional conduct and professional competence.
1. Suspension may be considered when a member of staff needs to be immediately
removed from the employing body’s premises to protect the interests of patients, other
staff, or the practitioner and /or to assist in the investigative process.
2. The authority to suspend, or extend a suspension period is vested in the Associate
Medical Director and the General Manager of the service. The practitioner will be
advised of their rights by the suspending officer.
3. Suspension is not a disciplinary sanction and will only be considered when all alternative
options have been considered.
4. The decision to suspend will be conveyed to the doctor / dentist concerned privately, with
a management witness present. The doctor / dentist will have the right to representation.
The Chief Executive Medical Director, Human Resources Director and Chief Operating
Officer should be informed of the suspension by the suspending manager at the earliest
opportunity.
5. Identification badges will be retained by the Board during the period of suspension and
will be requested during the verbal suspension meeting. If for any reason the
identification badge cannot be provided during this meeting, the doctor / dentist will be
required to return it to the relevant General Manager at the earliest opportunity.
6. The Human Resources Director will inform SGHD when any doctor or dentist is
suspended. The name of the practitioner, their specialty, the date of suspension and the
reasons for the suspension should be given. The Human Resources Director will provide
monthly progress reports, which will include information on progress to date, the reasons
for any delay in resolving the case, an explanation of how it is proposed to overcome
these delays, the costs incurred and the anticipated date of conclusion of the disciplinary
process.
7. The suspension should be immediately confirmed in writing, to the suspended clinician.
This confirmation will clearly state the effective date, time, content of the allegations. The
suspended clinician will be advised that an investigation will follow, its anticipated
duration, which policy applies and all other relevant conditions.
8. The nature of suspension isolates practitioners from their normal organisational support
mechanisms. Suspended practitioners must not contact any colleagues other than the
suspending officer and a designated contact person, who will be identified at the outset
and who is responsible for keeping the suspended practitioner updated on the progress
of the investigation.
9. The suspension will be on full pay.
10. The particulars of the allegations should be investigated and clarified within 10 days.
Where this is not possible, the practitioner should be told why and informed when further
information will be provided.
11. There should be provision in all cases for review of the suspension as the investigation
continues. At each review, careful consideration should be given as to whether the
interests of patients, other staff, or the practitioner and/or the needs of the investigative
process continue to necessitate suspension. This process should also take into account
the option of the practitioner returning to limited or alternative duties where practicable.
12. A review of the position should normally be undertaken at least every 2 weeks and the
outcome reported to the Medical Director, Human Resources Director, Chief Executive
and the appropriate Committee of the Board.
13. The practitioner will be informed of the outcome of each review by the designated
contact.
14. After a minimum period of 8 weeks of suspension, a doctor can request a review of their
situation by writing to the Director of Human Resources stating the reasons why they feel
15.
16.
17.
18.
19.
their suspension should be lifted. The Director of Human Resources and the Medical
Director will undertake a review of the reasons for suspension and the current status of
any investigation and will inform the doctor within 2 weeks from the date of his/her letter
of their decision.
If the investigation has not been completed within 3 months of the date of suspension, a
report should be made to the Chief Executive, Medical Director and Director of Human
Resources, outlining the reason for the delay and indicating how long the suspension is
expected to continue, together with a plan for completion of the investigation.
If the suspension continues, reports should be made by the suspending manager on a
monthly basis to the Chief Executive, Medical Director and Director Human Resources.
If at any time after the practitioner has been suspended, investigation shows that either
the allegations are without foundation or that further investigation can continue with the
practitioner working normally, the suspension should be lifted and the practitioner allowed
to return to work as soon as practicable. Appropriate arrangements will be put in place to
facilitate the return.
Whilst it is impractical to lay down strict time limits for the overall duration of suspension,
it should be kept to an absolute minimum in all cases.
During the period of suspension, practitioners may not take up locum employment
without the express permission of the Board. The practitioner will be required to inform
any prospective employer, including those within the private sector, of his or her
suspension and advise them that they are required to contact the Board, in writing, with
reference to the reasons for the suspension.
Appendix 2
Options Available When Formal Action is Deemed Unnecessary
1. Organisational issues identified - assistance will be provided to the individual doctor, or to
the wider team, to assess and resolve any organisational problems.
2. Specific Personal Development Need identified – where the individual doctor is aware of
a specific development need, the provision of a specific training opportunity may be
agreed as the appropriate response to the concern. The doctor will provide evidence to
his/her AMD and appraiser that the educational objective has been satisfactorily met.
3. Assessment of Training Need Identified – as assessment will be commissioned through
the doctor’s Royal College, Specialty Group or other agreed process. Outcomes might
include targeted training, re-training or a mentorship arrangement. (See 4).
4. Mentoring – a mentor will be provided to work with the doctor. The doctor will need to
agree to work with and participate in the mentoring process. The mentor will be an
experienced clinician who works for the Board or, by agreement, someone who works in
another NHS organisation. The issues to be addressed will be agreed in a letter provided
by the AMD. Regular reports on progress will be provided by the mentor and a final
report submitted to the AMD. It is expected that the final report will be agreed between
the doctor and the mentor.
5. Coaching – a coach will be identified to work with the doctor to address identified
development needs.