Working with a Dr with Difficulties

TIMELINE FEB Didn’t turn up for regional event hosted by own Consultant – said was there when challenged. Didn’t work the night shift Time owed to dept – paid back MAR Late – When challenged about being on time, said working elsewhere Reporting to senior when arrives APR Multiple concerns raised by nurses Distracted behaviour, disappearing – concerns re mental health raised Not seeing patients asked to. Failing to self-care Sent home sick several times by senio Informal meeting Occ Health referral Time off JUN DNA Occ Health review – letter written but received by dept 3/52 later Further instances of lateness. Provable that reason was not true Formal letter from Consultant colleague raising concerns, times & dates provided Formal meeting with HR present AUG Changeover. Dr pursued alternative career Note - these events happened many years ago. Some of the events have been changed

PRINCIPLES Be fair to both sides as it is likely there are facts you do not know: Follow Trust guidance, use HR expertise Avoid constructive dismissal What do you want your endpoint to be? What is best for patients, dept & that person Confidentiality But ensure those who need to know do in order to avoid undermining the interventions you are using

Drs specifics- who is available for advice? HR Responsible Officer – GMC What tools do you have? MSF – person to choose who asked. Can be used to disprove a general problem, too ES / CS – College Tutor & TPD now available if trainee PSU - if trainee Occ Health – self-referral vs management referral

TO Consider Risks to patients Underperforming Drs Not fitting in with system & processes Interpersonal skills Burden on colleagues If you need time off sick, you need time off sick. Cover can be arranged

Risks to Dr Continued deterioration Insight or guilt – eg asking to stay late, may not be in best interests Should not be doing extra or later shifts at risk to normal shifts Risks to Others Driving Colleagues left with unexpected rota gaps

1. Importance of having everything in writing Cannot act on hearsay & rumour, or unless something happens Must have proof Accumulation of concerns may start small Not witch-hunt / bullying. Have to keep that person at the centre Leadership 2.Importance of clear plan eg Lateness - report to senior Everyone understands acting together – no mixed messages /not being undermined. Not punitive

3. DOCUMENTATION Minimises comeback 3. DOCUMENTATION Minimises comeback. Can demonstrate being fair Same format & reason as clinical notes Especially if lack of insight 4. Often multiple areas of concern Clinical , reliability / teamworking ePortfolio 5. Is this a Dr with difficulties / Dr in difficulty

SUMMARY Principles applicable to many other situations Curriculum Prioritisation of patient safety CC7 NTS Team working & patient safety CC8 Communication & co-operation with colleagues CC15 Personal Behaviour CC24 Medical Ethics & confidentiality CC17