The National Clinical Assessment Service, the UK body that helps hospital trusts manage doctors' performance problems, is proposing a nationwide rehabilitation process for all doctors whose practice has previously given cause for concern.
The proposals—developed by the service over the last 18 months in collaboration with royal colleges, regulatory bodies, lay groups and educationalists—are out for consultation until 12 December, with the aim of producing a resource pack by next spring.
An estimated 1% of doctors are currently suspended or face some form of investigation or assessment because of concerns about the safety of their practice. But the service's associate director, Pete Snowden, said that only a small minority ever returned to practice, because of the convoluted and unpredictable nature of the present process.
“If you're lucky you might have some support locally, there might be some retraining possibilities, or it might be who you know. But that's really not good enough. There is no overall structure in place.”
“What we're talking about is not relying on enthusiasts but having in place a system that has a good chance of working.
“We may live in a disposable society, but I think doctors are too valuable a resource to throw them away when difficulties emerge. Many years of training and funding go into producing a consultant, and often the situation is repairable.”
Under the proposals all employers would be expected to offer return to work programmes for doctors who get into difficulties. Likely interventions would include tutorials, workshops, focused reading, coaching, mentoring, and feedback.
The National Clinical Assessment Service also envisages centres of expertise being set up across the country to provide accredited return to work placements with special trainers and clear arrangements about indemnity and patients' consent. The centres might be based on a group of teaching hospitals and training practices or might be a list of approved training establishments across the country.
The consultation document estimates that the cost of retraining could be between £5000 ($8800; €7400) and £10 000 for each doctor and says that this sum could be shared between employer and practitioner—with practitioners expected to make a “substantial” contribution.
The service's director, Alastair Scotland, said the new, structured approach could help to bring as many as two thirds of problem doctors back into the fold. Evidence from a 10 year Canadian retraining programme showed that 70% of doctors there were now back in safe practice.
It was critical to address the problem early, he said. At the moment doctors were sometimes out of work for more than a year before the issue was tackled. “We're trying to do two things: to increase the numbers who get back and make the whole process easier to handle.”
The consultation document, Back on Track: Restoring Doctors and Dentists to Safe Professional Practice, is available at www.ncas.npsa.nhs.uk