Maintaining Good Medical Practice

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Maintaining Good Medical Practice
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Maintaining Good Medical Practice

•         plans to recognise more specifically the
  responsibilities of trusts, health authorities
  and health boards for good-quality health care
•         the introduction from 1 July 1997 of our
  new procedures for dealing with 'seriously
  deficient performance' (under the Medical
  (Professional Performance) Act 1995) and
•         discussions with chairmen, chief
  executives and senior managers during and
  following our 1997 roadshows.

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Maintaining Good Medical Practice

• When deciding whether to refer a doctor to us,
  you should carefully consider the circumstances
  of the case.
• You should always refer the doctor to us if
•         local action would not be practical
•         you have tried local action and it has
  failed
•         the problem is so serious that we
  clearly need to be involved or
•         the doctor has been convicted of a
  criminal offence.

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The following are the most common examples of
serious problems in doctors and their practices.
Clinical

• If a doctor
•         does not keep professional knowledge and
  skills up to date
•         gives unsuitable prescriptions
•         does not recognise the limits of their
  professional ability
•         does not keep suitable clinical records
  
•         is not willing or able to take a
  patient's history or carry out a physical
  examination properly
•         tries to practise techniques without
  suitable training
•         is not willing or able to communicate
  effectively with patients or their relatives
•         does not work effectively with
  colleagues or
•         seriously neglects or ignores
  professional responsibilities to patients.

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The following are the most common examples of
serious problems in doctors and their practices.
Clinical

• Dishonesty
• If a doctor
•         commits fraud or misconduct in research
  
•         declares that information is true when
  they know that it is false or that information
  which they have not checked is true
•         charges private fees to NHS patients or
  makes false claims on the NHS or
•         commits any other act of dishonesty.

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The following are the most common examples of
serious problems in doctors and their practices.
Clinical

• Health
• If a doctor
•         has a serious mental condition
•         abuses alcohol or
•         abuses drugs.

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We have three fitness to practise procedures.
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The following are the most common examples of
serious problems in doctors and their practices.
Clinical

• Relationships
• If a doctor
• abuses their position of trust, including
  misusing confidential information or
• commits an act of indecency or makes sexual
  advances towards a patient.

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Relationships
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Relationships
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Example

• A consultant physician showed a lack of skill
  carrying out practical procedures. She also had a
  habit of not listening to patients or colleagues,
  and would reply aggressively to people who
  expressed concern. She had no sense of urgency
  when responding to requests for help from anxious
  juniors. Despite local offers of counselling, she
  refused to accept that there was a problem.

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Example

• A trust employed a locum senior house officer
  (SHO) in obstetrics and gynaecology for seven
  days. The doctor was in his fifties and, although
  he claimed long experience in the specialty, was
  slow to deal with requests to see patients and
  indecisive when he did see them. He had
  difficulty carrying out straightforward
  procedures which should have been within his
  grasp, and was reluctant to ask advice from more
  senior colleagues when out of his depth. As a
  result, the nursing staff twice had to bypass the
  SHO and contact the registrar to avoid a serious
  incident.

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Fitness to practise procedures

• We have three fitness to practise procedures
  which we may use for doctors reported to us - the
  conduct, health and performance procedures. These
  are described in more detail in the Annex. If you
  refer a case to us, we will decide which
  procedure will be most relevant.
• If we decide to apply the performance or health
  procedure, this may involve insisting that the
  doctor take action to improve or encouraging the
  doctor to get help or treatment. It is important
  for authorities and organisations which refer
  cases to us to recognise that they may have a
  role in helping and encouraging the doctor in
  that process.

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Evidence and referral procedures

• You should send us a summary containing details
  of
•         the problems
•         particular incidents and
•         any action already taken, and the
  results.
• Local procedures may vary, but they should all
  include the following.
•         The local co-ordinator should first make
  sure that there is enough evidence to support the
  complaint. (You do not need to carry out a full
  investigation locally, but there must be enough
  evidence to show that there is a case to answer.)
  
•         If there has been an investigation
  locally, you should send full details to us.
•         If there has not been an investigation
  locally, you should collect evidence and send it
  to us. If relevant, this should include written
  statements from people who can offer evidence.

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How we deal with doctors health problems

• We receive references from individual patients or
  their relatives, community health councils,
  medical colleagues, the practice partnership,
  LMCs, managers in the NHS or elsewhere, and other
  health care organisations, patient groups and
  public authorities.
• Cases involving doctors in NHS practice are
  normally best referred to us through the relevant
  trust, health authority, health board or LMC. If
  the doctor is in training, you should first
  contact the postgraduate dean or regional
  director of postgraduate general practice
  education before deciding whether to refer the
  doctor

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How we deal with doctors health problems

• You should always refer the doctor to us if
•         local action would not be practical
•         you have tried local action and it has
  failed
•         the problem is so serious that we
  clearly need to be involved or
• the doctor has been convicted of a criminal
  offence.

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'Is there enough evidence of poor practice,
direct from reliable sources, to show that there
is a case to answer?

• You do not have to refer performance or health
  issues to us immediately unless patients are at
  risk of harm
• the doctor is not willing or able to put things
  right immediately.

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Maintaining Good Medical Practice

• GMC Fitness to Practise Directorate178 Great
  Portland StreetLondon W1N 6JE
• Helpline 0171 915 3692General enquiries 0171
  915 3603Enquiries about sick doctors 0171 915
  3580Fax [phone]