Needs and demands of professionals

1. Needs and demands of professionals Dr. Ewan Macdonald Division of Occupational Health Department of Public Health

2. What do Professionals Need • To be competent • To be confident • To be capable • To be consistent • To be coherent • To be communicators • To be caring • To have capacity • To be conscientious

3. What do Professionals Need • Mission • Marketability • Money • Maintain registration

4. The General Medical Council UKThe GMC comprises 104 members: • 54 elected by the profession • 25 appointed by the University medical schools and postgraduate institutions • 25 lay people nominated by the Privy Council

5. The GMCThe GMC’s functions: • To keep up-to-date registers of qualified doctors • To promote high standards of medical education • To guide doctors on standards of conduct, ethics and performance • To deal firmly and fairly with doctors whose fitness to practise is in doubt

6. GMC - Fitness to practise Complaintsandinformation Conduct Health Performance

7. Performance procedures - the law The Medical (Professional Performance) Act 1995 • Gave GMC power to require assessment • Gave assessors access to medical records • Enables CPP to impose sanctions on doctors

8. Performance procedures - standards of performance expected of doctors • The specific standards which apply to practice in the doctor’s specialty • Advice in “Good Medical Practice” on the duties of doctors

9. Standards of performance - “Good Medical Practice” Examples: “As a doctor you must: • make the care of your patient your first concern • treat patients with consideration and courtesy • work with colleagues in ways that best serve patients’ interests • recognise the limits of your competence • keep your knowledge and skills up to date”

10. Good Occupational Health Practice -Communications • Providing patients with information to protect themselves against occupational risk • Advising on control measures • Advising on health surveillance • Encouraging employers to accommodate workers with disability • Advising employers on statutory and other requirements

11. Performance procedures - serious deficiency “Seriously deficient performance is a departure from good professional practice - whether or not it is covered by specific GMC guidance - sufficiently serious to call into question the doctor’s registration; that is, a repeated or persistent failure to comply with the professional standards appropriate to the work being done by the doctor or with the GMC’s guidance in Good Medical Practice, particularly where this places patients or members of the public in jeopardy.”

12. The GMC’s Fitness to practise procedures in perspective • 190,000 registered doctors • About 3,500 complaints per annum • About 300 conduct cases per annum • About 120 new health procedure cases per annum • 120 performance cases so far, and over 60 potential cases in screening process

13. Performance procedures- Committee on Professional Performance Functions: • Assesses complaints about the doctor • Decides formally whether doctor’s performance is seriously deficient • If so, it can • impose conditions on registration • suspend registration • It can also direct doctor to be assessed

14. Performance - examples Case A: A series of complaints are received about a general practitioner, qualified for 25 years: the complaints suggest that: He has refused to visit a number of patients whose histories and symptoms clearly indicated that visits were necessary. He prescribes erratically, often on the basis of inadequate information. In one case this has led to a serious adverse reaction. Case notes, when present, are scanty and often incoherent. The doctor also shows a difficulty in completing death certificates and cremation forms.

15. Performance - examples Case B: Complaints are made to the local NHS Trust about the circumstances in which two patients of a surgeon have died within a few days of ‘routine’ surgery. This prompts a comparison of the surgeon’s mortality rates with those of five colleagues working in the same field. That comparison reveals an alarming discrepancy: the doctor’s rate is about 5 times higher than that of any of her colleagues. There are also complaints about the surgeon’s frequent use of out-of-date techniques, and concerns have been expressed by junior doctors and general practitioners about standards of post-operative care.

16. Performance - examples Case C: A consultant paediatrician displays clumsiness in carrying out practical procedures. Also the doctor habitually refuses to listen to patients or colleagues, and responds aggressively to expressions of concern. Time management is a major problem, with no sense of urgency when responding to requests for help from anxious juniors. Despite offers of counselling, Dr C refuses to accept that there is a problem. (Subsequent assessment reveals underlying deficiencies in his basic knowledge and skills.)

17. Performance procedures - key principles • Effective 1 July 1997 • Protection of public is primary aim • Rehabilitation where possible • Centre on a comprehensive local assessment • No referral to Committee if doctor co-operates and public not at serious risk • Hearing by the Committee on Professional Performance (if required)

18. Complaints received by the GMC about Occupational Physicians • Confidentiality and Ethics • Communications • Competence

19. Performance - types of case • Patterns of seriously deficient performance • Deficiencies of • knowledge • Skills(eg communications) • attitudes

20. Performance procedures- Stage 2: assessment • The GMC invites doctor to agree to be assessed • Trained assessors 2 professional,1 lay assessor • Assessment based on Good Medical Practice • Peer review –standard approach • What does the doctor do in practice? • Tests of knowledge and clinical skills • Principle of triangulation – standard is public safety

21. Performance procedures- Stage 2: assessment • What if the doctor refuses to be assessed? • What is the goal of the assessment? • On what basis are the assessors for each case chosen? • What if the doctor at first agrees to be assessed but then does not co-operate with the assessment?

22. WHO CORE COMPETENCIES • Identification and assessment of risks from health hazards in the work place • surveillance of workers’ health based on legal requirements, the magnitude of occupational risks to workers’ health or by voluntary agreement • Surveillance of factors in the working environment and working practices which may affect workers’ health • Advising on the occupational health, safety and hygiene, ergonomics and on individual and collective protective equipment • Organizing first aid and emergency treatment • Advising on the planning and organization of work including the design of workplaces, the choice, maintenance and condition of machinery and other equipment, and on substances used in work

23. Participating in and guiding the process of formulating HES policy based on sound ethical principles • Promoting the adaptation of work to the worker; assessing disability and fitness for work; promoting work ability • Advising on fitness for work and adaptation of work to the worker in the special circumstances of vulnerable groups and specific legislation, for example the EU Directive on Protection of Pregnant and Lactating Mothers 92/85/EC • Collaborating in providing information,training and education in the field of occupational health, safety and ergonomics to management and the workforce WHO core competencies

24. Contributing to scientific knowledge regarding hazards to health and safety at work, by research and investigation into health and work ability problems at work, following the ethical principles attached to research work and to medical research and including an evaluation by an independent committee on ethics • Advising on, supporting and monitoring the implementation of occupational healthand safety legislation • Recognizing and advising on hazardous exposure in the general environment arising from industrial from industrial activities • Participation in workplace health promotion programmes • Management of the OHS • Working as part of a multidisciplinary service WHO core competencies

25. Needs and demands of Occupational physicians • Maintain and develop competencies • Perform consistently well • Meet needs of workers and enterprises • Adapt to new hazards • Influence employers and legislators • Maintain their fitness to practice • Meet requirements for REVALIDATION and continuing registration

26. Demands on Schools of Occupational Medicine • Meet needs of society-teach the relevant competencies • Produce competent doctors who can perform well • Maintain and develop their competencies • Provide appropriate training, specialist,non-specialist,and CME/CPD • Enhance communication performance –not just what they know, but what do they DO