Your role is to be their employer, not their doctor
In this situation, you are dealing with a number of competing concerns: the running of the practice, the health of your colleague, your personal relationship with them, and the possible impact on practice finance and workload. I suggest you put aside these considerations and focus simply on securing a safe service for patients.
What is it, exactly, that has led to your concerns - a decline in performance, or timekeeping, or attitude? Is there misuse of alcohol or drugs? What might be the consequences for patients and the practice? When you approach your colleague, stick to the facts and clearly articulate your concerns in a non-judgemental manner.
Your practice manager may have considerable expertise in dealing with performance issues, HR issues and employment law. It would be wise to involve them. Remember, any discussion with an employee to talk about performance issues is a formal meeting and someone should take notes.
Before considering options with the salaried GP, you must first secure delegated authority from your other partners and agree the options available in advance. These may include a period of leave, reduced working hours or changes to workload. You may consider referral to an occupational health physician or a private counselling service. Think of these measures as an investment that may save the practice from greater expenses later on.
Finally, your colleague should be encouraged to turn to their own GP for help and support. Your role is to be their employer, not their doctor.
Dr Ruth Livingstone is a recently-retired GP partner from Stamford.
Your first responsibility is to your patients
GMC guidance in ‘Good Medical Practice’ states that your first responsibility is to your practice’s patients. In a case of diminished clinical competence due to alcohol or erratic behaviour he or she may need to see their own doctor and be referred to a specialist for assessment. This should be specified in their contract along with responsibility for locum insurance and dispute procedures. If using disciplinary procedures standard employer/ employee procedures should be followed, in such cases the BMA can provide useful guidance and advice. If there are issues of concern regarding the clinical competence of your colleague, then your medical defence society should be consulted at an early stage or the GMC.
Your second responsibility is to your distressed employee. If there are no patient safety issues you could have an informal talk; if simple errors have occurred you may need to convene a critical incident review. They might need time off work, and/or a reduction in their duties which may require re-negotiation of their contract - once again the BMA can provide invaluable advice.
Research on treatment for burnout is in its infancy. Llimited evidence from Denmark shows that counselling may help, cognitive approaches have been examined, and my charity runs an RCGP-accredited course for GPs which promotes resilience.
It is of paramount importance that all interactions, discussions with colleagues and practice management, formal and informal, written and verbal and advice from outside bodies should be recorded.
Dr Alastair Dobbin is director of the charity, the Foundation for Positive Mental Health, an Honorary Fellow of Clinical Sciences at Edinburgh University, and was a GP for 30 years until 2010.
There is no quick solution here - you will need to look at a long-term plan
Whilst it may be a difficult topic to raise, you need to start by having an informal chat with the employee. See if you can get to the route of the problem and explore solutions. If patient safety is a concern then you should also undertake a risk assessment. With the employee you should review duties and hours, identify any problem areas and brainstorm solutions.
Notwithstanding the above, you are under a duty to provide a safe system of work. If you fail to do so there is the risk of potential claims for; personal injury, breach of contract, disability discrimination (see below) and/or constructive unfair dismissal. This is only in the most severe cases and if you fail to address work-related problems.
The employee’s condition could amount to a ‘disability’, depending on the circumstances, under the Equality Act 2010. If so then the duty to make reasonable adjustments is engaged. It is advisable to make a referral to an occupational health adviser at an early stage. The adviser can suggest adjustments and whilst you must be supportive to the employee, adjustments need only be reasonable.
The Health and Safety Executive has published ‘Management Standards’ to assist employers with dealing with such issues. ACAS has also published guidance such as ‘Stress at Work’ which may be useful.
Depending on discussions you should introduce a programme of support and have regular meetings to monitor the situation. There is no quick solution here so you will need to look at a long-term plan.
Victoria Patterson is a solicitor in the employment team at Veale Wasbrough Vizards.