NHS England Performance Review Process
Amongst the plethora of organisations that supervise, regulate, and oversee GPs work are the regional NHS England Professional Performance Teams whose responsibilities include identifying, managing a supporting GPs on the Medical Performers List if their professional performance has raised concern. The Performance Team consists of GPs, other Clinicians, and Managers who specialise in this area. The team has access to trained investigators, both clinical and non-clinical.
Here in the Southwest the regional team also offers help to GPs who may not be underperforming but could be struggling due to work pressures. Where appropriate, NHSE works closely with the GMC to ensure that investigations are not duplicated and the GMC sometimes refers relatively minor matters into the NHSE performance review system.
For locally raised concerns, an informal conversation with NHSE may often be enough to agree on what to do about a minor or irrelevant concern, but otherwise it will be taken to the Performance Advisory Group (PAG) which is a small, local panel of people whose purpose is to provide advice, and support, assess, and act where performance concerns have been raised.
A small proportion of doctors will be investigated due ill-health and their ability (or not) to perform their duties, or because of cognitive or physical impairment – including the misuse of drugs or alcohol. Some will be investigated due to behavioural concerns, such as irritability or anger, or unusual behaviour that is at odds with work ethics and which affect their ability to do their job. Rarely GPs may be investigated due to alleged criminal activity, such as fraudulent use of prescriptions, claiming for monies that they are not entitled to, or failing to deliver services to the level expected. Doctors can also be investigated for persistent poor clinical performance or sub-optimal decision making those risks impacting on patient care or wider service delivery.
The LMC sends a non-voting member to PAG meetings whose main role is to provide a view as to what the normal standards expected of a GP would be. Most referrals can be dealt with by the PAG who often decide that no action is required, or that the issues are not serious and advice is given.
Matters which are deemed to be more serious are referred to the PLDP (Performance List Decision making Panel).
PLDP (Performance List Decision making Panel)
This is the formal end of the process and the doctor will usually be expected to attend a panel meeting. The PLDP understands that to go through this process can be hugely stressful. Its role is to look objectively at the evidence to see if the GP’s performance has fallen below an accepted standard and, if this is the case, to see if this put patients at risk. The Panel also looks for evidence that the practitioner shows insight and has reflected on the problem. If something has gone wrong, it is important to consider what has been learnt and what will happen to prevent this happening again. This overall process is mainly about support for the doctor and ensuring patient safety, not punishment!
Once a case has been considered, the Panel has many options:
- Exonerate the GP and essentially say that there is not a performance issue.
- Detail concerns and suggest that the GP voluntarily undertakes some learning or changes their practice.
- Decide that there are more serious concerns and consider placing conditions on the GPs registration. For example, this may mean restricting the prescribing of controlled drugs or working under supervision, or it may be that there is a recommendation for training which the individual must undertake or risk being removed from the performers list.
- Suspend the GP. This would usually be whilst the facts are being investigated after are serious performance concern.
- Referral to the Occupational Health Service and/or NHS Resolution to establish if there are any underlying health issues and if the practitioner needs support or special measures for them to continue working.
In the most serious circumstances, NHS England can remove a GP from the performers list and prevent them from working as a GP. It should be noted that only the GMC can prevent a doctor working in another medical role.
The relationship between Somerset LMC and our regional Professional Performance team has always been very good and our experience is that their processes have been scrupulously fair. Wherever possible their objective is to guide doctors through a bad patch and restore them to safe and effective practice.
