Appendix C. Performance management policy for practice X (pro forma)

Preamble

Practice X has a duty of care to the public (patient safety) as well as the GPs working in practice X (GP safety). Consequently, practice X has a responsibility to:

• the standard of performance and behaviour of its GPs
• ensure that every GP understands and complies with their responsibilities
• manage performance concerns regarding its GPs.

With respect to managing performance concerns, practice X’s role is to:

• ensure that processes for performance management are transparent, fair and equitable
• provide a supportive environment that allows performance management to take place without putting patients or the identified GP at risk.

Purpose

To outline the process for managing performance concerns of GPs at practice X.

Scope

This policy:

• applies to all GPs at practice X, regardless of the terms of their employment
• provides a framework for addressing performance concerns.

Note: With general practice registrars, performance concerns are managed, in the first instance, by their supervisor. Significant performance concerns will be referred to the registrar’s Regional Training Organisation (RTO), but may also require involvement from practice X.

Guiding principles

This policy is guided by the following principles:

• the safety of patients and the public
• the needs and wellbeing of the GP
• the integrity of practice X
• the requirement to take a comprehensive approach
• processes that are fair and transparent
• confidentiality for the GP (this need for confidentiality will, however, be balanced against the need to ensure that information is passed to colleagues where appropriate, and patients are properly informed before giving consent to care from a practitioner who has restrictions placed on their practice)
• personal and professional support for the GP and the team that they are working in
• drawing on external expertise to facilitate processes and ensure better outcomes for all.

Definitions

Managing underperformance is also termed ‘remediation’. It is a process that begins with identifying a concern, followed by investigation, assessment, decision making and, finally, implementing a management plan. A range of possible interventions, or remedial activities, may be implemented, from simple advice and support through to formal supervision and retraining. These interventions encompass:

• reskilling or retraining: the process of addressing deficits in knowledge, skills and/or behaviours to enable the GP to practise safely
• rehabilitation: the process of supporting the GP with ongoing health issues and/or disability to
  • surmount the difficulties that hinder them from practising safely
  • assist with making adjustments in the workplace to enable them to practise safely.

Roles

Once a performance concern is identified, assistance from various individuals or agencies may be necessary at any or all stages of the performance management process. Those who may be involved in the performance management process include the following.

The governing body of practice X (practice principal/chief executive/board of directors):

• has overall responsibility for ensuring that identified cases of underperformance are properly managed
• leads the performance management panel, but delegates these responsibilities to an appropriate person when there is a conflict of interest
• nominates the members of the performance management panel
• convenes discussions regarding performance concerns with the performance management panel
• obtains advice and/or assistance, as relevant, from AHPRA, the RACGP, practice X’s MDO and experts in performance management.

The performance management panel:

• is responsible for managing identified performance concerns
• makes decisions regarding performance concerns
• comprises the governing body (or their representative), the practice manager and a GP of the clinic.

The practice manager:

• is responsible for ensuring policy implementation and compliance
• is responsible for enabling the early identification of performance concerns
• refers concerns about patient safety directly to the governing body
• participates in discussions regarding performance concerns
• may participate as a member of the performance management panel.

The GP is responsible for ensuring their safety to practise. The onus is therefore on the GP to:

• continually reflect on their practice
• maintain the required level of knowledge and clinical skills appropriate to that practice (prevention)
• demonstrate that any identified performance concerns are addressed and resolved.

The GP may also be called on to assist:

• as a member of a performance management panel
• the identified GP in a supervisory, mentoring and/or educational role.

The clinical supervisor (a suitably experienced GP from within the practice):

• is a doctor in the practice who may be asked to supervise a GP about whom there are performance concerns. Supervision may be formal or informal and will depend on the context that assists the GP with their learning plan (development and execution)
• monitors the GP’s progress
• reports to the governing body and makes recommendations about the GP’s progress and any concerns they may have
• evaluates the outcomes of the Remediation Plan.

The mentor:

• provides personal support
• challenges and promotes the development of reflective skills.

Mentoring is a developmental process whereby a more experienced GP (‘mentor’) helps a less experienced GP (‘mentee’) in their personal and professional development.

The mentor does not have to be from practice X and may be of the identified GP’s choosing.

The assessor/investigator (an external expert having experience with remediation and assessment of clinical skills):

• ensures they are clear about their decision making and any recommendations they make with respect to a Remediation Plan
• assists practice X to
  • investigate performance concerns
  • assess the clinical skills of GPs and identify deficiencies
  • make a determination as to the GP’s safety to practise
  • make recommendations for addressing the performance issues
  • evaluate the outcomes of the Remediation Plan.

The medical educator (has experience in medical education and remediation):

• assists in the investigation and assessment of performance concerns
• delivers and monitors Remediation Plans
• assists in evaluating the outcomes of Remediation Plans.

Occupational health and rehabilitation services assist when there are concerns regarding the identified GP’s health. Referral to such specialist services may be necessary when adjustments or modifications need to be made in the workplace to assist the identified GP in their practice.

AHPRA must be notified (under legislation) when there is serious concern regarding patient safety. Practice X may have a role in supporting the GP with respect to any determination made by AHPRA.

Practice X’s performance management process