Needs and demands of professionals

1
Needs and demands of professionals

• Dr. Ewan Macdonald
• Division of Occupational Health
• Department of Public Health

2
What do Professionals Need

• To be competent
• To be confident
• To be capable
• To be consistent
• To be coherent
• To be communicators
• To be caring
• To have capacity
• To be conscientious

3
What do Professionals Need

• Mission
• Marketability
• Money
• Maintain registration

4
The General Medical Council UKThe GMC comprises
104 members

• 54 elected by the profession
• 25 appointed by the University medical schools
  and postgraduate institutions
• 25 lay people nominated by the Privy Council

5
The GMCThe GMCs functions

• To keep up-to-date registers of qualified doctors
• To promote high standards of medical education
• To guide doctors on standards of conduct, ethics
  and performance
• To deal firmly and fairly with doctors whose
  fitness to practise is in doubt

6
GMC - Fitness to practise
Complaints and information
Conduct
Performance
Health
7
Performance procedures - the law

• The Medical (Professional Performance) Act 1995
• Gave GMC power to require assessment
• Gave assessors access to medical records
• Enables CPP to impose sanctions on doctors

8
Performance procedures - standards of
performance expected of doctors

• The specific standards which apply to practice in
  the doctors specialty
• Advice in Good Medical Practice on the duties
  of doctors

9
Standards of performance - Good Medical
Practice

• Examples
• As a doctor you must
• make the care of your patient your first concern
• treat patients with consideration and courtesy
• work with colleagues in ways that best serve
  patients interests
• recognise the limits of your competence
• keep your knowledge and skills up to date

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Good Occupational Health Practice -Communications

• Providing patients with information to protect
  themselves against occupational risk
• Advising on control measures
• Advising on health surveillance
• Encouraging employers to accommodate workers with
  disability
• Advising employers on statutory and other
  requirements

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Performance procedures - serious deficiency

• Seriously deficient performance is a departure
  from good professional practice - whether or not
  it is covered by specific GMC guidance -
  sufficiently serious to call into question the
  doctors registration that is, a repeated or
  persistent failure to comply with the
  professional standards appropriate to the work
  being done by the doctor or with the GMCs
  guidance in Good Medical Practice, particularly
  where this places patients or members of the
  public in jeopardy.

12
The GMCs Fitness to practise procedures in
perspective

• 190,000 registered doctors
• About 3,500 complaints per annum
• About 300 conduct cases per annum
• About 120 new health procedure cases per annum
• 120 performance cases so far, and over 60
  potential cases in screening process

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Performance procedures- Committee on
Professional Performance

• Functions
• Assesses complaints about the doctor
• Decides formally whether doctors performance is
  seriously deficient
• If so, it can
• impose conditions on registration
• suspend registration
• It can also direct doctor to be assessed

14
Performance - examples

• Case A
• A series of complaints are received about a
  general practitioner, qualified for 25 years the
  complaints suggest that
• He has refused to visit a number of patients
  whose histories and symptoms clearly indicated
  that visits were necessary.
• He prescribes erratically, often on the basis
  of inadequate information. In one case this has
  led to a serious adverse reaction.
• Case notes, when present, are scanty and
  often incoherent.
• The doctor also shows a difficulty in
  completing death certificates and cremation
  forms.

15
Performance - examples

Case B Complaints are made to the local NHS
Trust about the circumstances in which two
patients of a surgeon have died within a few days
of routine surgery. This prompts a comparison
of the surgeons mortality rates with those of
five colleagues working in the same field. That
comparison reveals an alarming discrepancy the
doctors rate is about 5 times higher than that
of any of her colleagues. There are also
complaints about the surgeons frequent use of
out-of-date techniques, and concerns have been
expressed by junior doctors and general
practitioners about standards of post-operative
care.
16
Performance - examples

• Case C
• A consultant paediatrician displays
  clumsiness in carrying out practical procedures.
• Also the doctor habitually refuses to listen
  to patients or colleagues, and responds
  aggressively to expressions of concern.
• Time management is a major problem, with no
  sense of urgency when responding to requests for
  help from anxious juniors.
• Despite offers of counselling, Dr C refuses
  to accept that there is a problem. (Subsequent
  assessment reveals underlying deficiencies in his
  basic knowledge and skills.)

17
Performance procedures - key principles

• Effective 1 July 1997
• Protection of public is primary aim
• Rehabilitation where possible
• Centre on a comprehensive local assessment
• No referral to Committee if doctor co-operates
  and public not at serious risk
• Hearing by the Committee on Professional
  Performance (if required)

18
Complaints received by the GMC about Occupational
Physicians

• Confidentiality and Ethics
• Communications
• Competence

19
Performance - types of case

• Patterns of seriously deficient performance
• Deficiencies of
• knowledge
• Skills(eg communications)
• attitudes

20
Performance procedures- Stage 2 assessment

• The GMC invites doctor to agree to be assessed
• Trained assessors 2 professional,1 lay assessor
• Assessment based on Good Medical Practice
• Peer review standard approach
• What does the doctor do in practice?
• Tests of knowledge and clinical skills
• Principle of triangulation standard is public
  safety

21
Performance procedures- Stage 2 assessment

• What if the doctor refuses to be assessed?
• What is the goal of the assessment?
• On what basis are the assessors for each case
  chosen?
• What if the doctor at first agrees to be assessed
  but then does not co-operate with the assessment?

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WHO CORE COMPETENCIES

• Identification and assessment of risks from
  health hazards in the work place
• surveillance of workers health based on legal
  requirements, the magnitude of occupational risks
  to workers health or by voluntary agreement
• Surveillance of factors in the working
  environment and working practices which may
  affect workers health
• Advising on the occupational health, safety and
  hygiene, ergonomics and on individual and
  collective protective equipment
• Organizing first aid and emergency treatment
• Advising on the planning and organization of work
  including the design of workplaces, the choice,
  maintenance and condition of machinery and other
  equipment, and on substances used in work

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• Participating in and guiding the process of
  formulating HES policy based on sound ethical
  principles
• Promoting the adaptation of work to the worker
  assessing disability and fitness for work
  promoting work ability
• Advising on fitness for work and adaptation of
  work to the worker in the special circumstances
  of vulnerable groups and specific legislation,
  for example the EU Directive on Protection of
  Pregnant and Lactating Mothers 92/85/EC
• Collaborating in providing information, training
  and education in the field of occupational
  health, safety and ergonomics to management and
  the workforce

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• Contributing to scientific knowledge regarding
  hazards to health and safety at work, by research
  and investigation into health and work ability
  problems at work, following the ethical
  principles attached to research work and to
  medical research and including an evaluation by
  an independent committee on ethics
• Advising on, supporting and monitoring the
  implementation of occupational health and safety
  legislation
• Recognizing and advising on hazardous exposure in
  the general environment arising from industrial
  from industrial activities
• Participation in workplace health promotion
  programmes
• Management of the OHS
• Working as part of a multidisciplinary service

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Needs and demands of Occupational physicians

• Maintain and develop competencies
• Perform consistently well
• Meet needs of workers and enterprises
• Adapt to new hazards
• Influence employers and legislators
• Maintain their fitness to practice
• Meet requirements for REVALIDATION and continuing
  registration

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Demands on Schools of Occupational Medicine

• Meet needs of society-teach the relevant
  competencies
• Produce competent doctors who can perform well
• Maintain and develop their competencies
• Provide appropriate training, specialist,non-speci
  alist,and CME/CPD
• Enhance communication performance not just what
  they know, but what do they DO