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New procedures to handle concerns about doctors performance

The Medical Council has recently consulted on rules to establish new procedures to handle concerns about doctors’ performance. This article describes the background to these developments and places these in the context of the role of the Medical Council.

Finding better ways to respond to concerns about doctors’ practice

The Medical Council promotes and ensures high standards of practice among doctors. This is achieved through setting and overseeing standards. It also involves the Medical Council taking appropriate and effective action when there is concern that standards are not being met. Each year the Medical Council receives complaints about doctors; a total of 361 complaints were received in 2010. The Medical Council’s Preliminary Proceedings Committee considers these complaints. It may refer the matter to the Fitness to Practise Committee and in 2010 it made 54 such referrals. In some cases, the Medical Council’s Health Sub-Committee oversees the management of these referrals, while in most cases a Fitness to Practise Hearing is conducted; 43 such hearings were completed in 2010. In the case of the majority of complaints about doctors, the Preliminary Proceedings Committee determines that referral to a Fitness to Practise Committee is not required. In these cases it may provide the Medical Council with an opinion on alternate management, which may include mediation, referral to another body or taking no further action.

Looking at international practice

The Medical Council recognised there are opportunities to improve this system to provide for a fairer and more effective way of responding to those concerns which are about a doctor’s performance by understanding why concerns arose and identifying solutions to support good professional practice. This recognition took into account the practice of other medical regulators in developed health systems which respond to concerns about doctors’ practice using a range of frameworks, including performance procedures. For example, the New Zealand Medical Council has successfully operated performance procedures since 1998 as an educational, not disciplinary, response to concerns about performance.

Consultation, consensus building and research

These new procedures have been developed following extensive consultation, policy development and research by the Medical Council. Important milestones included the Consensus Statement “Performance in Practice” and “Performance Assessment – Developing Standards” which reported on a pilot of performance assessment methods.

Preparing for establishment of new procedures

Part 11 of the Medical Practitioners Act 2007 – Maintenance of Professional Competence, provided the Medical Council with a statutory mandate to focus on doctors’ continuing practise. In 2010, the relevant legislative provisions were commenced and since then the Medical Council has been focussed on establishing new performance procedures. This included forming a new Professional Competence Committee to oversee performance assessment and action planning, finalising assessment methods and instruments to ensure that these benchmark with international best practice and are fit-for-purpose in the Irish context, and identifying and training medical and non-medical assessors to conduct assessments. It published draft rules in October 2011 and used the opportunity to engage with the public, the profession and a range of other stakeholders to hear their views on how it should best respond to concerns about doctor’s performance. Council will publish the final rules in the New Year, making the procedures operational.

A new way to protect patients, support good practice and maintain trust

From 2012, The Medical Council will select doctors to participate in these procedures. The doctor will be assessed by an independent team of assessors who conduct on-site assessments, observe interactions with patients and review performance in practice. The team will comprise of two medical doctors and one patient representative and, where appropriate, will make recommendations for remediation of any deficits identified. The doctor participating will be kept informed throughout the process and will have an opportunity to present their views. An assessment is not an investigation or a disciplinary process and is designed to provide the doctor and the Medical Council with findings and recommendations that are objective, balanced and focussed on improving practise.

The new procedures will strengthen and modernise the role of the Medical Council and provide it with a wider range of options to enable it to respond effectively to concerns about doctors’ practice. In this way, the Medical Council is better enabled to safeguard patients, support good professional practice and maintain trust between the public and the medical profession.