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Maintaining Good Medical Practice

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Title: Maintaining Good Medical Practice


1
Maintaining Good Medical Practice
2
Maintaining Good Medical Practice
  •         plans to recognise more specifically the
    responsibilities of trusts, health authorities
    and health boards for good-quality health care
  •         the introduction from 1 July 1997 of our
    new procedures for dealing with 'seriously
    deficient performance' (under the Medical
    (Professional Performance) Act 1995) and
  •         discussions with chairmen, chief
    executives and senior managers during and
    following our 1997 roadshows.

3
Maintaining Good Medical Practice
  • When deciding whether to refer a doctor to us,
    you should carefully consider the circumstances
    of the case.
  • You should always refer the doctor to us if
  •         local action would not be practical
  •         you have tried local action and it has
    failed
  •         the problem is so serious that we
    clearly need to be involved or
  •         the doctor has been convicted of a
    criminal offence.

4
The following are the most common examples of
serious problems in doctors and their practices.
Clinical
  • If a doctor
  •         does not keep professional knowledge and
    skills up to date
  •         gives unsuitable prescriptions
  •         does not recognise the limits of their
    professional ability
  •         does not keep suitable clinical records
  •         is not willing or able to take a
    patient's history or carry out a physical
    examination properly
  •         tries to practise techniques without
    suitable training
  •         is not willing or able to communicate
    effectively with patients or their relatives
  •         does not work effectively with
    colleagues or
  •         seriously neglects or ignores
    professional responsibilities to patients.

5
The following are the most common examples of
serious problems in doctors and their practices.
Clinical
  • Dishonesty
  • If a doctor
  •         commits fraud or misconduct in research
  •         declares that information is true when
    they know that it is false or that information
    which they have not checked is true
  •         charges private fees to NHS patients or
    makes false claims on the NHS or
  •         commits any other act of dishonesty.

6
The following are the most common examples of
serious problems in doctors and their practices.
Clinical
  • Health
  • If a doctor
  •         has a serious mental condition
  •         abuses alcohol or
  •         abuses drugs.

7
We have three fitness to practise procedures.
8
The following are the most common examples of
serious problems in doctors and their practices.
Clinical
  • Relationships
  • If a doctor
  • abuses their position of trust, including
    misusing confidential information or
  • commits an act of indecency or makes sexual
    advances towards a patient.

9
Relationships
10
Relationships
11
Example
  • A consultant physician showed a lack of skill
    carrying out practical procedures. She also had a
    habit of not listening to patients or colleagues,
    and would reply aggressively to people who
    expressed concern. She had no sense of urgency
    when responding to requests for help from anxious
    juniors. Despite local offers of counselling, she
    refused to accept that there was a problem.

12
Example
  • A trust employed a locum senior house officer
    (SHO) in obstetrics and gynaecology for seven
    days. The doctor was in his fifties and, although
    he claimed long experience in the specialty, was
    slow to deal with requests to see patients and
    indecisive when he did see them. He had
    difficulty carrying out straightforward
    procedures which should have been within his
    grasp, and was reluctant to ask advice from more
    senior colleagues when out of his depth. As a
    result, the nursing staff twice had to bypass the
    SHO and contact the registrar to avoid a serious
    incident.

13
Fitness to practise procedures
  • We have three fitness to practise procedures
    which we may use for doctors reported to us - the
    conduct, health and performance procedures. These
    are described in more detail in the Annex. If you
    refer a case to us, we will decide which
    procedure will be most relevant.
  • If we decide to apply the performance or health
    procedure, this may involve insisting that the
    doctor take action to improve or encouraging the
    doctor to get help or treatment. It is important
    for authorities and organisations which refer
    cases to us to recognise that they may have a
    role in helping and encouraging the doctor in
    that process.

14
Evidence and referral procedures
  • You should send us a summary containing details
    of
  •         the problems
  •         particular incidents and
  •         any action already taken, and the
    results.
  • Local procedures may vary, but they should all
    include the following.
  •         The local co-ordinator should first make
    sure that there is enough evidence to support the
    complaint. (You do not need to carry out a full
    investigation locally, but there must be enough
    evidence to show that there is a case to answer.)
  •         If there has been an investigation
    locally, you should send full details to us.
  •         If there has not been an investigation
    locally, you should collect evidence and send it
    to us. If relevant, this should include written
    statements from people who can offer evidence.

15
How we deal with doctors health problems
  • We receive references from individual patients or
    their relatives, community health councils,
    medical colleagues, the practice partnership,
    LMCs, managers in the NHS or elsewhere, and other
    health care organisations, patient groups and
    public authorities.
  • Cases involving doctors in NHS practice are
    normally best referred to us through the relevant
    trust, health authority, health board or LMC. If
    the doctor is in training, you should first
    contact the postgraduate dean or regional
    director of postgraduate general practice
    education before deciding whether to refer the
    doctor

16
How we deal with doctors health problems
  • You should always refer the doctor to us if
  •         local action would not be practical
  •         you have tried local action and it has
    failed
  •         the problem is so serious that we
    clearly need to be involved or
  • the doctor has been convicted of a criminal
    offence.

17
'Is there enough evidence of poor practice,
direct from reliable sources, to show that there
is a case to answer?
  • You do not have to refer performance or health
    issues to us immediately unless patients are at
    risk of harm
  • the doctor is not willing or able to put things
    right immediately.

18
Maintaining Good Medical Practice
  • GMC Fitness to Practise Directorate178 Great
    Portland StreetLondon W1N 6JE
  • Helpline 0171 915 3692General enquiries 0171
    915 3603Enquiries about sick doctors 0171 915
    3580Fax 0171 915 3642
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