Central Lancashire has a large number of highly skilled independent contractors. However, when concerns are raised it is important that investigations are carried out in a fair and open environment.
All too often, this process is carried out behind closed doors, with organisations gathering a dossier of evidence that is presented to the underperformer long after problems are first raised.
My team takes a different approach. When an issue is raised, it is shared with the underperformer, usually in person. This can cause them anxiety, so they are encouraged to bring a friend or colleague. This transparent approach has been successful. Often things are put to rest at this stage with a simple explanation.
Then, initial concerns are raised with the core performance team, which includes myself, a performance manager, contracts manager and professional adviser.
We undertake a baseline assessment to see if there are other known concerns and establish the severity level of these concerns.
If the issue is isolated, the incident is raised with the contractor performance assessment committee, learning for the individual and the organisation is prescribed, and the file is closed. If there is a pattern showing more than an isolated incident, visits and discussions with professional advisers can be undertaken.
We ask the contractor to respond to the concerns within an agreed timescale, or outline an action plan. Half of all concerns end at this point due to the open approach.
However, if the problem proves to be of high frequency with concerns about patient safety, a performance case is opened and reported to the contractor performance assessment committee.
In accordance with statutory regulations, a full investigation is undertaken and interventions to improve performance are set out.
In the first two years of using this process, there have been 43 preliminary investigations and 53 performance cases reported to the contractor performance assessment committee.
The process has been recognised as best practice by the National Clinical Assessment Service.
- Managing performance of independent contractor policy
- Procedure on carrying out performance reviews and investigations
- Contractor performance assessment committee - terms of reference
- Performance panels – terms of reference
- Flow chart showing grading of performance concerns
Maureen Kirwan is associate director of clinical quality and assurance at NHS Central Lancashire, Maureen.firstname.lastname@example.org