Performance

The term “Performance” can mean a number of different things but in this context it is the performance of individual GPs. Wider performance issues concerning GP practices, such as contractual performance or performance against a set of indicators are dealt with elsewhere.

There is a small proportion of doctors, who at some stage in their career, find themselves “under the spotlight” for something that has happened in their professional practice. This can be a worrying and challenging time for the doctor concerned and a major role of the LMC is to support doctors through such processes. The LMC is likely to be involved with individual doctor, giving support, advice and representation with the GP during the performance review process. It also links in to the GP Mentoring Scheme for GPs in Cumbria and Lancashire. So any GP who finds themselves the subject of a performance issue should contact our office for a confidential discussion as soon as possible. We have a significant amount of experience dealing with such issues and can ensure that a doctor receives a fair hearing, that all the facts are considered and that any response is proportionate and commensurate with the issue identified. In some instances a requirement will be identified for further training, awareness raising or remediation. It is also our duty to ensure this is put in place and followed through for the doctors needing such support.

There is a new definitive national framework by which doctors whose performance gives cause for concern will be dealt with. This framework will be operated by the Area Teams of NHS England. Whilst this is unlikely to affect most GPs, occasionally someone finds themselves “on the radar.”

The position of NHS England (through the Area Teams) on the subject of professional performance recognises that in many instances this can be unintentional and the clinician’s performance may be affected by a combination of personal and situational factors, such as illness or professional isolation. NHS England Area Teams will therefore always seek to take the most appropriate action in order to protect patient safety and to help the primary care performer or contractor involved. It is also acknowledged that lasting damage can be caused to the reputation and future career of a primary care performer or contractor by unfounded and malicious allegations. Any and all allegations, including those made by patients or relatives of patients, or concerns expressed by colleagues, will therefore be investigated fully to properly establish the facts. The facts will be considered and a decision made whether there is a case to answer.

There are two levels at which issues will be addressed in each NHS England Area Team. The Performance Screening Group (see  and Procedure for Individual Performance Concerns) is the first tier and will a repository of expertise provided by individuals with in-depth knowledge of performance procedures and professional standards and able to provide advice on handling individual cases. The group will review on a regular basis all new and on-going cases of performance concerns.

They will do this by receiving all intelligence which highlights issues of concern relating to the performance and conduct of primary care performers or contractors. They will consider each individual case presented in detail and decide whether further action is required, further information is required, or that there is no case to answer. Where appropriate the PSG will initiate an investigation. Following this they will decide upon and agree ideally through consensus, but if not through the majority, a relevant course of action, the level of support required and the resources required. They will then monitor progress against all cases and action plans, and decide when the case can be closed, or whether further action is required.

Part of their scope will be to consider referring for external advice from the National Clinical Assessment Service (NCAS), national professional and representative bodies, local representative committees, local education and training boards, or other advisory bodies.

For cases of a serious nature, or in cases where the primary care performer or contractor has failed to make significant improvements, the Performance Screening Group  will refer cases to the Performers List Decision Panel (see  and Procedure for Individual Performance Concerns).
This panel can make one or more of the following decisions:

  • Take no further action and refer back to the PSG
  • Request a formal investigation
  • Make recommendations for improvement through remedial action
  • Take disciplinary action in compliance with current and relevant National Health Service regulations which result in conditional inclusion, contingent removal, suspension, exclusion and removal
  • Consider action under the contractual arrangements
  • Refer to the relevant professional regulatory body
  • Refer to the National Clinical Assessment Service for advice and consideration of an assessment and/or remedial action
  • Refer to the police
  • Refer to NHS Protect
  • To request the issue of an alert through the agreed NHS CB mechanism according to the Healthcare Professionals Alert Notice Direction (2006)
  • Referral to occupational health.

LMC nominees are core members of both of these groups and have full voting rights. This is a major step forward in recognising the vital role of the LMC in acting for the profession. The role of the LMC nominee on the Performers List Decision Panel is specified as “responsible for providing advice as the clinical expert to the NHS CB in this decision making process.” The role is, therefore, over and above that of the individual whose performance is under review. The nominee is there to represent the profession as a whole and indicate what is acceptable and not acceptable.

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