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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' (un
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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 Directorate 178 Great Portland Street London W1N 6JE
Helpline: 0171 915 3692 General enquiries: 0171 915 3603 Enquiries about sick doctors: 0171 915 3580 Fax: 0171 915 3642
