Professional Competence – Friend Or Foe

May 2011 saw the introduction of a statutory requirement for medical practitioners to commit to a formal process of professional development, including the completion of 50 hours of continuing professional development per year.

More recently, in December 2011, the Medical Council has gone one step further in its role of promoting high standards in professional conduct and education. This includes publishing new rules permitting the performance assessment of a practitioner, where concerns arise that he or she is not maintaining the required level of professional competence.

In that the Medical Council's goal is to improve medical practice and encourage patient safety, an ambition shared by every healthcare practitioner, it is not unsurprising that they have been met with a generally positive response. In a survey of over 350 practitioners, carried out in September last year, 79.5% welcomed the introduction of performance assessment as an additional procedure for handling concerns about performance.

However, in considering the impact of the new requirements, a number of observations can be made.

On one hand, it is arguable that these new procedures may lessen the number of Fitness to Practise Committee Inquiries, as the Preliminary Proceedings Committee will now have an alternative means of managing a complaint. On the other hand, however, where a performance assessment reveals a serious concern, the Medical Council may, itself, initiate a complaint against a practitioner. As such, the new requirements could, in fact, result in an increased number of inquiries.

Given that the new requirements are so recently introduced, it is premature to speculate overly on their impact. However, for practitioners looking to understand how the process works, the following section outlines the various steps involved.

Performance Assessment – Getting There

A medical practitioner may be referred for performance assessment:

1. Following consideration of a complaint by the Preliminary Proceedings Committee;

2. Following a Fitness to Practise Committee Inquiry, a practitioner may undertake to be referred for performance assessment; or

3. Following a Fitness to Practise Committee Inquiry, the Medical Council may direct referral for performance assessment.

The Process

If you or your practice has been referred for performance assessment, the Professional Competence Committee (the 'Committee') or an assessment team appointed by the Medical Council (the 'Assessment Team'), will investigate your practice. It is important to note that you will be informed of all stages in the process and further, any information obtained during the process will be confidential to the assessment. Some or all of the following may occur:

1. The Committee or Assessment Team may seek background information from you to assist in understanding the scope of your practice.

2. An occupational health assessor may be appointed to conduct a health assessment, to ascertain whether there are any personal, physical or mental health reasons influencing your performance.

3. A questionnaire may be provided to colleagues and patients, nominated by you, to obtain, collate and analyse their views on your performance. Survey results will be shared with you and may be incorporated into the final assessment report.

4. The Assessment Team may visit your workplace. They will observe your interactions with patients, assess your knowledge and skill, and review your performance and practice. The team will be independent of the Medical Council and will comprise of two medical assessors and one non medical assessor, appointed by the Medical Council. On-site assessment may include the following activities:

(a) Review of clinical practice
The assessors may review your systems and processes. They may seek copies of guidelines, policies and standard operating procedures and protocols, in order to ascertain whether they support good clinical care.

(b) Interview
The assessors may interview you and/or any third parties, if necessary.

(c) Review of clinical records
Medical assessors may request sight of patient records for the purpose of review. Patient records are to be reviewed in confidence.

(d) Direct observation
Assessors may observe you in the course of your day to day clinical work. Depending on the speciality of your work, assessors may observe between 10-14 interactions between you and your patients.

(e) Case based assessment
Having reviewed the clinical records and observed you in action, the assessors may raise queries regarding your assessment of a patient.

Report

If an Assessment Team has been appointed, it will prepare a report, setting out whether you meet the standards that can reasonably be expected of a practitioner practising medicine in your discipline. The report will also propose recommendations for improvement of knowledge and skills, to encourage you to maintain professional competence. You will have an opportunity to provide your observations on this report, together with proposals for an action plan, to improve your knowledge and skill.

Determination

Once information has been gathered, the Committee will consider this, with any report by the Assessment Team and any written submissions made by you. They will then determine whether your professional competence, ie knowledge and skills, and/or the application of knowledge and skills, adheres to good practice. Furthermore, they will decide what action (if any) is necessary to improve competency and will monitor you until they are satisfied that you are maintaining professional competence.

Non compliance

Please note that if you fail, cease or refuse to cooperate and ensure the maintenance of professional competence, you will be in breach of the Medical Practitioners Act 2007. In such circumstances, the Medical Council may initiate a complaint against you, with a view to disciplinary action.

Costs

Practitioners undergoing performance assessment will be required to discharge fees and expenses, as determined by the Medical Council, from time to time.

Conclusion

This article is intended to provide practitioners with guidance in relation to the new procedures. However, in the case of any doubt, practitioners should seek advice from their indemnity body.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.