Responding to concerns glossary (A-Z)

This glossary has been produced to bring together terms and definitions in general use. Wherever possible, definitions have been taken from key stakeholder guidance documents and relevant sources have been included. This glossary is intended as a guide for those involved in responding to concerns teams to help build consistency in the use of regular terminology. It should not be considered definitive or final.

In some cases definitions are given from more than one source. This is to demonstrate where the same term is used in a different context, for example within regulatory processes.

A – B (Action plan › Boundary awareness)

C – D (Case based reviews › Duty of co-operation)

E – F (Evidence › Further training)

G – M (Informal complaint › Mini-clinical evaluation exercise)

N – P (On-site assessment and training › Public Interest Disclosure Act)

Q – R (Regulators › Root cause analysis)

S – T (Self awareness › Triangulation)

V– Z (Whistleblowing › Workplace reporting)

A

Action plan

An action plan is “a comprehensive ‘map’ describing how a practitioner’s identified further training needs might be addressed. An action plan is also a developmental/educational contract between a practitioner and his/her employer/contracting body.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Appraisal

An appraisal is “a review of a practitioner’s performance against agreed objectives to identify further training needs and set new objectives, either specific to the current post or to meet wider career objectives. Appraisal processes vary across professions and sectors but generally use a ‘portfolio’ to provide evidence of time spent and types of educational activity undertaken. Appraisers should be trained in appraisal interviewing so that their questioning helps the practitioner identify training needs appropriately.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Appraisal (Medical)

Medical appraisal is appraisal of a doctor by a trained appraiser, informed by supporting information defined by the GMC, in which the doctor demonstrates that they are practising in accordance with the GMC Good Medical Practice Framework for appraisal and revalidation. The NHS Revalidation Support Team has published a piloted and tested model of medical appraisal, the Medical Appraisal Guide, which complies with the needs of revalidation.

A completed annual medical appraisal is one where the appraisal meeting has taken place between nine and 15 months of the date of the last appraisal and the outputs of appraisal have been agreed and signed-off by the appraiser and the doctor within 28 days of the appraisal meeting.”
Source: Medical Appraisal Policy (NHS England, 2013)

Assessment

Assessment is “a formal, structured and methodologically sound process conducted to assess performance across a practitioner’s scope of practice, taking into account the concerns raised in order to identify development needs. Assessment undertaken by NCAS aims to improve understanding of why issues have arisen and make recommendations for the referring body and the practitioner based on robust evidence.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

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B

Balance of probabilities

“The balance of probabilities is the standard of proof required in most civil proceedings. It is met if allegations appear more likely to be true than not true.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Behavioural coaching

Behavioural coaching is “method for identifying and modulating emotional, behavioural and psychological blocks and their resultant behaviours.”
Source: Supporting Doctors to Provide Safer Healthcare (2013)

Boundary awareness

Boundary awareness is “an understanding of the difference between a professional relationship and a personal relationship, to ensure that openness and vulnerability are not exploited.”
Source: Supporting Doctors to Provide Safer Healthcare (2013)

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C

Case based reviews

Case based reviews are “a structured review of clinical records and case notes designed to explore professional judgement exercised in clinical cases.”
Source:
Supporting Doctors to Provide Safer Healthcare (2013)

Case investigator

“A case investigator examines the relevant evidence in line with an investigation’s terms of reference, determining findings of fact and producing a report.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Case manager

“A case manager co-ordinates the investigation, organises its administrative support and tries to ensure that the investigation is completed to a timetable.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Clinical placement

A clinical placement is “a placement provided for a practitioner in a hospital or community clinic, in a medical or dental practice or in a community pharmacy. This is normally a supernumerary position, providing a period of supervised practice for training and/or assessment.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Clinical records

Clinical records include any information relating to the care or treatment of any current or former patient, including notes made by clinical staff, correspondence between clinicians, clinical photographs, video and audio recording, pathology results.”
Source: NCAS Handbook (NCAS, 2011)

Clinical supervisor

“A clinical supervisor’s role is to ensure safe practice, to monitor progress against milestones and report this to the programme co-ordinator. The monitoring role cannot be over-emphasised. Regular contact with the practitioner ensures timely, robust and reliable feedback can be reported throughout the programme. This will allow early intervention if problems arise.
Source: Back on Track Framework for Further Training (NCAS, 2010)

Coach

“A coach’s role is to help a practitioner address issues (primarily but not necessarily behavioural) that may have emerged from a performance assessment. The coach helps the practitioner reflect, develop self-awareness, learn from mistakes, set goals for change and practise improvements against these goals. A coach may have a psychology background but could also be a clinical colleague with relevant training and experience.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Conduct (Personal)

Personal conduct includes aspects of behaviour that apply to all healthcare staff and include honesty, punctuality, civility, respect for patients and co-workers etc. See also ‘Professional conduct’.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Conduct (Professional)

Professional conduct describes the expected standards of behaviour for healthcare professionals. It includes all aspects of providing care for patients, working with colleagues and in teams, respecting the contribution of other health professionals, maintaining confidentiality and high professional standards.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Confidentiality

Confidentiality is a legal obligation as well as a requirement of professional codes of conduct. It is also a specific requirement within NHS employment contracts and breaching confidentiality can lead to disciplinary action.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Counter fraud agencies

The counter fraud agencies are “the NHS Counter Fraud and Security Management Service in England and Wales, and equivalent bodies in Northern Ireland and Scotland.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Complaint

“A complaint is a formal expression of dissatisfaction or grievance. It can be about an individual doctor, the team or about the care of patients where a doctor could be expected to have had influence or responsibility. Complaints should be seen as another type of feedback, allowing doctors and organisations to review and further develop their practice and to make patient-centred improvements.”
Source: Supporting Information for Appraisal and Revalidation (GMC, 2012)

Concerns

Concerns about practice are “any aspects of a practitioner’s practice, performance, conduct or behaviour which may:

  • pose a threat to patient safety or public protection
  • expose services to financial or other substantial risk
  • undermine the reputation or efficiency of services in some significant way
  • be outside acceptable professional or working practice guidelines and standards.”

Source: NCAS Handbook (NCAS, 2011)

Corroboration

To corroborate means… “to get or give supporting evidence”
Source: Oxford English Dictionary (Oxford University Press, 2013)

…or “to strengthen; to add weight or credibility by additional and confirming facts or evidence.”
Source: Black’s Law Dictionary Free Online Legal Dictionary, 2nd Ed.

Cultural competence

Cultural competence can be defined as “an ability to interact effectively with people of different cultures.”
Source: Supporting Doctors to Provide Safer Healthcare (2013)

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D

Decision-making group (DMG)

“While procedures in primary care organisations vary, there will usually be a two-tier structure, with a performance advisory group (PAG) and a decision-making group (DMG). See NCAS guidance, Handling performance concerns in primary care (2010).”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Defence societies

“Amongst a range of member services, defence societies advise practitioners whose performance has caused concern.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Duty of co-operation

“Practitioners have a professional and usually also a contractual responsibility to co-operate with investigations into standards of care and related issues. Only if co-operation could lead to incrimination are practitioners entitled to decline to answer questions.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

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E

Evidence

Evidence is the totality of the information relevant to the investigation to establish the facts about events. Evidence will come from a variety of sources and may be written or oral and in paper or electronic format.”
Source:
How to Conduct a Local Performance Investigation (NCAS, 2010)

Educational supervisor

An educational supervisor “from a deanery/college or equivalent body may advise on goals, standards, competencies, methods for reviewing progress and the programme outcome, depending on the post to which the practitioner is expected to return.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Exclusion

“‘Suspension’ is a general practice (GP) term while ‘exclusion’ is used amongst employed hospital and community (H&C) practitioners. Both mean that the practitioner is removed from clinical work. The practitioner will usually (but not always) remain on full pay so these measures entail cost if locum and other arrangements are needed to maintain patient services. At the same time, suspension or exclusion may be necessary to protect patient safety so cost must be balanced against safety benefit.”
Source: Use of NHS exclusion and suspension from work amongst doctors and dentists in 2010/11 (NCAS, 2011)

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F

Fair process

Fair process means that the proceedings are conducted in a way that ensures that both sides have an opportunity to see and challenge all the evidence.

The proceedings should include both the investigation and decision making stages and should be carried out in a fair and reasonable way.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Formal complaint

This is not a recognised term. See complaint.

Fitness to practise

The public is entitled to expect that their doctor is fit to practise, and follows the GMC’s principles of good practice as described in Good medical practice. The Meaning of Fitness to Practise guidance sets out the standards of competence, care and conduct expected of doctors, under four domains.

For further details visit the GMC website via the following link:
Source: The Meaning of Fitness to Practise (GMC, 2013)

Further training

Further training refers to “remediation, reskilling and rehabilitation programmes with the normal deanery-led postgraduate training or normal CPD and PDP cycles. For example, a trainee might use further training to address specific concerns raised during specialist training, or a consultant might use it to address gaps identified at appraisal.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

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G, H, I

Informal complaint

This is not a recognised term. See complaint.

Insight/self-awareness

Insight or self-awareness are defined as “a practitioner’s understanding and acceptance of the problems identified in relation to performance, coupled with a willingness to work through a further training programme. Insight and self-awareness are not all-or-nothing concepts and a practitioner might have only partial insight into certain difficulties. Work with a psychologist, coach or mentor to improve insight could then be useful before and during a further training programme.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Investigation

An investigation is “a process undertaken by an organisation to find out the facts in order to understand an adverse event or series of events, and the role that a practitioner (amongst others) may have played in causing this event. A number of methods may be adopted, with root cause analysis being one.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Note: An investigation can also be carried out into the role of the organisation, systems or equipment and should reveal any mitigating circumstances.

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J, K, L

Lead investigator

See also ‘Case investigator’.
“Where more than one case investigator is appointed, a lead investigator should be identified with responsibility to ensure that the investigation is completed as required under its terms of reference.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Local investigation

A local investigation is “an investigation instigated and conducted by the organisation where the practitioner is working, as distinct from an investigation by a professional regulator, for example.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Local performance investigation procedure

A local performance investigation procedure is “a procedure published by the organisation and governing the conduct of local performance investigations.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Local representative committee

Local representative committee is “a generic term describing local dental committees, local medical committees, local pharmacy committees and also local optical committees. These are the groups representing the interests of primary care practitioners.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Look-back exercise

A ‘look-back exercise’ is “a retrospective review of the care provided to patients to determine if advice or treatment given was correct and safe, and whether further advice, investigation or treatment is required in response to any shortcomings identified during an investigation.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

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M

Mentor

“A mentor is an individual who is tasked with providing personal confidential support for a practitioner, in a safe environment outside the line management system. The mentor should be someone whose views and feedback are likely to be respected by the practitioner (the mentee). The mentor helps people deal with difficulties and test out options and opportunities. Mentoring is a developmental process separate from clinical supervision and has no formal input to performance management.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Monitoring

“Close observation of a further training programme’s operation. Monitoring takes place on two levels. Day to day, the clinical supervisor will normally use continuous assessment, review and constructive feedback to ensure that services are safe while the practitioner is working to improve performance. Second level monitoring is undertaken by the programme supervisor or director who reviews accumulating evidence (feedback from the supervisor and the practitioner’s formative work) to track progress against agreed milestones. This allows informed decision-making during the life of an action plan and at the end of the process, based on evidence about engagement, progress and whether or not objectives have been achieved.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Mini-clinical evaluation exercise (Mini-CEX)

A mini-clinical evaluation exercise is “a structured assessment of an observed clinical encounter.”
Source: Supporting Doctors to Provide Safer Healthcare (2013)

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N, O

On-site assessment and training (OSAT)

On-site assessment and training (OSAT) refers to “the assessment of practical skills and knowledge carried out in the workplace.”
Source:
Supporting Doctors to Provide Safer Healthcare (2013)

Objective structured clinical examination (OSCE)

An objective structured clinical examination (OSCE) is “an examination or assessment process designed to test clinical skill performance and competence in skills such as communication, clinical examination, medical procedures usually comprises a circuit of short stations, to examine on a one-to-one basis using either real or simulated patients (actors).”
Source: Supporting Doctors to Provide Safer Healthcare (2013)

Observership

An observership is “an unpaid clinical attachment with a supervising consultant/senior clinician/practice principal, during which the practitioner would not have direct patient contact, consult or treat patients or provide services. The practitioner should keep a reflective learning log during an observership and the supervisor should be asked to provide a report.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Occupational health assessment

Occupational health assessments “advise organisations and practitioners on work-related health issues, including advice on the effects of identified conditions on a practitioner’s ability to perform certain roles and on general fitness to work.”
Source:
How to Conduct a Local Performance Investigation (NCAS, 2010)

Organisational re-entry

Organisational re-entry is “the part of a further training programme that supports the practitioner returning to the workplace if they have been away from clinical practice for an extended period of time or have undergone further training in an external placement.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

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P

Patient safety

The term patient safety refers to “processes and procedures put in place to prevent avoidable harm to patients, including the identification of performance concerns about practitioners.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Performance advisory group (PAG)

A performance advisory group (PAG) is “a group giving expert advice on performance handling within a primary care organisation. See also ‘decision making group’.
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Performance assessment

“Where local investigation has not produced enough information to identify a clear way forward, the organisation may consider a performance assessment. Assessments are undertaken by different bodies for different purposes. For information about NCAS assessments go to www.ncas.nhs.uk
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Performance investigation

“The purpose of a performance investigation is to determine whether or not there is a performance problem requiring action. A performance investigation is not a free-ranging inquiry.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Personal development plan (PDP)

A personal development plan is “part of the action planning continuum and a means to identify educational need and to document and demonstrate that the need has been addressed. (NB different form an action plan which is directed learning).”
Source: Back on Track Framework for Further Training (NCAS, 2010)

A personal development plan “is a document setting out a doctor’s plans for continued professional development over a set period. All doctors should have an active PDP. In the context of conditions or undertakings it is a starting point for the process of remediation or retraining. The plan should cover all areas of GMP, but must specifically set out an action plan for addressing the deficiencies identified in a performance assessment report, or by a Fitness to Practise Panel.

The PDP should identify the planned action, measure and aimed completion date. Postgraduate Deaneries and in some cases medical directors can give a doctor advice about preparing a PDP in this context but it is the doctor’s responsibility to prepare their PDP.”
Source: Glossary of Terms used in Fitness to Practise actions (GMC, 2012)

Professional supervision

Professional supervision is “participation in regular and supported time out to reflect on the delivery of professional care to identify areas for further training and to sustain improved practice.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Programme co-ordinator

A programme co-ordinator “should be a practising clinician, overseeing the clinical parts of the programme and reporting to the programme director on the practitioner’s progress against milestones and objectives.
Source: Back on Track Framework for Further Training (NCAS, 2010)

Programme director

A programme director leads the programme and is accountable to the organisation for its development, progress and outcome. The role might be taken by a medical director, responsible officer, clinical director, clinical governance lead or person of equivalent rank.
Source: Back on Track Framework for Further Training (NCAS, 2010)

Public Concern at Work Policy

A Public Concern at Work Policy is “a policy published by the organisation setting out the responsibility of employees and other to notify the responsible manager of concerns about patient safety or other matters threatening to undermine the integrity of the service. See also ‘Whistleblowing’.
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Public Interest Disclosure Act 1998

The Public Interest Disclosure Act 1998 “provides some protection from dismissal and victimisation to employees raising genuine concerns about performance or conduct. In certain circumstances it will also provide redress.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Public Interest Disclosure Act

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Q, R

Regulators

Regulators are statutory bodies responsible for the regulation of groups of health professionals and for establishing that practitioners are fit to practise. The General Dental Council, General Medical Council and General Pharmaceutical Council are all regulators.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Rehabilitation

Rehabilitation is “the supervised period and activities for restoring a practitioner to independent practice – by overcoming or accommodating physical or mental health problems.”
Source: Tackling Concerns Locally: report of the Working Group (Department of Health, 2009)

Remediation

Remediation is “the overall process agreed with a practitioner to redress identified aspects of underperformance. Remediation is a broad concept varying from informal agreements to carry out some reskilling, to more formal supervised programmes of remediation or rehabilitation.”
Source: Tackling Concerns Locally: report of the Working Group (Department of Health, 2009)

Reskilling is the “provision of training and education to address identified lack of knowledge, skills and application so that the practitioner can demonstrate their competence in those specific areas.”
Source: Tackling Concerns Locally: report of the Working Group (Department of Health, 2009)

Responsible manager

A responsible manager decides what actions should be taken in response to a performance concern, on behalf of an organisation. This might include a decision to hold an investigation. The responsible manager will also decide the actions to be taken once an investigation is complete. It is common for the medical director or equivalent to fill this role.
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Responsible officer

Responsible officers are senior doctors in certain organisations (designated bodies) who have specific functions for specified doctors that will ensure doctors are appraised annually and where there are concerns about a doctor’s fitness to practise they are investigated and referred to the GMC. In England where the concerns are below the level where referral to the GMC is considered necessary responsible officers will investigate, identify the cause and take the appropriate action to bring the doctor back on track. The responsible officer for a designated body has responsibilities relating to the evaluation of the fitness to practice of every medical practitioner who has a prescribed connection with that body.”
Source: Closing the gap in medical regulation: Responsible officer guidance (Department of Health, 2010)

Restrictions on practice

Restrictions on practice refer to “a requirement or formal undertaking to limit professional practice to specific agreed areas or to define specific exclusions.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Note: Restrictions may include for example, Supervision (clinical) or (educational), able to perform clinics, but not surgery etc.

Root cause analysis (RCA)

Root cause analysis (RCA) “is a method of problem solving that tries to identify the root causes of faults or problems that cause operating events.

RCA is a structured investigation that aims to identify the true cause(s) of a problem, and the actions necessary to eliminate it. (Anderson and Fagerhaug, 2000)

A systematic investigation technique that looks beyond the individuals concerned and seeks to understand the underlying causes and environmental context in which the incident happened. RCA Toolkit. www.npsa.nhs.uk

An interdisciplinary, impartial process (involving experts from frontline services and those who are most familiar with the situation) that identifies changes that need to be made to systems. It involves continually digging deeper by asking why, why, why at each level of cause and effect. VA

Root cause analysis is not a single, sharply-defined methodology; there are many different tools, processes, and RCA philosophies in existence. RCA is a collection of problem solving methods aimed at identifying the root causes of problems or events.

The practice of RCA is predicated on the belief that problems are best solved by attempting to correct or eliminate root causes, as opposed to merely addressing the immediately obvious symptoms. By directing corrective measures at root causes, it is hoped that the likelihood of problem recurrence will be minimised. Wikipedia”
Source: Glossary – Root Cause Analysis (NPSA, 2009)

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S

Self-awareness

Insight or self-awareness are defined as “a practitioner’s understanding and acceptance of the problems identified in relation to performance, coupled with a willingness to work through a further training programme. Insight and self-awareness are not all-or-nothing concepts and a practitioner might have only partial insight into certain difficulties. Work with a psychologist, coach or mentor to improve insight could then be useful before and during a further training programme.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Serious incident

“A serious incident requiring investigation is defined as an incident that occurred in relation to NHS-funded services and care resulting in one of the following:

  • unexpected or avoidable death of one or more patients, staff, visitors or members of the public
  • serious harm to one or more patients, staff, visitors or members of the public or where the outcome requires life-saving intervention, major surgical/medical intervention, permanent harm or will shorten life expectancy or result in prolonged pain or psychological harm (this includes incidents graded under the NPSA definition of severe harm)
  • a scenario that prevents or threatens to prevent a provider organisation’s ability to continue to deliver healthcare services, for example, actual or potential loss of personal/organisational information, damage to property, reputation or the environment, or IT failure
  • allegations of abuse
  • adverse media coverage or public concern about the organisation or the wider NHS
  • one of the core set of “Never Events” as updated on an annual basis. The updated list for 2012-13 can be download from the DH website. Few of them have direct correlation with screening but numbers 23 and 24 may be relevant.”

Source: National Framework for Reporting and Learning from Serious Incidents requiring Investigation (NPSA, 2010)

Significant event

“A significant event (also known as an untoward or critical incident) is any unintended or unexpected event, which could or did lead to harm of one or more patients. This includes incidents which did not cause harm but could have done, or where the event should have been prevented.”
Source: Supporting Information for Appraisal and Revalidation (GMC, 2012)

Simulation

Simulation is “the imitation of a process or clinical technique in real time using either actors or equipment to represent patients.”
Source: Supporting Doctors to Provide Safer Healthcare (RST, 2013)

Separation of roles

No person involved in one stage of an investigation should take part in subsequent disciplinary proceedings or appeals based on the same set of facts. Separation of roles is an important element of securing fair process.
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Soft information

Soft information does not have a firm evidential basis but nevertheless may contribute to the evaluation of concerns, if credible.
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Supervised

GPs: “The doctor’s day-to-day work must be supervised by a GP whose name appears on the GP Register. The supervisee must not work as a single-handed practitioner but may be the only GP on site at a particular time. In such circumstances, the supervising GP must be available off site to provide advice and/or assistance. However, as a minimum, the doctor’s work must be reviewed at least once a fortnight by the supervising GP via one to one meetings and case based discussion.”

Hospital doctors: “The doctor’s day-to-day work must be supervised by a consultant, who may be off site but must be available on-call. However, as a minimum, the doctor’s work must be reviewed at least once a fortnight by the supervising consultant via one to one meetings and case based discussion.”
Source: Glossary of Terms used in Fitness to Practise actions (GMC, 2012)

Supervised – closely supervised

GPs: “The doctor’s day to day work must be supervised by a GP whose name appears on the GP Register, who must be on site and available at all times. As a minimum, the doctor’s work must be reviewed at least twice per week by the supervising GP via one to one meetings and case based discussion.

Hospital doctors: The doctor’s day to day work must be supervised by a consultant, who must be on site and available at all times. As a minimum, the doctor’s work must be reviewed at least twice per week by the supervising consultant via one to one meetings and case based discussion.”
Source: Glossary of Terms used in Fitness to Practise actions (GMC, 2012)

Supervised – directly supervised

“The doctor’s work must be directly supervised at all times by a consultant based in the same place of work. The level of supervision required is equivalent to that of an FY1 trainee.”
Source: Glossary of Terms used in Fitness to Practise actions (GMC, 2012)

Supervised remediation programme

A supervised remediation programme is “a formal programme of remediation activities, usually including both reskilling and supervised clinical placement, with specific learning objectives and outcomes agreed with the practitioner and monitored by an identified individual on behalf of the responsible healthcare organisation.”
Source: Supporting Doctors to Provide Safer Healthcare (RST, 2013)

Supervisor – educational supervisor

“The educational supervisor is responsible for the supervision of a trainee’s progress over time. Educational supervisors are responsible for ensuring that trainees are making the necessary clinical and educational progress. Educational supervisors will need all the skills of clinical supervision, plus an appreciation of supporting educational theory, the ability to undertake appraisal, work with portfolios and provide careers advice. Managing the trainee in difficulty will also, inevitably involve the educational supervisor with support from deanery training structures.”
Source: London Deanery

(for established practitioners) “An educational supervisor from a deanery/college or equivalent body may advise on goals, standards, competencies, methods for reviewing progress and the programme outcome, depending on the post to which the practitioner is expected to return.”
Source: Back on Track Framework for Further Training (NCAS, 2010)

Supervision – educational supervision

Educational supervision “is organised supervision taking place in a workplace context and is appropriate for doctors where there has been a decision that the doctor has deficient performance.

The educational supervisor will help devise and/or implement a training programme in line with the doctor’s personal development plan. The educational supervisor will provide feedback to the GMC on the doctor’s professional performance and progress against the aims of the personal development plan.

This is not to be confused with clinical supervision; it is not the role of the educational supervisor to provide day to day supervision of clinical work.”
Source: Glossary of Terms used in Fitness to Practise actions (GMC, 2012)

Supervision – clinical supervision

“The clinical supervisor is responsible for day-to-day supervision in the workplace. Clinical supervision involves being available, looking over the shoulder of the trainee, teaching on-the-job with developmental conversations, regular feedback and the provision of a rapid response to issues as they arise. All trainees should have a named clinical supervisor for each post (though there may be contextual differences between specialties), who must be able to tailor the level of supervision to the competence, confidence and experience of their trainee. Workplace-based assessment will also tend to fall to the clinical supervisor.”
Source: London Deanery

Supervision (medical)

Medical supervision “must be directed for all cases where a doctor’s fitness to practise is impaired through ill health. The medical supervisor is appointed from an approved list held by the GMC. The supervisor will meet with the doctor regularly to discuss their progress; they will also liaise with treating doctors and the workplace/remedial/educational supervisors.

The medical supervisor reports to the GMC on a regular basis, setting out their opinion in relation to the doctor’s progress under treatment, compliance with conditions or undertakings and fitness to practise in general.”
Source: Glossary of Terms used in Fitness to Practise actions (GMC, 2012)

Suspension

“‘Suspension’ is a general practice (GP) term while ‘exclusion’ is used amongst employed hospital and community (H&C) practitioners. Both mean that the practitioner is removed from clinical work. The practitioner will usually (but not always) remain on full pay so these measures entail cost if locum and other arrangements are needed to maintain patient services. At the same time, suspension or exclusion may be necessary to protect patient safety so cost must be balanced against safety benefit.”
Source:
Use of NHS exclusion and suspension from work amongst doctors and dentists in 2010/11 (NCAS, 2011)

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T

Terms of reference

Terms of reference define the nature and purpose of an investigation, documenting its scope – what is included and what is excluded.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Triangulation

(This term is not best practice – see Corroboration)

Triangulation can be defined as “the process of obtaining data from more than two different sources, thereby ensuring sufficient data is collected in order to evaluate and make a judgement. By collecting data from multiple sources, the data can be verified and enable an accurate assessment to be made.”
Source: Supporting Doctors to Provide Safer Healthcare (RST, 2013)
Note: The term triangulation has been found to be susceptible to legal challenge and it is advised that the term corroboration has the same intention but is safer to use, i.e. more defensible.

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U, V, W

Whistleblowing

Whistleblowing means the raising of concerns outside normal organisation procedures because attempts to use the procedures appear to have failed. All organisations should have whistleblowing policies and procedures in place.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Witness

“A witness of fact has first-hand knowledge about the event(s) in question and can help clarify issues for the investigators. An expert witness has specialist knowledge and can assist in the interpretation of events, standards of care or other relevant issues.”
Source: How to Conduct a Local Performance Investigation (NCAS, 2010)

Workplace reporting

“Every doctor who is working, and has conditions imposed by a FTPP [fitness to practise panel] or has given undertakings, should have a workplace reporter in place. The person undertaking this role could be the educational supervisor, or another person identified within the workplace. This person will be contacted by the GMC soon after the decision to restrict the doctor’s registration has been made. The reporter must agree to provide regular feedback to the GMC/medical supervisor/PG Dean. In general, feedback should include:

  • confirmation that the doctor is complying with their restrictions
  • confirmation of any complaints received
  • confirmation of progress made in relation to any remedial activities
  • any other relevant information.”

Source: Glossary of Terms used in Fitness to Practise actions (GMC, 2012)

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