Complaints and performance concerns are not always easy to address at the local or practice level. Sensitivity is required because the GP in question may not accept criticism and they may react negatively, such as with anger or denial. It is not uncommon for GPs to question their self-worth and their abilities as a doctor.
While a GP cannot be compelled to undergo remediation, helpful strategies for enhancing engagement and their cooperation include:
- maintaining an open mind (eg not making assumptions, guarding against bias and prejudicial statements)
- seeking advice and/or assistance from someone more experienced in providing feedback on performance or managing difficult situations
- seeking advice and/or assistance from a colleague who the GP respects
- informing the GP that the issues are being raised out of concern not only for patient safety but also the practitioner’s safety
- assisting the GP to better understand the concerns
- listening to the GP’s perspective, allowing them to relate their story and what they perceive the issues to be
- advising the GP that they may need to seek support from their medical defence organisation (MDO) and allowing the GP to have a support person with them at meetings
- reassuring the GP that they will be supported through the remediation process and providing that support
- reinforcing the notion that better outcomes will be achieved by working together.
When a GP lacks insight or refuses to cooperate, consideration will have to be given to the action that should be taken. Possible actions for the practice to take include:
- issuing a warning to the GP and placing them on probation
- when there are health concerns, asking the GP to take sick leave or to present a certificate of fitness to practise from their treating health professional
- reporting the GP to AHPRA under the mandatory reporting regulations when there are serious performance concerns.
When a complaint or notification has been made to AHPRA, often the first that the GP hears of it is when they receive a request for further information or an explanation from AHPRA. In addition to the initial shock, the complaints process can be very long and costly, and therefore very stressful. The GP’s welfare during this time is important and supportive initiatives, such as regular consultation with their GP and/or referral to a clinical psychologist, are helpful.
The practice may or may not be aware that a complaint has been made to AHPRA. If not, they should be informed by the GP because the practice itself will want to look into the matter and take appropriate actions (which may range from support for the GP through to measures to ensure patient safety).