Support for GP’s ? A new way

1. Support for GP’s ? A new way Dr Richard Weaver Wessex Deanery 10th November 2009

2. Doctors with a Problem?

3. General practitioners (Oxford CDU) Career dilemma 14 self referrals Performance 19 referrals from PCTs (Data from Oxford Deanery 2004-2008)

4. 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)

5. 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

6. 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

7. 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

8. 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

10. 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;…………………………..

11. Wessex Insight; Professional Support

12. Wessex Insight • Is a new, confidential educational support service set up by the Wessex LMCs and Deanery to support the needs of GP’s across Wessex

13. 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)

14. 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

15. 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.

16. 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.

17. WHO IS NOT SUITABLE FOR REFERRAL? • Those already involved in “poor performance procedures” • Those whose needs can be met through existing education provision.

18. 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.

19. LMC/Wessex Deanery Strategy • AIMS • To promote early identification of Doctors needing educational support • To provide clinical and educational supervisors with a clear structure for identifying and addressing these needs

20. LMC/Wessex Deanery Strategy • AIMS • To clarify lines of responsibility for other educators involved in managing doctors in need of support • To provide a network of support for educators throughout Wessex • To establish a group of experts who can deal with specific areas of difficulty and identify opportunities for targeted support or training

21. 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.

22. 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.

23. 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??

24. Positives Responsive to needs of individual One contact point Consistency of approach Peer referenced Tailored plan

25. Negatives of current position HoS!! 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

26. 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?

28. ANY QUESTIONS? www.nesc.nhs.uk