Addressing performance concerns

Abstract

Aim: To assess the impact of the National Clinical Assessment Service (NCAS) on governance activity for medical and dental practitioners in Northern Ireland. Method: Telephone interviews were conducted with a purposive sample of referrers to NCAS in Northern Ireland. Results: Twenty-two referrers agreed to take part and nineteen were interviewed. Respondents held a range of positions, including senior human resources personnel, but the majority were Medical Directors or Clinical Directors. The majority of referrals were for issues related to clinical competence, although this frequently overlapped with behavioural, health and probity issues. As well as automatically-triggered referral as part of disciplinary cases, reasons for seeking input from NCAS included seeking reassurance, expertise and objective advice. In some cases, employers reached their limits with a case, and NCAS filled the 'governance gap' between local and regulatory responsibility. All respondents expressed satisfaction with the service and found NCAS to be approachable, accessible and neutral. Some challenges remained in handling performance concerns. These included: achieving a balance between patient safety, service delivery and responsibility to the practitioner in question; initial contact with the practitioner; and challenges in identifying and managing performance concerns in doctors who were not located with a long-term employer (i.e. trainees and locums). Conclusion: NCAS has value as an independent non-regulatory body in addressing performance concerns, and could have a positive future role in supporting the regulatory process of revalidation.