Discipline in general practice

This page is produced to provide guidance for trainers in those rare situations where disciplinary matters arise with registrars. It has been produced as a consensus document by a working group of Directors, Scheme and Course Organisers. in all situations, the following words should come immediately to mind.

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Disciplinary problems with registrars can be classed as:

  1. Personality clash 
  2. Health
  3. Criminal
  4. Failing academically
  5. Unexplained Absence from Work
  6. Absence from Half-Day Release

Sources of Help

1. Personality Clashes

Share your concerns with your Trainer Group, a Scheme or Course Organiser if they are not part of the Trainer Group, and with the registrar. These situations should be faced sooner rather than later. A Scheme or Course Organiser or sometimes an Associate Director will involve themselves at this stage with the aim of clarifying issues and arbitrating if this is feasible. It is vital that trainers document their concerns and also share these concerns with the involved registrar. The outcome of this arbitration may be to move the registrar to another practice. It is important that neither of the involved bodies see this as failure. The Scheme will have a responsibility to keep in contact with those involved over the next few months to deal with any developments.

What not to do? 

Do not keep these situations to yourself. Do not think that the answer is to sack” the registrar.

2. Health Matters

The important principles again are to share concerns about registrar health both with the registrar and with your scheme representatives. You should encourage registrars to have a personal GP who is not within the involved training practice. You should document any concerns. We now have access to an Occupational Health Service for registrars and you should refer them via your Scheme for an occupational health assessment if you are concerned. It may be necessary for the registrar to take sick leave to allow this process to happen.

The Deanery has mechanisms for ensuring extended training where registrars lose a period of training due to illness.

In a small number of cases, the health problem will be such that it will raise doubts about the safety of the doctor in practice. If you have these concerns, you should share them urgently with your Scheme and with the Postgraduate Institute. The Institute has mechanisms for referral to the General Medical Council. It is important that you have documented your concerns, as you will have to provide a report for the General Medical Council.

3. The Registrar who may have committed a criminal act

As an employer, you must follow employment law. All training practices should ensure that they both provide registrars with a contract of employment and that this contract has a section relating to discipline and current employment law.

You should once again share any concerns at the earliest possible moment with your Scheme and/or the Postgraduate Institute. You may have to suspend the registrar on full pay whilst investigations take place.

4. The Registrar who is failing academically

The key words again come into play. You must share your concerns with the Registrar at the earliest possible time. You must document all concerns that you have. You must involve the Scheme, who may involve the Postgraduate Institute, at the earliest point of your concern.

The Deanery has mechanisms, which allow the relevant Associate Director to take over responsible for signing the VTR form, based on the information that has been collected.

DO NOT FALL INTO THE TRAP OF SIGNING THE VTR FORM IN THE HOPE THAT THE DOCTOR WILL IMPROVE IN FUTURE POSTS.

5. Unexplained Absence from Work

Any unexplained absence from work should trigger an attempt to contact the involved registrar. Case law usually suggests that there is an underlying problem that has overwhelmed the involved doctor.

Be supportive. If you are unable to contact the doctor or uncover a significant problem, communicate with your scheme who may involve the Deanery. Do not sack a registrar without discussing this with your scheme first.

6. Absence from Half-Day Release

There is variation in attendance at half-day release between registrars. In future, Schemes will inform you of your registrars’ absence. It may well be that in consultation with you and the relevant Course Organiser, they have identified a more effective method for personal education. What is not acceptable, however, is absence because they don’t feel like attending. If they are not in the surgery at that time, they are, in fact, acting fraudulently and action will have to be taken.

Sources of Help

Use your Trainer Group but ensure that if you have a specific problem, your Scheme or Course Organiser also knows of your concerns. Use the Postgraduate Institute. Your relevant Associate Director is there to help and advise you and also remove the load of making difficult decisions from you if this would be helpful.

Use the BMA Industrial Relations Officer if you have concerns about contractual issues. Do not act first and ask later – rather the reverse.

We hope this sheet is of use to you and I am happy to hear from you if you feel it should be modified in any way.

 

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