ProblemRegistrars

In general trainers have been very good at dealing with GP Registrars with performance difficulties, commonly putting in a lot of extra work and supervision.

Some pitfalls that can occasionally be a problem include:

* A move to action before all the facts are known, all the options generated and the longer term consequences explored.

* Failing to share concerns, often for very good motives - perhaps in an expectation that the problem will improve with the training input.

* Incomplete documentation.

Here are four useful resources to consider when dealing with GP Registrars who have performance difficulties.

1. http://www.yorkshiredeanery.com/files/10262004_28288.doc

The Yorkshire Deanery guidance from our website. The take home message is to SHARE concerns, to DOCUMENT the problems and to INVOLVE appropriate expertise.

"Appropriate expertise" includes: other trainers, the course organiser, the associate director, human resources (local Hospitals Trust and/or BMA), occupational health, PCT clinical governance lead.

2. http://careerfocus.bmjjournals.com/cgi/content/full/325/7359/S43

A helpful BMJ article looking at "difficult doctors", asking what makes these doctors "difficult" and suggesting some strategies. Looking at difficulties in terms of the doctors capacity, their learning needs, their motivation, any distractions (including illness) and their attitudes.

3. http://www.ncaa.nhs.uk/pubs/other/ncaa_report_understanding_performance_difficulties_in_doctors.pdf

The National Clinical Assessment Authority gives a further insight into performance difficulties. It is a practical guide with some advice about identification, assessment and intervention when concerns are raised about a doctor's performance.

4. http://www.acas.org.uk/publications/H02.html

This is a document setting out good employment practice with respect to discipline and grievance procedures at work. Most doctors who experience difficulties will respond to feedback and appropriate training input. This guidance includes handling problems in an inclusive and timely way, informal action to encourage improvement, the place of the formal disciplinary meeting, taking disciplinary action.

Dr Mark Purvis

Associate Director (PGGPE)

The Yorkshire Deanery

Postgraduate Medical & Dental Education

Willow Terrace Road

University of Leeds

LEEDS

LS2 9JT

Tel. (0113) 343 1703

Fax. (0113) 343 1530