Managing Poor Performance The Wolves Way

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Managing Poor PerformanceThe Wolves Way

• Lynne Allen
• Director of Primary Care
• Barbara Dingley
• PCC Advisor

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How do you search them outits never been easier
!!!!

• Infection control audit
• Premises report
• QOF- organisational
• - clinical
• Contract monitoring
• Enhanced services monitoring
• SFBH reporting
• Customer services reports - informal
• -
  formal
• Sickness
• Bizarre behaviour
• Criminal charges / prosecutions
• Whistleblowing
• Fraud
• GMC to PCT referral

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What can you do with them when you find them ???

• Suspension / removal from Performers List
• NCAS referral
• GMC referral
• Contract notice
• Police
• Local counter fraud team referral

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Panic !!!! How shall we handle it now we have
found it ????

• Each case is different
• No one fit for all
• Dont rush in where angels fear to tread
• Think / reflect / take advice / plan / execute
  review / learn / revise

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How Wolves get started

• 3 wise men and 2 women
• All cases considered using
• Procedure for Practitioners Whose
• behaviour gives Cause for Concern
• Supportive, sensitive developmental approach
• Action plans targeted support when necessary
• Referral onwards as appropriate.

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Procedures for Practitioners whose Performance
gives Cause for Concern
Formal Complaints, Long Term Sickness, Informal
Expressions of Concern, PCT Data or issues
etc. DOES THIS REQUIRE ACTION?

• CLARIFICATION
• Responsible Locality Lead GP, Director of
  Primary Care Timescale 1 week

No Action needed
Inform the Professional List Panel

• PRIMARY DECISION
• Responsible Professional Support Sub Committee
  (PSSC) Timescale 4 weeks (Urgent cases within 5
  working days)

No action needed
Report to PEC, PCT and Trust Primary Care
Clinical Governance Boards
C. PRIMARY ASSESSMENT Responsible practice
Assessment Team (PAT) Locality Lead GP, Clinical
Governance Lead, GP Tutor, Lay member and
Director of Primary Care Timescale 2 weeks
Health problem identified
LRC Model of support
Contd
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Contd .

• SUPPORT PLAN
• Responsible PAT lead identified
• Timescale 2 weeks

Support plan Not agreed
Report to Director of Primary Care

• IMPLEMENTATION
• Responsible As needed likely to include Locality
  lead GP , Tutor, PCT staff. Timescale
  identified in Support Plan

• REFERRAL
• Refer to National Clinical Assessment Service
  (and GMC if indication)
• Responsible Director of Public Health in
  consultation with the Chair of the Clinical
  Governance Board

F. SECONDARY ASSESSMENT Responsible PAT
Timescale As per plan usually within 3 months

• SECONDARY DECISION
• Responsible PSSC
• Timescale 4 weeks (Urgent cases within 2 working
  days)

Unsatisfactory outcome
Anonymised report to PC Clinical Governance
Board. To PEC, Trust Board via Clinical
Governance Report
Satisfactory outcome and long term support and
review
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EXPERIENCES

• GMC / Police and judicial / performers list
  proceedings can run simultaneously but to
  different timescales
• Removal of contract and not from performers list
  only shifts the problem to others
• Dont mix up contract with performers list
  regulations
• GMC refers cases to PCT for action
• NCAS assessment robust but protracted. Can end up
  at GMC
• Using local GPs for improvement plans not
  effective especially in areas where general
  practice is underdeveloped. Thresholds lower
• If you make an error with proceedings go back and
  un pick
• Use contract breech notices more frequently

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What does a PCT need to have in place

• Robust policy and procedures for management of
  contractor lists
• Robust procedures for practitioners whose
  behaviour gives cause for concern
• Performance management framework for contractors
• Sick doctor procedures