Concerns about doctors’ performance are usually only picked up following a crisis, putting patients at risk and increasing the cost of remediation, according to a new report.
The report by the Department of Health’s steering group on remediation recommended NHS organisations “strengthen” their processes for picking up concerns to reduce the “severity” of performance issues, which were often only dealt with following a serious untoward incident.
It said strong medical and human resource leadership was essential and recommended HR be involved earlier in the process. Doctors newly recruited to career grade posts should be mentored and possibly subject to six monthly reviews during their first two years in post.
The report, led by NHS Confederation medical director Hugo Mascie-Taylor, concluded that “ignoring a problem until it became a crisis, sometimes seemed to be the easiest solution”.
The results of a survey of NHS trusts in 2009 suggested there were around 1,000 cases of remediation ongoing at any one time.
Based on interviews with providers and primary care trusts as well as information from the National Clinical Assessment Service, the steering group found a six month remediation package could cost almost £200,000.
Initial investigation could cost up to £20,000 per doctor, a six month retraining placement in another organisation around £60,000 plus around £100,000 for locum cover during that period. On top of this, GPs were usually paid about 90 per cent of their salary during remediation while doctors working in secondary care could expect to receive the full amount.
The report highlighted the case of an anonymous London hospital that had spent “hundreds of thousands of pounds” trying to remediate a doctor over five years and had another surgeon it could not find another provider to take for retraining.
The report found earlier intervention could be cheaper and more effective and recomended the DH consider whether doctors should pay more towards their remediation costs. It pointed out that this approach had been found to make doctors more “motivated” and likely to reach a “successful conclusion” in places such as the US, Australia and New Zealand.
It also called for a single organisation to be given responsibility for advising on remediation and where necessary coordinating the process and accrediting organisations to provide placements.
In the foreword to the report, professor Mascie-Taylor said the introduction of revalidation for doctors should improve the quality of the medical workforce but would “inevitably” identify some doctors in need of remediation.
“We found that whilst there was much good practice in managing clinical competence and capability concerns, [remediation] was still an area that many employers and contracting bodies found difficult to manage,” he said.