Essential principles for managing performance concerns

There should be clear processes for documenting performance concerns. Documentation should include any firsthand evidence as to the concerns that have been raised, such as specific examples of problems that have arisen and patient complaints (whether formal or informal). All relevant discussions, decisions made, and action taken should be documented contemporaneously. Any such documentation should be kept separate from the patient file. Consideration should also be given to privacy and confidentiality and, consequently, to the levels of access to this documentation among staff and management, regardless of the form of the documentation (paper-based or electronic).

Communication of important information to key individuals in the performance management framework is vital but this needs to be weighed against considerations of privacy and confidentiality.

Inadequate or insufficient information and poor documentation can make it difficult to enforce processes and regulations when a GP disputes the issues and is either reluctant or refuses to comply with a planned intervention or any decisions that are made.

Refer to Appendix B. Significant event reporting (pro forma). This pro forma outlines a framework for practices for reporting and documenting incidents that are concerning.

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).

AHPRA supports the15 National Boards that are responsible for regulating the health professions with protected titles under the Health Practitioner Regulation National Law Act 2009 (Cwlth). One of the National Boards is the Medical Board, the primary role of which is to protect the public and to set the standards and policies that all registered medical practitioners must meet.

In addition to supporting the National Boards, the role of AHPRA is to:

• manage the registration and renewal process for health practitioners and students around Australia
• on behalf of the Medical Board, manage investigations into the professional conduct and performance of medical practitioners, except in
  • New South Wales, where investigations are undertaken by co-regulators, the Medical Council of New South Wales and the Health Care Complaints Commission, via a formal consultation process designed to determine which agency is better placed to deal with a particular complaint or practitioner
  • Queensland, where it may be undertaken by the Queensland Health Ombudsman
• work with the Health Complaints Commission in each state and territory.

The Medical Board comprises medical practitioners and community members who are conversant with clinical practice and systems. All regulatory decisions that might affect a practitioner’s registration are made by the Medical Board or by a Civil and Administrative Tribunal.

The roles of AHPRA and the Medical Board are complementary. AHPRA staff provide the administrative support that enables the Medical Board members to consider the available information and make decisions.