Employers use disciplinary procedures to tell employees that their performance or conduct isn’t up to the expected standard and to encourage improvement. Please see Section 9.7.
Practice Manager (PMgr) should have the following checklists on file and staff should be shown about the details and where files are located for reference.
23.6.1 Investigating Checklist
- The details of the key elements of the investigation process have been listed with probable queries arising from such investigation. The written notes have been handed to the practitioners.
- Familiar with key statements on professional standards made by the GMC. They are also familiar with Good Medical practice for GPs. Both publications are on file.
- There are policies in file for Alcohol and Drugs/substance misuse and when the management should act in the best interests of the individual family and the practice.
- The practice has a policy in file on Disciplinary Procedures pertaining to work/suspension and all actions that needs to be taken prior to enforcing suspension.
- The practice has in files Harassment, Bullying and Victimisation Policy and procedures. Practitioners are aware of the procedures.
- The practitioners are aware in general terms about local procedures for an investigation into a practitioner’s performance and the role of NCAS. The case are usually referred to NCAS for a formal assessment in two main cases:
- When the practice has an incidence(s) of malpractice and Serious Untoward incident(s);
- When the practice has not been having any procedures or protocols and record keeping even though no malpractice had been found.
- Manager has the general conception that anything relating to records, CDM procedures, protocols, recruitment, health and safety etc. are issues, which can be dealt with internally without NCAS involvement. These could be resolved, some informally and some formally.
PMgr should be aware that in cases of malpractice referral to NCAS might be made by PCT and in extreme cases, where a patient has come to serious harm or death or in cases of fraud; the referral to GMC may take place. Police may be called in by PCT or GMC as they deem fit.
- There is a policy in file. The facility is available.
- Root cause analysis policy is in file and every one is aware. Application of this policy will be applied in cases of serious untoward incidents, mental health issues etc.
23.6.2 Managing Checklist
- The Partners, in particular the Clinical Lead, should be quite confident in his/her ability to manage the doctors in the following areas:
- Clinical skills
- Clinical Governance
- GPs and Nurses
- Financial management
- QOF and CDM management.
- The PMgr should be able to manage the
- reception staff
- medical secretary
- IT manager
- GPs and Nurses in so far as admin. issues are concerned.
There are other checklists like Developing, Alerting etc. and these are quite involved when Remedial actions are taken. It is better that Partners, GPs and PMgr are aware of these procedures and checklists.
Disciplining Check List
1. Disciplinary procedures and protocols should be in place and kept in practice manager’s office for reference. There is a 6 monthly review of the procedures with a view to tightening them or upgrading them.
2. The practice manager and Clinical Lead have appropriate work experience and the practice manager usually attends HTPCT courses when they are being conducted.
3. List of training courses available externally are in hand and will be utilised as the need arises.
4. Lawyers will provide supporting or managing role as need arises.
5. Clinical Lead and Practice manager work in tandem aiming for the same goal of doing things right for the good of the practice.
6. Templates for Conduct, Capability and probationary issues are available with various letters to use at various stages.
7. Managers are aware of the distinction between Investigative interviews where in the cause of the issues are discussed; and disciplinary interview where in the issue of disciplinary actions are discussed and decided.
8. Occupational health service protocols are in place and would be issued when a situation arises
- The practice is very transparent about its policies, procedures and finance.
- All appraisal reports are kept. Performance related issues when discussed are kept in their personal files.
- Data protection Act plays a crucial role in terms of confidentiality and manager is not only aware but takes care to implement it. The confidentiality of each staff member details is of paramount importance.
- At monthly meetings, the complaints received for each practitioner and for the practice are discussed and recorded. Also, when complaints are received on the same day it is discussed with the Practitioner and the Clinical Lead and they are kept abreast of actions taken.
- Both Clinical lead and the manager are aware of the procedures, which are in files, to follow should an investigation were to be conducted. Regularly consulted ACAS and BMA for advice on such occasions to ensure that the current practices are followed.
- Locum files have similar information.
- Separation of information as ethnicity and other details are well known to all members of staff.
- If the complaint is about the practitioner, then a record is kept in the Practitioner’s file in addition to complaints file for the year. Untoward incidents, if it pertains to the practitioner is also copied in the Practitioner’s file (summary only), in addition to the practice file. All records pertaining to the practitioner and correspondence with him are kept in his file. Suitable references would be kept in the practitioner’s, if the main information is bulky and in practice files.
Alerting Check Lists
- There is a policy to let the manager know of any area of concern – not so much as ‘whistle-blowing’ policy but as constructive comments for the improvement of the practice and individuals. The guidance for Public Concern at Work and two other documents on Do’s and Don’ts are in practice files for reference.
- All members of staff have been told and shown about the whistle-blowing Policy and shown where it s kept for reference. It is part of continual training programme and discussed in monthly meetings as issues arise.
- Posters are not displayed but procedures are available for reference in the office.
- GPs express any shortage of skills directly to the Clinical Lead, who then informs practice manager. Nurses and admin. staff inform practice manager first, who then informs the Clinical Lead.
- Team working is crucial part of the training and practice development programme for all staff. Staff are encouraged to see it this way only. Without team work the practice cannot function effectively. Emphasis is laid on meeting where all staff is present and issues aired for general discussions and suggestions.
- As far as GPs are concerned the performance problems are highlighted when Clinical lead does appraisal, clinical supervision and both informal and formal meetings with the GP. Should the GP raise issues about trust in the process the issue is discussed and in relevant cases it is modified. The aim is to have a working policy won, which GPs have total trust.
- No special benchmark is used other than informal discussions with the neighbouring practices; comparing their policies with ours; suggestions raised in their practices would be incorporated if considered relevant.
- All discussions with GPs are shared with them informally, formally when they meet and also in monthly meetings as the main focus are to improve practice performance.
- The practice manager does exit interviews in case of GPs in general. However, in some cases Clinical lead does the interview in presence of other partners. Lessons learnt documented for future.
Developing Check List
- Clinical Lead is primarily responsible for the development of the Practitioners. He is also responsible for their continual clinical supervision and appraisals.
- The admin. The Practice Manager deals with system associated with the above development.
- The practitioners also attend courses in HTPCT on every Tuesdays. Courses are also offered for their study leave period to upgrade their skills. Any additional courses, relevant to the practice and to their skill levels, are also attended.
- The induction processes for the new GPs involve other existing GPs in so far as clinical issues are concerned. The practice manager deals with the admin issues. Similar procedures apply for the nurses. For all admin staff there is an induction programme, which is rigidly followed and the practice manager takes the lead role in their continued development.
The following issues are dealt with: Mandatory for all staff:
Health and Safety Policies; Fire Safety; Housekeeping; Accidents and abnormal occurrences; Smoking; Personal hygiene; Risk assessments; Safety advisers and committee; Occupational health; Health and safety training requirements; Clothing; Use of computers; Electrical equipment; Chemical hazards; spillages; disposal; Consulting rooms/kitchens; use of other equipment; any other hazards; patients and supplier visits; Basic communications; Absenteeism and lateness; other locations; Grievance procedures; discipline procedures; Security etc.
- Development delivery is reviewed for clinical effectiveness e.g. from informal discussions and formal discussions on specific case studies and how best to handle it in the future. Lessons learnt are recorded in the GPs file for review during the annual appraisal.
Development delivery is reviewed for admin. issues as below:
Exit interviews (when a candidate leaves); feedback from staff; suggestions; pre-course briefing; interim validation as programme proceeds; end of programme assessment; short test/questionnaire for admin. staff on reception duties; review meeting to discuss further action plans; Final implementation of review meeting; and modifications to training programme from lessons learnt from staff/ GP/manager.
- Staff selection process involves a close match to practice requirement – costs and objectives.
The training costs do not have a pre-set amount. No restraint is placed on training because of the costs. The underlying principle being – training saves money in the long run and time in terms of avoiding new recruitment due to staff leaving.
- The partners have a system by which each one covers when the other is absent or on holidays. The Practice manager trains one member of staff as replacement practice manager during any absence.
- Courses arranged by HTPCT or neighbouring colleges are used to develop communication skills for the nurses and practice manager. Admin. staff skill improvement is by HTPCT courses.
- Practice manager is skilful in dealing with irate patients, conflict situations. PMgr does not lose his/her cool and focus is on the interests of the practice bearing in mind the staff development plans.
- The practice stands primarily for patient care and it is always kept in focus. No compromise to that Mission objective would be made. Decision-making and conflict resolution always tends to reflect that. However, no compromise would be made by sacrificing guidelines or legal procedures.
- The Clinical Lead does have overall responsibility for all GPs, Nurses and practice staff and all aspects of management.
- All concerns are raised with PMgr in the initial instance and for clinical issues depending on seriousness with the Clinical Lead
- The PMgr should inform the Clinical Lead when the surgery is over and the Clinical Lead decides on actions to be taken. This procedure has been followed and found to be a robust system.
- The action points are relayed to all staff, including the one who raised the issue; lessons learnt are minuted and avoidance in the future is clearly stated.
- The GPs, Nurses and admin. staff was given Job descriptions and Contract of Employment with standard terms as per guidelines.
- The responsibilities, clinical skills and clinical governance issues are stated clearly at the outset. All supportive documents are held in the main office for the staff/nurses/GPs to refer from time to time. GPs, Nurses and all admin. staff should go through a yearly appraisal and personal development plans reviewed. Any issues raised by the staff are discussed in full to their satisfaction and record of interview and appraisal kept in their files.
- All the GPs in the surgery should have all been involved in the past with interviewing. However, prior to interview details are discussed in detail about the candidate after giving them the CV and details of the candidate. Equal Opportunities procedures are stressed and are sensitive to all cultural issues at the time of interview.
- All GPs are selected by interview only.
- The emphasis, when a new GP joins or for an existing GP, is placed on the assessment process – Clinical aspects and Clinical Governance.
- All GPs who join will have an induction programme and appraisal in 3 months time followed by annual review after that. Also, Clinical Lead does Clinical supervision in formal way once in 3 months and informal way, almost every other day, when cases are discussed after the morning surgery and after clinics in the afternoons.
- Procedures and protocols are in place for local policies e.g. child protection, mental health etc. Continual discussions on these issues take place in monthly meetings.
- Quick reference guides for local policies and procedures are also in place.
- List of all staff including those who work Part-time:
- All GPs, Nurses and admin. Staffs have annual appraisals. No one is excluded.
- Health Visitors; CPN; Link worker; District Nurses; Counsellors; Secondary Care Team etc.;
- PCT personnel e.g. Prescription Advisor, Complaints Manager, Clinical Governance Lead etc. also advice on our performance and management on various issues. Their details to be kept on file.
- Local Information: List of all Doctors, Dentists, Pharmacists, Opticians, Hospitals and its departments with Consultants names, Social Services, Authorities and Trusts etc. are given at the time of joining the practice.
List of Policy and Guidance A-Z:
Equality and human rights;
Freedom of information;
Health advice for travellers;
Health and social care topics;
Human resources and Training;
Medicines, pharmacy and industry;
Research and development;
Social services inspectorate;
Social services performance assessment;
Please see the websites for further studies in addition to the policies, which should be kept in practice manager’s office for reference.