Clarity is needed on dealing with inadequate doctors

The UK government has asked the General Medical Council to provide more guidance on how and when responsible officers should deal with inadequate or dangerous doctors.

The enhanced systems of appraisal, clinical governance, and responsible officers that underpin revalidation should ensure that poor performance is tackled at an early stage and that patients aren’t put at risk while the concerns are investigated and referred to the GMC, the government has said.

Dealing with poorly performing doctors is “primarily a clinical governance issue,” however, and is usually best dealt with at a local level, it adds.

“For the small proportion of doctors about whom there may be concerns, the strengthening of local clinical governance and a more objective annual appraisal provide the means for identifying problems earlier and either putting in place remediation or, if not possible, taking steps to remove them from clinical practice,” it has said.

In response to an inquiry by the parliamentary select committee on health into the slow progress of revalidation, the government agreed that although the main aim of the process is to provide “a positive affirmation of a doctor’s fitness to practise,” revalidation should also identify and deal with inadequate and potentially dangerous doctors.

The Health Committee said in February that it was “unsatisfactory” that so little attention had been given to how to deal with doctors whose practice gives cause for concern, asking the GMC to look at this “important weakness” of revalidation.

The government has agreed with this recommendation and emphasised that guidance is needed on when responsible officers should intervene regarding poorly performing doctors and what responsible officers should do next if they’re unable to make a positive recommendation about revalidation.

“The Department [of Health] agrees there is a need for guidance that makes it clear to responsible officers and doctors when a doctor’s conduct and performance can be considered to be below the level which is acceptable and fitness to practise procedures will be triggered,” the government’s response said.

It also agreed with the Health Committee’s view that doctors are being asked to provide an “immense” amount of documentation for revalidation and recommended that the process should be simplified and made more flexible so that it makes effective use of doctors’ time.

“We will continue to work closely with the GMC and other bodies to test revalidation to ensure the system is effective, supports high quality care, and provides confidence to patients and the public,” said the secretary of state for health, Andrew Lansley.