New on-site practice assessments of doctors' performance will put in place improved safeguards for patients, writes DR MUIRIS HOUSTON
THE REGULATORY landscape in which doctors practice continues its rapid pace of change. Following on from making fitness-to-practice hearings public events, the Medical Council is about to introduce on-site practice assessments of doctors’ performance for the first time.
It means a small number of doctors can expect their standard of patient care to be looked at as they actually go about their daily work – their interaction with patients and how they perform in real life will now be closely examined.
We have come a long way from scandals involving Harold Shipman in the UK and Michael Neary in the Republic. Shipman infamously murdered more than 200 of his patients; following his conviction he then took his own life in jail. Neary was found to have recklessly removed women’s wombs at Our Lady of Lourdes Hospital in Drogheda and was struck off after a high-profile fitness-to-practice inquiry.
The actions of these medical practitioners were rare and exceptional; nonetheless they caused the public to re-evaluate their trust in all doctors.
In turn, politicians took steps to tighten oversight of doctors’ professional activities.
Here, a new Medical Practitioners Act came into force. Among many changes it increased lay representation on the Medical Council; fitness to practice proceedings now take place in public unless the complainant specifies otherwise; and it strengthened the oversight of doctors’ continuing medical education.
Not least the new Act made it easier to detect and help doctors who were underperforming because of personal illness or addiction. And new performance assessments will now further strengthen the Medical Council’s regulatory role.
According to council president Prof Kieran Murphy: “New performance procedures will further enhance the Medical Council’s processes in protecting the public. This marks the culmination of a number of years of development work and is a further safeguard which will help to both protect patients and to promote good professional practice among doctors.
“While doctors endeavour to provide safe, high-quality care, sometimes performance problems may arise. Performance assessment will not replace other procedures which the Medical Council already has in place, but will allow us to work in a more targeted and effective way with doctors who are experiencing problems in some aspects of their practice.”
So when can patients and doctors expect to see the first performance assessment visits?
“Patients can expect to see performance assessments from the end of March. It is difficult to predict the number of assessments which will be conducted in the first year, as it will depend on the number of instances that arise where council feels it needs assurances about the quality of a doctor’s practice,” Murphy says.
But taking New Zealand as a country with a similar population, and using similar procedures, it conducted about 20 performance assessments in 2010. In half of these cases, doctors were formally required to engage in further education to maintain their knowledge and skills.
The council has trained some 30 assessors to begin with. They include both medically qualified individuals as well as non-medical assessors to represent the views of patients.
A team of three assessors will conduct the assessment visit, which will be timetabled over a number of days. Even before the visit, the team will have gathered together, in some depth, information about the practice.
Both staff and patients will be canvassed for their views on a wide range of issues concerning the doctor’s professional abilities and attributes.
A sample of the practice’s patient records will be looked at to assess their quality; and the doctor may be asked to demonstrate his or her clinical skills to the assessors.
At the end of the process, a report will be considered by the Medical Council, which will then decide what action (if any) is necessary to ensure the ongoing competence of the doctor who has been assessed.
Murphy sees the latest development as a key element in the overall package of protecting the public. “Trust in the competence of doctors is at the heart of the patient-doctor relationship, and the Medical Council safeguards that trust by promoting and ensuring the highest possible standards among doctors,” he says.
“It’s important that the public is aware that these procedures will be used when council feels it needs assurances about the overall quality of a doctor’s practice.
“While this situation may arise following a complaint about an isolated incident, in general these new procedures will be triggered by the council in response to information about the overall pattern of a doctor’s performance rather than how the doctor performed in relation to an isolated incident.
In other words, fitness to practice inquiries will remain the principal mechanism through which the council investigates a doctor whose care in a specific case is alleged to have fallen below an acceptable standard.
It’s all part of an intricate jigsaw with patient safety at its centre. Where the Medical Council identifies resource or systems failures as part of a visit or investigation, it will write formally to the Health Service Executive or the Health Information and Quality Authority about the problem. In turn, these agencies are expected to communicate with the council about any concerns that arise about the performance of individual doctors.
As the pieces of the jigsaw are put in place, the likelihood of poor or dangerous healthcare going unchallenged over a lengthy period diminishes.
All of which will help achieve that age-old medical dictum: Primum non nocere (First do no harm).
QUALITY CONTROL: THE IMPORTANCE OF PROFESSIONAL COMPETENCE
Maintenance of professional competence helps to promote and continually improve the quality of a doctor’s practice.
All doctors in Ireland have a legal obligation to fulfil specific professional competence activities on an annual basis.
There is a body of research to show that engaging in professional competence helps doctors to maintain their knowledge, skills and quality of their practice.
But there is no direct link between the quantity of continuing professional activity undertaken by a doctor and the quality of their practice.