NHS Fife acknowledges and agrees with the importance of regular and timely review of policy/procedure statements and aims to review policies within the timescales set out.
New policies/procedures will be subject to a review date of no more than 1 year from the date of first issue.
Reviewed policies/procedures will have a review date set that is relevant to the content (advised by the author) but will be no longer than 3 years.
If a policy/procedure is past its review date then the content will remain extant until such time as the policy/procedure review is complete and the new version published, or there are national policy or legislative changes.
1.1 Remediation is the process of addressing performance concerns (knowledge, skills, and behaviours) in relation to trained doctors, where such concerns have been recognised, through assessment, investigation, review or appraisal, so that the practitioner is supported by the Board and has the opportunity to return to safe practice.
1.2 This document sets outs guidance for the remediation process within NHS Fife for all non-training grade medical and dental staff, including locums. Remediation for Training Grade Doctors is the responsibility of NES, with appropriate support from NHS Fife.
2.1 This policy applies to all Medical and Dental staff (non-training grades) employed within NHS Fife.
3.1 The responsibility for application of this policy rests with the Managers, Clinical Directors, the Director of Public Health and the Associate Medical Directors / Medical Director detailed within the policy.
4. OPERATIONAL SYSTEM
4.1 Remediation includes all activities providing help and support from simple advice or referral to occupational health, through formal mentoring, further training and re-skilling.
4.2 Where concerns are raised about a doctor's performance or conduct, it is imperative that there is an initial informal process to decide how to address these concerns. This process must take into account existing contractual requirements. This is not a formal process of enquiry which could lead to unilateral decisions or action, it is informal (and should be relatively brief) and its purpose is only to decide amongst a range of possible approaches. It is anticipated that in all but the most serious situations remediation would be the normal way of addressing concerns.
4.3 The options available include:
- Establishing there is no need for further action.
- Agreeing with the doctor that a remediation approach is necessary.
- Offering support to the doctor.
- Initiating a formal investigation in line with the relevant circulars and procedures.
- Treating the matter as a health problem and using health policies and procedures.
- Informing the GMC.
4.4 Independent General Practitioners have a separate agreed process.
4.5 Remediation can only be undertaken with the doctor's agreement. If the doctor does not agree at the outset that there is any problem which requires remediation, then the Medical Director must decide whether or not there is a matter which requires further investigation. If it is determined that further investigation is indicated this will be undertaken through the existing formal processes. In the event the manager determines that there is no case to answer then this must be formally documented. The decision must be confirmed in writing to the doctor concerned.
4.6 Dealing with Concerns
4.6.1 The Clinical Director / Lead Clinician has responsibility for raising performance or conduct concerns at the earliest opportunity.
4.6.2 If the Clinical Director / Lead Clinician becomes aware of concerns, they will initiate a one-to-one informal meeting with the individual. Given that performance or conduct issues may commonly be related to physical and/or mental health problems, the informal meeting should include consideration of whether an Occupational Health referral is indicated.
4.6.3 Normally the outcome of this meeting will be:
- that there is no need for further action;
- agreement that there is a health problem and involving occupational health; and / or
- agreement that remediation is necessary.
4.6.4 If agreement cannot be reached, the Clinical Director / Lead Clinician will immediately refer the issue to the Associate Medical Director with responsibility for the Directorate / Service.
4.6.5 The Associate Medical Director will meet with the doctor concerned as soon as possible to try to resolve the issue. If ultimately it is not possible to agree a way forward, then the issue must be referred to the Board Medical Director, as it may have to be dealt with formally in line with the national provisions for managing issues regarding the conduct or competence of Consultant, SAS Doctors and Dentists and Salaried GPs employed by NHS Fife.
4.6.6 The Board Medical Director will then meet with the individual before determining if a formal approach is required.
4.6.7 Individual doctors will actively engage with NHS Fife in discussing the concerns and where relevant, in identifying and accepting support and working collaboratively to ensure resolution of the agreed issues which necessitated the remediation process.
4.7 Examples of guidance and support mechanisms when concerns about a doctor are identified include:
4.7.1 Identification of appropriate educational opportunities for clinicians whose skills need to be refined and improved. This may include working in another unit outwith NHS Fife.
4.7.2 Coaching – (facilitating performance improvement through feedback, questioning and listening). Coaching may be used when the individual requests help, or recognises the need for support to develop skills or knowledge, accepts responsibility for improvements and actively participates in the process. A coach may be external to NHS Fife and the individual coach will be agreed with the doctor concerned.
4.7.3 Counselling – if the identified problem is one that might be helped by counselling, then this option should be offered to the doctor and arrangements made for this.
4.7.4 Mentoring – (helping people to take charge of their own development, release their potential and achieve results that they value). This helps someone become better at helping themselves and is particularly useful at times of change. Mentors may have several roles, including sounding board, critical friend, facilitator and role model. Each mentoring relationship is different. Some are intense and last over time, whereas others are brief, and related to a specific situation. The mentor must be agreed with the individual doctor concerned and a mentoring agreement should be clearly defined at the outset.
4.7.5 Performance Counselling – this is a systematic process of guidance and advice on conduct / behaviour. Counselling may be used when a performance shortfall has been identified and there is a need to agree an improvement plan to meet expectations.
4.7.6 If interpersonal relationships are identified as being a factor, then mediation may be appropriate, including external mediation.
4.7.7 This list is not exhaustive and other solutions to individual circumstances, such as agreed temporary or permanent changes to the job plan can also be considered.
4.7.8 NHS Fife is responsible for funding the agreed remediation process.
4.8 Concluding the Remediation Process
4.8.1 The Board Medical Director will have to determine if a remediation process has been successful and that the doctor or dentist can continue in / return to their substantive role. If the Board Medical Director considers further support under the remediation framework is necessary, then this would have to be agreed with the individual doctor concerned. Any extension would also have to include appropriate review(s) and indicate the point at which the Remediation process would conclude.
4.8.2 The Board Medical Director will confirm their decision in writing, stating that the Remediation process has concluded, or if that is not the case the Board Medical Director will detail the further action to be taken along with the agreed timescale and the consequences if the Remediation process is unsuccessful.
4.8.3 In a situation where the Remediation process has concluded but has been unsuccessful the Board Medical Director will confirm the reasons for this in writing and also detail how the Board intends to proceed.
4.8.4 Where Remediation has involved a placement outside the organisation or a period of supervised practice, it will be necessary to agree with the doctor concerned how the return to the substantive post will be managed.
4.9.1 Any doctor involved in this process is entitled to be accompanied to any meetings by their Trade Union / Professional Organisation representative, or a colleague who is a current employee of NHS Fife.
4.10 Monitoring Compliance with this Policy
4.10.1 Compliance with this policy will be monitored as part of the quality assurance process for Medical Revalidation.
5. RISK MANAGEMENT
5.1 Patient safety is the paramount consideration and as the Responsible Officer for NHS Fife, the Board Medical Director has the overall responsibility for the processes outlined in this policy.
6. RELATED DOCUMENTS
6.1 NHS Fife Conduct Policy
6.2 NHS Fife Capability Policy
6.3 NHS Fife Management of Ill Health Policy
6.4 NHS Fife Medical Appraisal & Revalidation Policy
6.8 GMC Referral Guidance
7.1 This policy has been developed with reference to current NHS Scotland Terms and Conditions of Service for Medical & Dental staff.