Birmingham Heartlands Hospitals is debating the introduction of a framework providing an alternative route to existing disciplinary procedures for tackling poor performance.

The aim, says medical director Dr Rowland Hopkinson, is to identify and tackle difficulties early on so that formal disciplinary action can be avoided.

'Using the disciplinary process is an admission of failure,' he says. By identifying deficiencies earlier, the trust can offer appropriate training to bring the doctor back in line or else change their work pattern so their skills are redirected in the most appropriate way.

The framework entails going through a series of steps attempting to resolve the performance concerns.

If the process fails to reach a solution by the final stage, there would still be the option to proceed to formal disciplinary procedures.