Medical Council News


What Do New Performance Procedures Involve?

Interview with Fergal McNally, Senior Executive Officer, Medical Council.

How were performance procedures developed?

The development of performance procedures marks the culmination of a number of years of research and development work to establish a system which is based on international best practice, and also tailored to the Irish context.  During 2010 and 2011 the Medical Council was developing its performance procedures that have since become operational in 2012. The development of these procedures involved collaboration with the UK National Clinical Assessment Service (NCAS) which has used similar procedures for a number of years. We also liaised with individuals in other organisations which have experience in running performance procedures, notably the General Medical Council in the United Kingdom, the Medical Directors at the Medical Council of New Zealand and the New South Wales Medical Board.  We were carefully working with NCAS to ensure that the lessons from its experience were adapted to be relevant to the work of the Medical Council and the context of the health system in Ireland.  Prior to formalising the rules for its performance procedures the Medical Council was involved in a consultation process that involved postgraduate medical training bodies, patient representative groups and the profession. The Medical Council adopted the Rules for performance assessment in December 2011.

The key focus for 2012 is on the management of cases that have been referred for a performance assessment. On-site assessments will take place so that the Medical Council can satisfy itself that the competence and performance of the doctor being assessed benchmarks with that of their peers.

What will the performance procedures involve?

The doctor being assessed will be treated in a fair, objective, transparent and respectful manner at all times. Every assessment is conducted in line with best international practice and is supported by an independent panel of trained assessors. The assessment team is carefully selected and usually comprises two doctors and one non-medical assessor (patient representative). The doctors selected are usually peers of the doctor being assessed and will understand what is reasonable to expect in terms of competence and performance.  The non-medical assessor does not have a medical background and is taking a patient-centred view of the practice. The assessment team will usually conduct the assessment in the doctor’s workplace over 3 days. It comprises an interview with the doctor, a site inspection, a review of clinical records and direct observation of the doctor practising medicine. Following the assessment a report is produced with findings, conclusions and recommendations (if any) on improvements to practice that may be required. Such reports are considered by the Professional Competence Committee and the doctor may be asked to develop an action plan to address improvements.  I think it’s important to emphasise that we approach an assessment visit with a very open mind. Just because the Medical Council asks a doctor to participate in a performance assessment doesn’t mean there is a problem.  It’s really about understanding how a doctor is performing in practice, confirming when performance is satisfactory and identifying areas where performance will be developed by the doctor following the assessment.   

In New Zealand, for example, the experience is that approximately 41% of doctors who participate in performance assessment receive reports confirming that performance in practice is satisfactory.

How do you ensure information is kept confidential?

The performance assessment process is by its very nature confidential and focused above all on supporting good professional practice. Doctors who are asked to participate in the Medical Council’s procedures and activities may find the experience sensitive and challenging. It is important that the confidentiality of information relating to the procedures and activities is preserved and not disclosed to third parties except where this is necessary to perform or assist with the procedures and activities. This is a legal duty under Section 95 of the Medical Practitioners Act. Section 95 of the Medical Practitioners Act 2007 outlines the provisions of confidentiality in relation to professional competence schemes. Information is carefully safeguarded as part of the procedures by trained assessors. As medical records often record highly technical information, case records will be reviewed by the medical members of the assessment team only and all doctors are also subject to the guidance regarding patient confidentiality outlined in the Guide to Professional Conduct and Ethics for Registered Medical Practitioners.

How will you liaise with patients?

The patient-doctor relationship is important and the Medical Council operates these performance procedures and activities to help to ensure that doctors are keeping their knowledge and skills up to date. Patients are involved in a number of ways. Patients may be asked to complete a survey to give feedback on a doctor. Patients may be asked if a Medical Council assessment team may observe their interaction with the doctor and the assessment team may look at patient records. The team itself includes a patient representative who is not a doctor and who ensures that the patients’ point of view is taken into account at all times. We will always seek a patient’s consent prior to the assessment, if a patient chooses not to take part in the assessment then we will respect their right.

What types of activities would you be involved in on any given day?

The Case Manager organises and supports the execution of performance assessments and accompanies and supports the assessors on assessment visits. The Case Manager is the principal point of contact and support at the Medical Council for the doctor and for the assessment team, providing support and guidance to the assessment team on Medical Council policies, protocols and guidance about the running of the performance assessment.

The role of the Case Manager includes:

•liaison between the team and the Medical Council

•liaison between the Medical Council and the doctor

•liaison with local contacts and third party interviewees

•ensuring that assessors are adhering to the standard Medical Council assessment process

On an assessment visit, I am responsible for ensuring that the performance assessment procedures run smoothly and are completed as timely and comprehensively as possible. My focus is on ensuring that procedures are operated in the best interests of the public, the doctor and the workplace.