DH report suggests doctors could pay entirely for own remediation

It would be 'reasonable' to make doctors pay for their own remediation, a DH-backed report has said.

The DH's Remediation Steering Group recently published its inquiry report on the current state of remediation for doctors in the NHS.

As part of its research the group looked at the results of a DH survey of NHS organisations in England on how performance problems were managed, undertaken between December 2009 to January 2010

The survey found that over the past 12 months, PCTs had investigated more doctors than acute trusts had; PCTs reported actively investigating 753 doctors, acute trusts reported investigating 552 cases and mental health trusts investigated just 97 cases.  

At the time of the survey PCTs were actively investigating 260 cases, 48 more than acute trusts.

In total the inquiry extrapolated that 2,800 doctors had been investigated over the last year, representing 2% of all NHS doctors.

Professor Hugo Mascie-Taylor, medical director of the NHS Confederation, which led the inquiry, said the group had found a great deal of variation in the way remediation was managed by NHS organisations across the country.

He said that remediation was often costly and difficult for many NHS organisations to manage.

‘We found that whilst there was much good practice in managing clinical competence and capability concerns, it was still an area that many employers and contracting bodies found difficult to manage.

‘Providing suitable remediation packages was also challenging and was often difficult and very expensive. Indeed, it appeared that ignoring a problem until it became a crisis sometimes seemed to be the easiest solution,’ he said.

Report recommendations
The report therefore made a number of recommendations on how NHS organisations could improve remediation, and in turn improve patient safety.

The report made six broad recommendations:

  • Performance problems, including clinical competence and capability issues, should normally be managed locally wherever possible.
  • Local processes need to be strengthened so as to avoid performance problems wherever possible, and to reduce their severity at the point of identification.
  • The capacity of staff within organisations to deal with performance concerns needs to be increased with access to necessary external expertise as required.
  • A single organisation is required to advise and, when necessary, to coordinate the remediation process and case management so as to improve consistency across the service.
  • The medical Royal Colleges to produce guidance and provide assessment and specialist input into remediation programmes.
  • Postgraduate deaneries and all those involved in training and assessment need to assure their assessment processes so that any problems arising during training are addressed.

The report said that in the future clinical commissioning groups (CCGs) were likely to be responsible for ‘ensuing that annual appraisals take place and that a personal development plan is agreed’.

The report also recommended that NHS organisations, including CCGs, should put a number of measures in place to reduce the risk of performance problems arising, such as six-monthly reviews and mentorship for doctors in the first two years of a career grade appointment.

In order to fund remediation, the report made a number of recommendations for the DH to consider. It found that currently almost a third of PCTs sometimes require GPs to entirely fund their own remediation. Almost 50% said they may ask the GP for a financial contribution towards the cost.

One option for funding remediation in the future could be to make doctors to pay entirely for their own remediation, the report said.

‘Doctors often fund part or all of their own CPD. It might be reasonable to think therefore that doctors should be expected to fund all or part of their own remediation,’ the report said.

Funding options
The group suggested that a ‘loan scheme’ could allow doctors to borrow the money needed for remediation; however it recognised that this may need to be underwritten by the state.

Other funding options included employer and PCT funding, an insurance scheme for doctors, linking remediation to clinical negligence schemes or mutuals or subscription clubs, the report said.

Another possible option would be to ask the private sector to contribute to the cost of remediation.

GPC deputy chairman Dr Richard Vautrey described the report as 'extremely disappointing'. He said that GPs paying for their own remediation was 'unacceptable'.

'The whole report is extremely disappointing; all the recommendations repeat possibilities that we knew were possibilities a few years ago.'

Dr Vautrey said the GPC was calling for remediation costs to be met by the NHS, not by the GP involved.

'If a GP should require remediation someone has to maintain their practice. If the practice has to take on a locum this comes at a cost that should be met by the health service,' Dr Vautrey said.

'(This report) just shows that this issue isn’t being taken seriously within government,' he added.

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