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REHABILITATION AND REMEDIATION OF DOCTORS PERFORMANCE POLICY
OCTOBER 2019
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Policy title Rehabilitation and Remediation of Doctors’ Performance
Policy HR41 reference
Policy category Human Resources
Relevant to All Medical Doctors
Date published June 2016
Implementation June 2016 date
Date last October 2019 reviewed
Next review May 2022 date
Policy lead Dr Koye Odutoye, Deputy Medical Director
Contact details Email: [email protected]
Accountable Dr Vincent Kirchner, Medical Director director
Approved by LNC (Group):
Approved by Workforce Committee
(Committee):
27 May 2016
Document Date Version Summary of amendments
history
Jan 2013 1 New Policy
May 2016 Oct 2019
2 3
Routine Review Routine Review
Membership of Dr Vincent Kirchner, Medical Director
the policy
development/ Dr Koye Odutoye, Deputy Director review team Consultation
All Medical Doctors and HR Staff
DO NOT AMEND THIS DOCUMENT Further copies of this document can be found on the Foundation Trust intranet.
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CONTENTS Page
1 Background 4
2 Introduction 4
3 Terms used in this guidance 4
4 Prevention 5
5 Principles of remediation/rehabilitation 5
6 Responsibilities 6
7 Investigating and managing poor performance and conduct concerns 7
8 Responding to remedial /rehabilitation needs 8
9 Action Planning 8
10 Quality Assurance of Refreshment and Remediation Programmes 10
11 Resources to support remediation and rehabilitation for doctors 10
Appendix A: Equality and Diversity Impact assessment 11
Appendix B: Scenario and Solution Examples 14
Appendix C: Action Plan Template from NCAS 15
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1. Background All doctors have a responsibility to keep their knowledge, skills and competencies up to date. Continuing Professional Development (CPD), which feeds into annual appraisals and personal development planning, is now mandatory for all doctors and a key part of keeping up to date and fit to practice. A doctor’s performance is subject to a range of influences including their health, the systems they are working in, support available and the expectations placed upon them. All these factors need to be considered in situations where remediation and rehabilitation are required. 2. Introduction This policy is designed to provide guidance on how to respond when concerns arise about the performance of a doctor acting individually or as part of a team. The policy has been drawn up by the Trust to support the C&I Designated Body. For doctors in postgraduate training on London Deanery managed programmes, their Designated Body and Responsible Officer (RO) are in the London Deanery. They should refer to the Deanery’s Trainee in Difficulty Management Framework The key principles underpinning this policy are:
Patient safety Trust’s responsibilities to support clinicians in remaining up to date and fit to practice Enabling individual doctors to address any areas of deficiency in their professional
performance early, systematically and proactively This policy applies to any situation where concerns are raised about a doctor’s performance or specific aspects of their performance including:
Doctors who have been absent from their work for more than six months for whatever reason (NB: those who have had shorter absences may also have specific needs as part of their re-introduction to work)
Self-declaration of a remedial need. Remedial needs are those which specifically highlight risks to patient and colleague safety and should be prioritised over other CPD needs. C&I will work with the doctors concerned to ensure their needs are met in a timely fashion
Doctors for whom a specific deficiency in performance has been identified through patient or colleague feedback or risk management systems
Doctors for whom such a need has been identified at appraisal Doctors for whom the need for remediation has been identified through a formal disciplinary
or fitness to practice procedure 3. Terms used in this guidance
Remediation: the overall process agreed with a practitioner to redress identified aspects of underperformance. Remediation is a broad concept varying from informal agreements to carry out some reskilling, to more formal supervised programmes of remediation or rehabilitation.
Reskilling: provision of training and education to address identified lack of knowledge, skills and application so that the practitioner can demonstrate their competence in those specific areas.
Supervised remediation programme: a formal programme of remediation activities, usually including both reskilling and supervised clinical placement, with specific learning objectives and outcomes agreed with the practitioner and monitored by an identified individual on behalf of the responsible healthcare organisation.
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Rehabilitation: the supervised period and activities for restoring a practitioner to
independent practice following an absence from work for example by
overcoming or accommodating physical or mental health problems
4. Prevention Professor Hugo Mascie-Taylor, Chair, Remediation Steering Group made recommendations to employers and contracting bodies to reduce the risk of performance problems arising and where they do, to identify them at an early stage. The recommendations can be seen using the following link: (http://www.nhsemployers.org/PlanningYourWorkForce/MedicaalWorkForce/MedicalRevalidation/Pages /Remediationreport.aspx) 5. Principles of remediation / rehabilitation This guidance follows the principles laid out in the NCAS document, ‘Back on Track’. The aim of remediation / rehabilitation is to restore a doctor to their full range of practice, where appropriate. Where not appropriate, the doctor and employer may agree a specific restriction on the range of practice. All aspects of performance including clinical knowledge, skills, health, behaviour and practice context should be addressed within a single action plan. Where applicable this in turn should relate back to the doctors personal development plan as drawn up at their last medical appraisal. Occupational health services should be involved in any situation where the doctor’s health is or has contributed to the need for a remediation / rehabilitation programme. HR advice and input should be sought for any concerns relating to the conduct or behaviour of the doctor. Available supporting resources should be publicised and doctors should be able to self-refer. Processes should be fair and open to scrutiny, taking into account all relevant evidence and information. It should be recognised that having to undertake rehabilitation or remediation is potentially stressful for a doctor; doctors in this situation should be offered appropriate support. When a doctor returns to work in these circumstances, the needs of the wider team will also need to be handled with sensitivity. For any doctor who works in more than one organisation, information about rehabilitation or remediation needs should be shared between organisations, including those in the private sector – the doctor concerned should always be involved in this communication. Where remediation or rehabilitation happens outside of the doctor’s Designated Body e.g. for
doctors in postgraduate training, their RO must be kept fully informed of progress and any issues
arising. There should be clear transparent lines of communication and reporting supported by
detailed documentation.
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6. Responsibilities 6.1 Doctor’s Responsibility It is the doctor’s responsibility to actively engage with the processes of design and delivery of any rehabilitation or remediation programme. The doctor should make their defence organisation and any other employer aware of the rehabilitation or remediation programme. The doctor should clearly understand the remediation/rehabilitation processes that they are engaging with including who they are accountable to and who they should report to if they become aware that they are not making progress according to their agreed action/rehabilitation programme. Progress in this programme should be explicitly discussed at annual appraisal, as well as at intervals during the programme. The programme should be referenced in their Personal Development Plan. Where the doctor works in more than one organisation they must take an active role in sharing
information with the ROs of all the organisations about their rehabilitation/remediation
programme. 6.2 Responsible Officer’s Role (RO) Under DH Responsible Officer legislation 2010 organisations employing / contracting with doctors are classified as Designated Bodies. Each Designated Body has to appoint, train and support a senior clinician in the role of RO. The duties of the RO as set out in the legislation are wide reaching and include:
Ensuring that their Designated Body’s medical appraisal systems meet revalidation requirements
There are systems in place to enable communication flows between ROs in other Designated Bodies where their clinicians may also be providing a service
Communication with the local Deanery and the Deanery RO for doctors in postgraduate training and the GMC
To investigate any fitness to practise concern raised about a doctor for whom they are the RO To ensure that appropriate measures are taken to address and remediate any concerns raised.
A RO can delegate function, but not responsibility. Therefore it is beholden on the RO in the Designated Body to ensure there are sufficient, appropriately trained staff able to support them in their functions, including setting up and supervising remediation/rehabilitation programmes. There needs to be robust communication channels internally within the Designated Body to ensure that these processes function efficiently and reliably. This includes sufficient staff to ensure patient safety and that service delivery is maintained alongside the provision of remediation and rehabilitation support. The RO or their nominated deputy is responsible for ensuring that a programme director and programme supervisor is appointed for a rehabilitation or remediation programme. 6.3 Programme Director’s role The programme director is responsible for overseeing the rehabilitation/remediation process and keeping the RO or their nominated deputy informed. If the doctor is a Consultant, the MD/RO or their nominated deputy will be the programme director.
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If appropriate, this role can be delegated to the Divisional Clinical Lead (DCL). For any other grades of doctor the DCL will be delegated the role of programme director and they will appoint a programme supervisor of appropriate grade and speciality. The programme director will identify in writing the areas of remedial need, and the doctor will confirm that they recognise these and agree to work with the employer to address these. 6.4 Programme Supervisor’s role The programme supervisor will develop an action plan with the doctor to meet the identified needs. They will regularly meet with the doctor to support them and review their progress. They may be requested to act as clinical or educational supervisor or, if necessary, a clinical/educational supervisor will be appointed in addition to the programme supervisor. The programme supervisor will undertake regular monitoring in terms of both impact on patient experience and care, and progress against the objectives for the doctor. They will keep the programme director informed. 6.5 Employer (Trust's) Responsibility It is the Trust’s responsibility to actively engage and support their RO in all aspects of medical revalidation including with the processes of design and delivery of a rehabilitation or remediation programme that is intended to improve or confirm an employee’s performance. 6.6 Royal College of Psychiatrists Role All colleges define and promote high standards of professional practice through education and
training, published guidance and scientific research, and these standards will continue to be general
benchmarks against which the need for remediation and the success of remedial interventions can
be determined. Following notification of a possible concern involving a doctor (where this is not serious enough to require immediate referral to the GMC), the Responsible Officer may decide to commission an external assessment of the clinical service to which the doctor contributes. In this situation, an invited review by the College may be helpful to establish whether there is genuine cause for concern and to provide a picture of the general health of the clinical service in which the doctor works – Remediation working group report The College was involved in the drawing up of and supports the recommendations of the Department of Health’s (England) Remediation Report (2011). See college report- CR172- Revalidation Guidance for Psychiatrists 7. Investigating and managing poor performance and conduct concerns Where a concern has been raised about a doctor’s performance Maintaining High Professional Standards and the Trust’s Capability and Disciplinary policies will be used as appropriate to investigate and manage performance and conduct concerns. The outcomes include: Informal handling with reference in annual appraisal Formal handling with remediation action plan Restriction of practice pending completion of action plan Temporary exclusion from work (with NCAS advice) Local disciplinary action / capability action / action under Maintaining High Professional
Standards Referral to the GMC No action required
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8. Responding to remedial / rehabilitation needs Once the requirement for remedial / rehabilitation action is raised, the Trust will:
Tackle concerns promptly, ensuring the primacy of patient safety Ensure that the RO is made aware of the concern. Where the concern is raised about a
doctor outside of the C&I Designated Body their RO will be informed. For doctors in postgraduate training their Dean will be informed
Fully assess concerns so that appropriate action is taken, following the relevant processes including Maintaining High Professional Standards and the Trust’s Capability and Disciplinary policies.
Fully involve both Human Resources (HR) and Divisional Clinical Lead (DCL) who should together lead the process
Maintain good documentation and record-keeping throughout the process Provide as much information as possible to patients about the processes that are undertaken
to resolve concerns that they have raised, whilst respecting the confidentiality of the employee
Ensure the DCL and the Associate Director HR and MD/RO (or a nominated deputy) work together to review whether there are organisational problems that also need to be addressed
Make it clear to a doctor who requires remediation what they must achieve before they commit to a programme. This should include clear boundaries, the method to be used for remediation, how they will be able to demonstrate that they have been remediated, how and who will assess whether they have successfully completed the programme, and the proposed timescale
Ensure that where a doctor causing concern has been recently appointed and/or promoted, the MD/RO will delegate to the DCL to liaise with their previous RO to establish whether the concern is a new manifestation or part of an on-going pattern of behaviour and/or performance
For doctors recently in postgraduate training programmes the MD/RO will delegate to the DCL or Director of Medical Education (DME) to liaise with the Deanery RO to seek any relevant information from the doctor’s postgraduate training
Ensure the remediation process remains as confidential and practicable as possible 9. Action Planning 9.1 Rehabilitation after a prolonged absence from work Before returning to work, the doctor must meet with their DCL and, if necessary, with the RO or their nominated deputy to agree the range of practice to which they will return and an action plan to support their reintegration into the workplace. Where return follows a period of ill-health or injury, consideration should be given to a phased return to work and any necessary reasonable adjustments with reference to the Trust Managing Absence and Attendance Policy. Occupational Health (OH) advice should be sought where necessary and the doctor themselves must submit “Fit Notes” from their own General Practitioner to inform the process. Where appropriate OH and HR advice should be sought as soon as it becomes apparent that an absence due to ill health will be prolonged. The Department of Health (DH) report Invisible Patients makes further recommendations for when a health professional returns to work after a period of sickness absence to help support that individual and protect the safety of patients.
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The London Deanery’s Professional Support Unit is available to provide additional resources to support doctors through the transition of a return to work programme. It may be advisable to do an early appraisal to review progress and development planning. 9.2 Remediation Action Planning In many cases, remediation will only apply to a part of a doctor’s practice. The programme director and the doctor should agree whether it is appropriate for the doctor to continue their whole range of practice during the period of remediation or whether it would be more appropriate to focus on the area of remediation. This will differ on a case-by-case basis. For example, if it is agreed that the doctor will visit another site for a period of time to develop a specific skill, it may be impractical for them to perform their normal duties at their usual place of work at the same time. The programme supervisor will develop an action plan with the doctor to meet the identified needs that includes SMART objectives. Examples are given in Appendix A. The action plan will be discussed with the programme director and the relevant service manager to ensure its practicality, and then agreed in writing with the doctor. A template for such an action plan is included in Appendix B. The learning needs highlighted in the action plan should be integrated into the doctor’s
personal development plan as agreed through annual appraisal and prioritised against other
needs. The programme director, programme supervisor and the doctor must meet at the start of implementation of the action plan, and then at regular intervals to ensure satisfactory progress. If it is not possible to agree an action plan the RO or their nominated deputy must be informed and they will consider seeking advice from the GMC and NCAS. Ultimately, the Trust reserves the right to insist on a doctor undertaking remedial education or training which is considered essential as part of the conditions for continued employment. Training and clinical experience within the Trust will be met by the Trust. The cost of training or clinical experience outside the Trust’s resources, if this training or experience is determined to be necessary by the programme director, will be borne by the Trust. Once the action plan has been agreed and signed, failure to evidence sufficient progress as agreed and/or lack of compliance will be handled through Maintaining High Professional Standards, the Trust’s Capability and Disciplinary Policies. 9.3 Progress and Completion The RO or their nominated deputy must receive written evidence of progress against the action plan from the programme director and/or programme supervisor on a regular basis. The doctor must keep a reflective log of their progress with the action plan and to submit this as part of the evidence. It may be necessary and advisable to defer annual medical appraisal until measurable progress is
being made. However the value of annual appraisal and the opportunity it creates for a reflective
conversation with a colleague should be valued by all parties in any rehabilitation and remediation
process. At the end of the action plan, the doctor, programme director and programme supervisor will sign a report confirming that the objectives have been met. This report should be sent to the RO or their
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nominated deputy and if they confirm that this is satisfactory they should report completion in the regular RO report to the Quality Committee. 9.4 After Rehabilitation/Remediation On satisfactory completion of the action plan, the doctor will revert to their normal work plan. Completion of the action plan should be referenced in his/her appraisal. A copy of the action plan and written evidence of its completion will be kept in the doctor’s personnel file. 9. 5 Confidentiality All action plan documentation and activity will be dealt with in confidence, and evidence of progress or otherwise will be shared on a strict need to know basis. This may include disclosure to another employer. 10. Quality Assurance The RO has responsibility for ensuring that any proposed rehabilitation or remediation action plan maintains patient safety as its first objective, and is appropriate to the needs of the doctor. The action plan must have a named supervisor of appropriate grade and speciality and include regular monitoring in terms of both impact on patient experience and care, and progress against the objectives for the doctor. There will be a system of anonymised reporting of the number of doctors taking part in a rehabilitation or remediation action plans, and information to provide assurance regarding patient safety, in the regular RO reports to the Trust Board. The RO will monitor the progress of rehabilitation or remediation action plans. Where satisfactory progress is not made, the MD/RO will consider whether alternative action may be required under Maintaining High Professional Standards and the Trust’s Capability or Disciplinary Policies. 11. Resources to support remediation and rehabilitation for doctors : External resources include: GMC Employer Liaison Adviser email: [email protected] telephone: 01619236602 Health at Work Centre London Deanery Professional Support Unit NCAS: advice line 020 7972 2999; general switchboard 020 7972 2988 Practitioner Health Programme
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Appendix A:
C&I Equality Impact Analysis Guidance Document
1. Please indicate the expected impact of your proposal on people with protected characteristics
Characteristics Significant +ve Some +ve Neutral Some -ve Significant -ve Age X Disability X Ethnicity X Gender re-assignment: X Religion/Belief: X Sex (male or female) X Sexual Orientation X Marriage and civil partnership X Pregnancy and maternity X The Trust is also concerned about key disadvantaged groups event though they are not protected by law Substance mis-users X Homeless people X Unemployed people X Part-time staff X Please remember just because a policy or initiative applies to all, does not mean it will have an equal impact on all.
2. Consideration of available data, research and information
Please list any monitoring, demographic or service data or other information you have used to help you analyse whether you
are delivering a fair and equitable service. Social factors are significant determinants of health or employment outcomes.
Monitoring data and other information should be used to help you analyse whether you are delivering a fair and equitable
service. Social factors are significant determinants of health outcomes. Please consult these types of potential sources as
appropriate. There are links on the Trust website:
• Joint strategic needs analysis (JSNA) for each borough
• Demographic data and other statistics, including census findings
• Recent research findings (local and national)
• Results from consultation or engagement you have undertaken
• Service user monitoring data (including age, disability, ethnicity, gender, religion/belief, sexual orientation and)
• Information from relevant groups or agencies, for example trade unions and voluntary/community organisations
• Analysis of records of enquiries about your service, or complaints or compliments about them
Recommendations of external inspections or audit reports
Key questions (supports EDS Goals)
Your Response Please reference data, research and information that you have reviewed which you have used to form your response
2.1 What evidence, data or information have you considered to determine how this policy/ development contributes to delivering better health outcomes for all?
This policy relates to medical staff remediation rather than direct service delivery to service users. By ensuring a competent and capable medical workforce, this policy does help promote better health outcomes for all service users. The main consideration has been whether there is any unfair impact on protected categories within the medical workforce. Review of central HR data on use of the remediation policy demonstrates only one example in the last 3 years and no evidence of risk of unequal impact on the person concerned.
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2.2 What evidence, data or information have you considered to determine how this policy/ development contributes to improving patient access and experience?
Not applicable as above. This policy does not relate to patient access or experience.
2.3 What evidence, data or information have you considered to determine how this development/policy contributes to delivering a representative and well supported workforce?
The main consideration has been whether there is any unfair impact on protected categories within the medical workforce. I have considered whether, when applying this policy in practice, there could be an unfair impact on Doctors with a disability (physical or mental health), age-related factors and ethno-cultural factors that could lead to concerns about performance/conduct: However, while such factors could be relevant when identifying such doctors (through a complaints or disciplinary process for example), this policy does not in itself lead to such potential discrimination. I have also considered whether the policy itself might directly discriminate against part-time employed doctors in that they may require a longer time period to engage with and/or complete any proposed remediation action plan. However, the policy is neutral in relation to suggested timescales for remediation and does not specify this and so no obvious discrimination arises. No fixed timescales are proposed.
2.4 What evidence, data or information have you considered to determine how this policy/development contributes to inclusive leadership and governance?
I have considered whether this policy discriminates against anyone in terms of inclusive leadership and governance. This has included consideration of the roles involved in applying the policy in practice (eg the RO; program director and program supervisor roles) as well as the doctor under remediation. The policy ensures that the relevant senior clinical management and HR work closely together and flexibly with the doctor to develop an appropriate remediation plan. It ensures that the clinical managers (eg the Divisional clinical director) closest to the doctor are closely involved in remediation and that there is a protocol for delegation as well as sharing information upwards with more senior clinical management/the RO if required. Finally, the policy also includes patients and complainants in the process by stipulating that they should receive updates and “as much information as possible” on action processes to resolve concerns.
3. It is Trust policy that you explain your proposed development or change to people who might be affected by it, or their representatives. Please outline how you plan to do this.
Group Methods of engagement
Not really applicable as there are no major proposed changes to the existing policy. However, as an extra precaution, I have sought the views (see below) of part-time medical workforce.
Part-time doctors Email Clinical Directors and direct discussion with part-time consultants to obtain their views on whether a more specific statement in the policy is required with regard to flexible “pro rata” timescales for remediation when required for the part-time medical workforce.
4. Equality Impact Analysis Improvement Plan
If your analysis indicates some negative impacts, please list actions that you plan to take as a result of this analysis to reduce
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those impacts, or rebalance opportunities. These actions should be based upon the analysis of data and engagement, any
gaps in the data you have identified, and any steps you will be taking to address any negative impacts or remove barriers.
The actions need to be built into your service planning framework. Actions/targets should be measurable, achievable,
realistic and time framed.
Negative impacts identified Actions planned By who No negative impacts identified
Not applicable Not applicable.
5. Sign off and publishing
Once you have completed this form, it needs to be ‘approved’ by Service Director, Clinical Director or an Executive Director or their nominated deputy. If this Equality Impact Analysis relates to a policy, procedure or protocol, please attach it to the policy and process it through the normal approval process. Following this sign off by the Sub Policy Group your policy and the associated EqIA will be published by the Trust’s Policy Lead on the website. If your EqIA related to a service development or business /financial plan or strategy, once your Director or the relevant committee has approved it please send a copy to the Equality and Diversity Lead ([email protected]), who will publish it on the Trust’s website. Keep a copy for your own records.
I have conducted this Equality Impact Analysis in line with Trust guidance
Your name: Koye Odutoye Position Deputy Medical Director
Signed: Date: 9.12.2019
Approved by: Koye Odutoye (On behalf of Vincent Kirchner, Medical Director)
Your name: Position Deputy Medical Director
Sign:
Date 9.12.2019
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Appendix B: Scenario and Solution Examples
A doctor who has poor communication with colleagues, in that colleagues perceive him/her as aggressive and uncooperative. Objective 1: To have weekly sessions with an expert in communication for six weeks to develop their communication style. Metrics: Confirmation from the communication expert that the doctor attended all the sessions. Reflective note by the doctor on what they learned from this development activity. Objective 2: To put into practice what they learned from the development activity over the succeeding six months. Metrics: Number of complaints to manager about doctor’s communication (aim for zero) 360 appraisal with colleagues with satisfactory outcome.
A doctor, who has poor time-keeping and a high rate of sickness absence, He/she does not communicate effectively with colleagues and is perceived to make poor decisions. Objective 1: To achieve timely attendance for work with low sick leave over a three month period. Metrics: Identify any reasonable adjustments as necessary Arrival on time as evidenced by time sheet signed by a manager Low sick leave with valid explanations for absence Objective 2: To improve clinical decision making through discussing all referred patients with a Consultant Metrics Consultant report on whether doctor called to discuss patients with him/her One CBD a week for six weeks regarding patients seen and discussed with Consultant.
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Appendix C: Action Plan Template (example taken from NCAS website)
PART 1 – AGREEMENT
Name of Dr
Work areas
Registration number
NCAS case number (where applicable)
1. Purpose The purpose of this plan is for the practitioner named above to address the performance concerns identified by [add]
2. Roles and responsibilities for management of this plan The Programme Director (usually MD/RO or nominated deputy or DCD) is: Name
Job title
The Programme Supervisor (usually the Divisional Clinical Director if they are not the Programme Director or a Consultant) is: Name
Job title
The Clinical / Educational Adviser (if necessary in addition to programme supervisor) is: Name Job title
3. Progress review
The plan is expected to last [add duration] months. Progress will be formally reviewed by the Programme Director and by the Programme Supervisor every [add interval] months and at the end of the plan.
The named practitioner must be able to demonstrate satisfactory and incremental progress throughout the programme and continuing ability to reflect and learn from [his/her] own and [his/her] colleagues’ practice.
4. Post to which the practitioner is likely to return On successful completion of the plan it is proposed that named practitioner will continue in practice or return to practice in the clinical post/area described below.
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Name of post
Broad description of post/clinical area Employer/Contracting body
Note that post, responsibilities and seniority may not be those applying at the time of the concerns resulting in assessment or other governance process
The [Programme Director – insert name] will consider taking management action in the following circumstances, if the expected progress towards objectives is not demonstrated:
Where failure to progress occurs at the first or second milestone - continuing with the action plan, but re-assessing objectives may be considered. A change of objective will only be agreed to where there is clear evidence of progress even though falling short of the performance standard defined in the plan. The overall time allotted to the action plan will not be extended.
A failure to progress in achieving the agreed objectives may result in [sanctions – add relevant possibilities such as use of disciplinary action, use of disciplinary/capability procedures, referral to regulatory body] and/or a new final employment goal such as redeployment. These possibilities will be considered if, in the opinion of the clinical supervisor and programme supervisor, the objectives are not likely to be met in the remaining time allocated to the action plan despite the practitioner having ample opportunity to demonstrate progress.
If a failure to progress raises concerns in relation to patient safety or professional probity, the programme
director or programme supervisor may make a referral to the [Add relevant regulator].
If a failure to progress is related to sickness absence, it may be appropriate to defer the plan’s completion date. The normal quota of annual leave may be taken during the period of the action plan, but this must be pro-rata. Any period of sickness absence greater than that covered by self certification must be supported by a doctor’s certificate. A cumulative absence due to illness of more than [Add – for example, two weeks in six months] will trigger a referral to the Occupational Health Service unless seen as unnecessary in the opinion of the clinical supervisor and programme supervisor. Reasons for not making an OH referral will be given.
Where an organisational action plan has been agreed (in addition to this plan for the individual practitioner)
progress will be reported to the practitioner at review points. [Delete as necessary]
5. Agreement
This plan has been developed with the cooperation of all parties who are satisfied that the identified objectives reflect the issues identified in:
the decision of the regulator when this body is involved and/or the assessment report and recommendations for NCAS cases and/or the review report and recommendations from the Royal College and/or local investigation [Add or delete as necessary] All parties agree to the objectives set out in the plan and will take forward the programme as set out in the plan, adhering to the accompanying notes. If further objectives need to be added to the plan during the course of the programme, these may be added following agreement of all parties.
Name and organisation Signature Date
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Practitioner
Responsible Officer
Programme Director
Programme Supervisor
Appointed representative of practice/pharmacy where applicable Clinical/Educational Supervisor Additional participants as necessary
