Local action can resolve concerns over doctors' behaviour

Dean Royles’ recent HSJ article, ‘Doctors’ discipline needs an overhaul’, made me sit up and take notice for two reasons.

First, I wanted to reassure our stakeholders that the National Clinical Assessment Service will continue to offer a free service at the point of use to the NHS in 2013/14. Second, I was interested to read Dean’s perspective on the ongoing debate about Maintaining High Professional Standards in the Modern NHS.

‘Capability is a difficult issue to tackle and would be so whatever framework was in place’

The document, designed as a statement of good practice to encourage the resolution of concerns locally, was drafted by the Department of Health with input from medical and dental professionals.

Because of its national role, NCAS has gained extensive experience of operating within the framework, as well as guidance from the courts in a number of cases on how the most contentious issues should be interpreted.

Complexity of capability

Parts one and two of Maintaining High Professional Standards provide guidance on carrying out investigations and exclusions respectively. As Dean noted in his article, the framework has succeeded in reducing the number of doctors excluded for lengthy periods.

The latest estimates are that NCAS, which has a particular role in exclusion under the standards, has reduced the period of exclusions from a mean high of 35 weeks in 2006/07 to a mean low of 19 weeks in 2011/12.

Part three refers conduct matters to local procedures, adding that there is a requirement for independent professional advice to be sought during the investigation. It also adds the requirement for professional representation on the hearing panel if the alleged misconduct relates to matters of a professional nature. Part five, on health, also effectively refers back to local procedures.

The difficulty for most of us engaging with Maintaining High Professional Standards arises from part four on capability. This may be partly because capability is a difficult issue to tackle and would be so whatever framework was in place.

The decision of the high court in Lim v Royal Wolverhampton Hospitals NHS Trust [2011] EWHC 2178 has added an extra layer of complexity and NCAS responded with an updated position statement on Maintaining High Professional Standards.

Rising referrals

Any capability process, as Dean said, must be fair and transparent, but it must also be robust enough to withstand legal challenge. I am sure we all wish capability issues could be resolved swiftly and fairly without referral to lawyers, but the reality is this will not be the case and any process developed must consider that fact.

‘Any low level concerns identified should be managed by local clinical governance’

Complex or not, the DH document is the framework we have in place and many of us will be drawing on it when significant performance concerns arise. We suspect concerns are increasingly being identified earlier and this is borne out by our referral rates

NCAS has just had its busiest period ever for referrals across primary and secondary care together. Maintaining High Professional Standards statements on good practice and resolving concerns locally clearly continue to be relevant.   

We do not believe revalidation should raise numbers of referrals under Maintaining High Professional Standards significantly. Any low level concerns identified should be managed by local clinical governance.

Local touch

To enable more local resolution, we are developing a suite of “light touch” interventions that will support the resolution of concerns that are deemed below the threshold for invoking capability procedures.

These will be useful not only for the medical profession, but for the dental and pharmacy sectors as well. These interventions will be in addition to our core service of case management, assessment and action planning in support of the more complex cases.

In October, NCAS won the contract to train case investigators across England for the NHS’ Revalidation Support Team, which is leading the revalidation change programme nationally.

The training will be designed to use our experience of managing concerns about the professional practice of doctors, dentists and pharmacists across the UK and our proven track record of providing educational services, including training for NHS staff on managing  concerns.

In the meantime, managers dealing with performance concerns in the NHS can rest assured that they can contact us without charge for the foreseeable future, and not just about Maintaining High Professional Standards. We are here to help resolve all your performance concerns.

Lynn Hugo is director at the National Clinical Assessment Service