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Spotlight on Performance Assessment

The Medical Council’s performance assessment process has been operating since 2012. The process seeks to protect the public and support doctors in the pursuit of good professional practice. It’s a non-punitive and confidential pathway for supporting doctors who are experiencing performance issues that can be remediated through a professional development process. 

Key points

  • The Medical Council’s performance assessment process has been operating since 2012
  • It’s used as a mechanism of understanding why there is a performance issue and how the performance issue can be addressed
  • It’s a confidential pathway for supporting doctors that experience performance issues and can be remediated through a professional development process.
  • Doctors may perceive involvement in a performance assessment as daunting but we would like to re-assure doctors it’s a non-punitive process of remediation.
  • The model incorporates the application of a number of assessment tools which are selected according to the presentation concern.
  • We have undertaken a strategic review of our model to reflect feedback and international development and will continue to ensure it remains current and fit for purpose. 

Background to our processes and why it’s in use

The Medical Council’s performance assessment process has been operating since 2012. The process seeks to protect the public and support doctors in the pursuit of good professional practice. It’s a non-punitive and confidential pathway for supporting doctors who are experiencing performance issues that can be remediated through a professional development process.

The aim is to help the Medical Council and the doctor resolve performance issues and this is done by using a variety of tools and activities which seek to assess the doctor’s knowledge, skills and performance. It also seeks to understand the cause of any performance issues and it provides a basis for remedial action.

Perception of our procedures

Doctors may perceive their involvement in a performance assessment as a daunting process but we would like to re-assure those doctors. The assessment is used as a mechanism of understanding the nature of the performance issue and how it can be addressed, for the benefit of the doctor concerned but also from a patient safety perspective.

Doctors may have found the process leading up to referral from our preliminary proceedings committee or fitness to practise procedures both worrying and stressful. 

We are aware that a performance assessment may be seen as a punitive measure, however we would always ask that a doctor views the assessment in a developmental way. If a practice visit takes place as part of the performance assessment then this should be seen as an educational visit from peers, at the end of which, the doctor may receive some helpful advice on how to improve their practice.

We understand that the assessment process may impact on a doctor, both on a professional and personal level. It is normal for people, wherever they work, to feel worried when they receive a complaint or a concern about their professional ability. We always encourage doctors involved in our processes to seek support from a trusted colleague, this might be another doctor who provides a collegial relationship, a work colleague or a friend from medical school.

What’s involved – the performance assessment tools

Various activities can be conducted as part of our assessment process. These include: record review, case-based assessment, direct observation of the doctor, practice visit, peer and patient feedback and self-reflection. A report is produced by our assessment team and this provides the doctor with an overview of the performance assessment findings which is made available for the doctor to comment on.  The report may also include recommendations that we would ask the doctor to take forward as part of an action plan, this would be done in a developmental way.

A referral for an occupational health assessment may be required if there are any personal, physical or mental health problems which may have influenced a doctor’s performance. 

What’s the outcome from our processes?

Where areas for improvement have been identified the doctor develops an action plan.  Areas for development can include attending courses such as record keeping, prescribing and communication skills.  Doctors would seek to address areas for development by engaging in continuing medical education, peer to peer discussion and quality improvement initiatives. Self-reflection is also encouraged in order for the doctor to consider their actions that resulted in referral to performance assessment. Occasionally where serious practice issues are identified it may result in further action being taken by the Medical Council.  In most instances doctor have engaged in the process by developing their skills through further training, reflection, audit and education.

What’s the feedback been like?

To date the feedback has been constructive, some doctors have commented that they were anxious and worried when they were referred to our processes but were relieved to find out that our processes are developmental by nature and non-punitive. They have commented that when an assessment team attends their practice, they are made feel at ease. This is an educational visit from peers, at the end of which, the doctor may receive some helpful advice on how to improve their practice.

Doctors have also commented that the reflective practice has been valuable. It has helped them understand that there may have been a better way to have dealt with the situation at hand. They have also used this to identify ways to improve their practice going forward.

Any developments?

Postgraduate medical training bodies are well placed to offer advice and guidance to doctors formulating and implementing action plans to address any areas of development. We anticipate that their role in this process will expand.

Doctors’ health and wellbeing is very important to us.  Organisations such as the Practitioners Health Matters Programme provide a confidential and independent service to doctors that may be going through a difficult and stressful time.  We encourage doctors to access these supports.

Employers have a duty in facilitating a doctor’s professional competence.  We will be working with the employers to ensure they enable doctors to attend CPD and assist the doctor where necessary in their professional development arising from an assessment.

We have taken on-board feedback of the many individuals involved in our processes, including the assessors that undertake assessments, the doctors undergoing the assessment, the non-medical assessors, our own Executive team, the postgraduate medical training bodies and the employers. Following from this, we have undertaken a strategic review of our model to reflect feedback and international development and will continue to ensure it remains current and fit for purpose.  

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