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Dilemma: Underperforming salaried GP

Your salaried doctor has been with you a long time, but is not stepping up to the mark. What do you do?

Get to the bottom of why the GP is not performing to optimal standards

Steve Mowle - online

As GP partners we take overall responsibility for the smooth running of our practice and the wellbeing of our staff and patients. If one of our salaried GPs is not pulling their weight then it has a knock-on effect on other members of staff and patients and it needs to be dealt with. The first challenge is getting to the bottom of why a GP is not performing to optimal standards.
We need to consider four situations, each with different ways of moving forward:

  • Is underperformance due to health or personal issues? In this case we need to act sympathetically and look for a way forward that supports the struggling GP without having a derogatory effect on the practice and the care patients receive.
  • Is there a clinical capability issue? If this is the case we need to swiftly implement a constructive personal development plan for the underperforming GP and recommend continuing professional development to improve the competencies that are lacking.
  • Is the problem organisational? As well as looking at the GP in question, we need to consider the possibility that the problem is internal and whether we expect too much of our staff. If this is the case then we seriously need to reflect on the way that the practice operates and if necessary, look into some form of reorganisation.
  • Is the GP’s low motivation and lack of professionalism down to their personality? If so, we may need to move to disciplinary action, either formal or informal and in serious cases, we may even need to report the GP to the GMC.

The most important thing in any of the above scenarios is that as a practice we are consistent in dealing with situations like this. It is also essential that everything is documented and that we are open and transparent with everyone involved about the next steps forward.
Dr Steve Mowle is vice-chair of RCGP council and a GP in Lambeth, London

Give the GP more autonomy, skill and purpose

Dr Richard Fieldhouse Charles Milligan - online

Dr Richard Fieldhouse Charles Milligan

Three issues seem to be at the heart of this dilemma: a lack of confidence to ask simple questions, a ‘siege mentality’ (highly contagious - did he pick it up from others in the practice?) and an air of peoples’ feelings being hurt. Are staff scared of how he’ll respond, whether he might leave if asked to do too much or are he scared of telling him the actual truth about himself? Whatever the issues are, the net effect here is one of lack of motivation - hopefully isolated to this individual and not endemic.

There’s a far greater imbalance between responsibility and control when working as an employee rather than as a partner or a locum, so that needs to be redressed. In order to motivate any employee, three key elements are needed: autonomy, skill and purpose. Allow him freedom to pursue an interest that benefits the practice - and it’s as simple as that. Work with him - maybe through an in-practice appraisal - to help them discover what gets them out of bed in the morning. What are his clinical interests? Does he have an interest is some sort of leadership role within the practice - in IT, or improving the appointments system - or within commissioning? What are his specific skills?

As his employer, ask if you are nurturing him. Would he value extra training or a mentor? Helping him know his purpose will improve his performance and strengthen the team.

You need to work with him to explore these three key elements. And once he starts skipping in to work and volunteering to take on extra commitments, you’ll know your job is done.
Dr Richard Fieldhouse is CEO of the National Association of Sessional GPs

Speak to the GP and consider disciplinary action

Paul Kelly - online

Dealing with a team member who is not pulling their weight is always difficult, especially if your practice is small and everybody works closely together. Unfortunately, behaviour like this is frequently allowed to go unchecked with the underperformer often not realising anything is wrong. 

If you can no longer ignore the situation, the practice really has three options:

  • Speak to the GP. It may be that an informal chat will resolve the problem. There may be reasons for the perceived underperformance that you were not aware of and which can be addressed by the practice relatively easily.
  • Take disciplinary action. If informal discussion does produce the desired improvement and the GP refuses to acknowledge their failings, then formal disciplinary action should be commenced without delay. This will involve a series of disciplinary meetings and warnings under the practice’s capability procedure and could ultimately result in the GP’s dismissal.
  • Plan the exit strategy. Often employers realise that formal action is futile and the employee will not change no matter what is done to encourage them. In this case, cutting to the chase and offering a package of compensation to leave is the obvious course of action. While this option can be beneficial to both parties, it is not without risk. The GP has employment rights and, if not done correctly, this could open the practice up to an expensive claim in an employment tribunal. 

Paul Kelly is a partner in the employment department at Blacks Solicitors LLP

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