Introduction

Performance concerns in general practice registrars may range from relatively minor, transient concerns to more significant and persistent concerns. They may occur in isolation or, more commonly, in combination, and their presentation may not always be overt but sometimes subtle or disguised. Therefore, depending on the presentation, managing performance concerns in general practice registrars can sometimes be complex. However, most problems and concerns that arise are of a relatively minor nature and are easily managed.

These guidelines will enable Regional Training Organisations (RTOs) to:

• assess and address the needs of general practice registrars having performance concerns
• determine the appropriate level of intervention
• effectively document, manage and evaluate an intervention, including formal remediation.

All RTOs should have documented policies and guidelines in place for managing performance concerns (refer to the RACGP’s Standards for general practice training second edition, Outcome 2.3.3). While the detail of these policies will reflect each RTO’s particular circumstances and structures, there are certain principles that should be followed if performance concerns are to be managed effectively. Policies should:

• be clear and robust
• reflect current best practice
• be available to general practice registrars and other stakeholders
• ensure patient safety
• ensure that processes are open, honest and fair
• be defensible.

The four cornerstones of an effective remediation program are:

1. the remediation officer
2. performance reviews
3. early identification
4. good documentation.

The key elements of an effective remediation process are:

• adequate information from multiple sources
• good communication with all involved, but particularly with the general practice registrar
• minimal delay with both notification and any action taken
• impartiality
• continuous support for the general practice registrar
• tailored management plans executed in a supportive learning environment.