Wessex Deanery 10th November 2009

Support for GP’s ? A new way

Dr Richard Weaver

Wessex Deanery

Doctors with a Problem?

Wessex Deanery

General practitioners (Oxford CDU)

Career dilemma 14 self referrals

Performance 19 referrals from PCTs

(Data from Oxford Deanery 2004-2008)

Wessex Deanery

Practitioner Health Programme (PHP)

• 147 referrals from 27,000 practitioners in last 2 years (Doctors & Dentists)

• 11% Dental practitioners

• Largest single Group; Psychiatrists

• 30% Known to GMC (From GMC only 10% return to work if suspended and 50% if Conditions imposed)

Wessex Deanery

Practitioner Health Programme (PHP) London

• 2/3 Mental Health (mainly depression)

• 1/3 Addiction problems, mainly alcohol but also included a case with addiction to street sold Heroin

• 10% Physical health problems

Wessex Deanery

Practitioner Health Programme (PHP)

• Many also have significant finance problems.

• Significant group clusters include younger females (with a significant number now reported to have alcohol problems) and older males

Wessex Deanery

How is the Wessex Deanery currently Involved

• Self referral• Appraisal and in the Future Revalidation• Practice/Others (Partners, family, Practice Manager,

etc)• Other educators• LMC• PCT (Performance Referral)• NCAS• GMC

Wessex Deanery

PCT Performance Panels

• Acts as a second, more expert, opinion but with different representation than the Screening Group

• PCT Director, PEC Chair, LMC Chair and CE, PCT NED, External Lay Person and GP Postgrad Education

• Detailed investigation completed within 28 days

• PCT has to pay for investigation and attendance at Panel, make arrange suitable educational or remedial programmes, fund most of the action plan, pay locum costs and fund any suspended GP

Wessex Deanery

Wessex Deanery

But we’re not talking about these GP’s

The LMC/Wessex Deanery Proposal is aimed at…………..

• Self referral• Appraisal and Revalidation• Practice/Others (Partners, family, Practice Manager,

etc)• Other educators• LMC;…………………………..

Wessex Deanery

Wessex Insight; Professional Support

Wessex Deanery

Wessex Insight

• Is a new, confidential educational support service set up Is a new, confidential educational support service set up

by the Wessex LMCs and Deanery to support the needs by the Wessex LMCs and Deanery to support the needs of GP’s across Wessexof GP’s across Wessex

Wessex Deanery

Wessex Insight

• INSIGHT is a scheme targeted at the common issues that many of us face which the Wessex LMCs and the Deanery feel can be helped by access to the right intervention, at the right time and at a reasonable cost (subsidised by the learning bursary)

Wessex Deanery

WHAT AREAS ARE COVERED?

• Time management• Communication and language skills• Coaching in particular skills • Mentoring• Careers advice• Seeing how others practice i.e. visiting GPs and observing different

practice contexts• Consultation skills • Specific support for certain groups of GPs i.e. locums, early years

post CCT, mid career GPs• Signposting to and providing information about specific agencies

and learning opportunities

Wessex Deanery

HOW MUCH WILL IT COST?

• Initial discussion with the Wessex LMCs and the Deanery Education Team is free.

• If WESSEX INSIGHT support is needed we can guide you and develop a specific learning programme with you.

• Wessex Insight will also offer where appropriate a learning bursary, to cover up to 50% of the costs for GPs registered with the Wessex LMCs.

Wessex Deanery

Insight Bursary

• The maximum learning bursary available through the Wessex Bursary scheme will be £2,000. The individual GP would be expected to match 50% of the Bursary granted up to the £2000 maximum figure.

Wessex Deanery

WHO IS NOT SUITABLE FOR REFERRAL?

• Those already involved in “poor performance procedures”

• Those whose needs can be met through existing education provision.

Wessex Deanery

Why ??

• This innovative scheme is aimed to bridge the formal educational support processes for doctors in difficulty and the existing provision which is not currently tailored to meet individualised learning needs.

Wessex Deanery

LMC/Wessex Deanery StrategyLMC/Wessex Deanery Strategy

AIMSAIMS

• To promote To promote early identification early identification of Doctors needing of Doctors needing educational supporteducational support

• To provide clinical and educational supervisors with a To provide clinical and educational supervisors with a clear structure for identifying and addressing clear structure for identifying and addressing these these needsneeds

Wessex Deanery

LMC/Wessex Deanery StrategyLMC/Wessex Deanery Strategy AIMSAIMS• To To clarify lines of responsibility clarify lines of responsibility for other educators for other educators

involved in managing doctors in need of supportinvolved in managing doctors in need of support

• To provide a To provide a network of support for educators network of support for educators throughout Wessexthroughout Wessex

• To establish a To establish a group of expertsgroup of experts who can deal with who can deal with specific areas of difficulty and identify opportunities for specific areas of difficulty and identify opportunities for targeted support or trainingtargeted support or training

Wessex Deanery

What happens after referal

• In depth meeting and interview.• Agree what the facts and issues are.• Agree leaning objectives and support.• Agree a “Learning plan” with Targets and timetable.• Agree resources needed (support, mentors etc).• Follow up with letter summarising all the above• Get written Agreement.

Wessex Deanery

What are possible Learning plans

• May be self directed set of objectives or activates.• May involve attachment or “Mentoring” from

Experienced GP Trainer or other Educator.• May involve “coaching” in certain skills.• May involve External Training or Support.• Will involve target dates and reporting back.

Wessex Deanery

At the End

• Review with 1 to 1 meeting and report.• Agree outcomes.• Have a “Long Term” plan or Strategy.• Report and then “Discharged”.......

……………………….Do we need longer term support??

Wessex Deanery

Positives

Responsive to needs of individual

One contact point

Consistency of approach

Peer referenced

Tailored plan

Wessex Deanery

Negatives of current positionHoS!! only contact

Ad-Hoc arrangements

Funding and support variable, not formalised

No long term follow up possible

Is it consistent

HoS; no peer support.

No Externality

No Training of involved Educators

Standard setting

Wessex Deanery

Other Issues

• Difficult doctor vs doctor in difficulty

• Which problems are remediable/not remediable?

• How do we know that chosen action has desired outcome (for doctor, employer, patients)?

• When to call a halt?

Wessex Deanery

Wessex Deanery

ANY QUESTIONS?

www.nesc.nhs.uk

Wessex Deanery