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A torturous remediation meeting

The doctor was angry.

It had been 18 months since he had admitted that he had been doing things in his practise that were not consistent with safe and standard NHS general practice.

Since then, his practice and behaviours had been scrutinised with a succession of interventions.

He had produced detailed professional and personal development plans, done audits, undertaken video consultation analysis, done patient and colleague feedback surveys and a considerable number of detailed clinical reviews and reflective statements.

He had had an external review of his record-keeping, his prescribing and his referrals and he had agreed to undertake a clinical assessment by NCAS (for which there was a considerable waiting time).

Each time he had achieved an objective, a new obstacle was put in his path.

Was it the GMC who had put him through such prolonged scrutiny? No: this was due to the demands and processes set by the former PCT (now the area team).

I attended a meeting between the doctor, his medicolegal adviser and representatives from the area team. The doctor’s anger was understandable but hard to hear. He felt as if he had been tortured and said he had ‘been to hell and back’. His whole life, his confidence and his family had been turned upside down. If he had not shown insight, acceptance and willingness to change from the start, my sympathy and understanding would have been limited.

But this was a good man and a good doctor, who had gone astray in a single area of practice – who had then put it right, doing everything that was expected of him and more.

What did the area team think of the documents and supporting information he had submitted eight months previously, as part of his enhanced development plan?

Unfortunately these had been filed unseen, as they were not considered a critical part of the scrutiny required by the decision-making panel for the performers list.

The medicolegal adviser, an experienced doctor, raised concerns.

‘Just what is going on here?,’ he asked. ‘When will someone undertake to review these documents submitted in good faith? I am very concerned about some of the practices and processes at work.’

Remediation should not be about striving for perfection but protecting patients, with action plans to put things right running to just one or two pages. Goal posts need to be agreed and then adhered to, with tight timescales so the process does not drag on.

There needs to be clarity as to what should be done locally (and who should fund it) and what should be done by the local education and training boards, the National Clinical Assessment Scheme, and the GMC. There needs to be funding for remediation for GPs just as there is for doctors in secondary care.

But throughout England, area teams are woefully short of people struggling to pick up the work previously done by PCTs.

As for the doctor, he is still angry. He reports that he has been left with a profound sense of despondence and bitterness toward a system that he feels commands so much power.

The LMC Insider is chief executive of an LMC in England. He is also a practising GP