NHS Practitioner Health Programme

Purpose

1. This Memorandum of Understanding (MoU) describes the roles of the NHS Practitioner Health Programme (PHP) and the General Medical Council (GMC).  It identifies areas where cooperation between the two bodies is necessary for both to meet their respective responsibilities. It sets down the principles underpinning the interaction between the two bodies and provides guidance on the exchange of information between them.

2. This MoU will be reviewed and revised in the light of experience of the PHP during its prototype stage.

Role of the PHP

3. The PHP will provide advice, assessment and case management services for doctors and, where necessary, onward referral to specialist services.  Doctors accessing the PHP will have health concerns that relate to:

• a mental health or addiction problem (at any level of severity) and/or
• a physical health problem (where that physical health problem may impact on the doctor’s performance).

4. Doctors approaching the PHP for help need to be assured that they have the same rights to confidentiality as any other patient. To this end PHP has devised a Confidentiality Policy for doctors (available on its website www.php.nhs.uk).

Role of the GMC

5. The GMC is a statutory body independent of the NHS and of Government, with responsibility for maintaining the medical register for the United Kingdom. The GMC’s purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine. The law gives the GMC four main functions under the Medical Act 1983:

• keeping up-to-date registers of qualified doctors
• fostering good medical practice
• promoting high standards of medical education
• dealing firmly and fairly with doctors whose fitness to practise is in doubt.

6. In relation to the final function, the GMC has statutory powers to take action where there are concerns about the fitness to practise of a registered medical practitioner.  This includes doctors whose fitness to practise is affected by their health.

7. Where the GMC finds that a doctor is not fit to practise, it has powers to erase that doctor’s name from the medical register, to suspend the doctor from the register or to place conditions on the doctor’s practice. These restrictions apply to practice in any sector of employment in any part of the UK.

Principles of the MoU

8. The PHP and the GMC are committed to working collaboratively and with others during the pilot phase to ensure that patients are protected.

9. The PHP and the GMC have a responsibility to complete their processes for all doctors referred to them and maintain the confidentiality of personal health information as far as possible.

10. This MoU is intended to ensure that effective channels of communication are maintained between the PHP and the GMC where information needs to be exchanged.

11. The governing principles in the relationship between the two organisations are that either organisation will provide the other with information in accordance with the legal framework and the statements of intent contained within this memorandum.

12. The legal framework governing information sharing includes, amongst others, obligations under the Freedom of Information Act 2000, Data Protection Act 1998, the Human Rights Act 1998, the common law duty of confidence, the NHS Code of Confidence and, in the case of the GMC, powers conferred under the Medical Act 1983.

Areas of possible communication

13. Communication between the PHP and the GMC is based on an overriding duty to protect patients, while, as far as possible, protecting confidential health information about individual doctors.  Areas of possible communication between the PHP and the GMC include the following (the list is not intended to be exhaustive):

       a.  “In principle” discussion – discussion about how best to manage concerns about a doctor and whether the regulator would need to be informed. In these cases normally the discussion will take place on an anonymised basis

       b. Point of referral discussion – discussion regarding concerns about individual doctors on the point of referral to either body, where there are concerns about public protection or the safety of patients under the care of the doctor. These discussions will establish how best to progress the case.  In these cases the discussion may need to take place on a named doctor basis

       c. Post-referral discussion - discussion regarding concerns about individual doctors after one of the bodies has received a referral, to avoid unnecessary duplication and to coordinate activity where appropriate

      d. Sharing method development, policies and procedures in relation to the assessment and supervision of doctors who are unwell

      e. Communications and educational initiatives

      f. Evaluation and research

      g. Access to specialist expertise.

14. Each of these areas is further explored in the following paragraphs.

“In principle” and point of referral discussions about individual doctors

15. Both the PHP and the GMC are approached for advice by NHS organisations which have concerns about the health of particular doctors; the purpose of these discussions is to determine whether the organisation should take further steps locally, refer to the PHP or refer to the GMC.

16. In many cases, it will be clear what advice should be given to the enquiring organisation at this stage. However, in order to clarify the most appropriate course of action, it may be necessary for the PHP and the GMC to liaise to clarify the issues involved. In these cases the PHP or GMC will discuss matters raised by the enquiring organisation, normally having obtained consent from that organisation to do so. If the organisation making the enquiry does not agree, they will be offered appropriate contact details for both bodies so they may conduct their own discussions.

Post-referral discussions about individual doctors

17. The PHP and the GMC recognise that there will be times where they both have a case open about a named doctor. They will work together to ensure that overlap between their roles and responsibilities is kept to a minimum, and that appropriate channels of communication exist. The PHP and the GMC aim to co-ordinate their processes for any individual doctor to achieve public protection and patient safety.  As far as possible they will also aim for the best outcome for the doctor with a health difficulty.

Referrals to GMC

18. Whenever the GMC receives a complaint about a doctor an initial assessment is conducted.  The complaint may include allegations that a doctor is unwell. 

19. Where the complaint raises issues which call the doctor’s fitness to practise into question the GMC’s Fitness to Practise procedures are engaged and an investigation will follow.  In these cases, for doctors who are ill, the GMC will seek to establish whether the doctor is currently undergoing assessment or treatment by the PHP. If so, it will, with the doctor’s consent, seek relevant information from the PHP.

20. If the PHP is already involved in the case of a doctor under investigation by the GMC, any information provided by the PHP will be considered by GMC decision makers in relation to that doctor’s fitness to practise. 

21. Where the PHP is not already involved and the GMC does not take action on the doctor’s registration, the GMC may still consider that a referral to the PHP is indicated. If so, the GMC will contact the employer to suggest referral to PHP, or refer directly to PHP.

22. Where the doctor is subject to a GMC Fitness to Practise investigation or where, following a GMC investigation, the doctor has restricted registration the GMC may seek a report(s) from the PHP about a doctor’s health. These will be provided with the doctor’s consent.  

Referrals to PHP

23. When the PHP receives a referral (either self-referrals or referrals from an employer or contracting organisation) they will ask the doctor (and/or their employer) whether they are currently under investigation by the GMC, and perform a GMC registration check to ascertain if restrictions are in place.

24. If the doctor or referring organisation indicates that the GMC is currently investigating them, the PHP will seek the doctor’s consent to contact the GMC to explain that the doctor has sought PHP intervention.  If consent is not forthcoming, the PHP will consider whether disclosure to the GMC is required, using the criteria set out in paragraphs 26 - 28.

25. There are certain circumstances where information about a doctor’s case will need to be disclosed by PHP to the GMC. Such disclosure will normally be made with the doctor’s consent, but, if consent is not forthcoming, disclosure may still be necessary.

Disclosure for concerns about a doctor’s health

26. Disclosure should be made where the doctor's health raises concerns regarding the possibility of impaired fitness to practise. This will normally be limited to those cases where the doctor's condition may significantly affect patient safety and the doctor is not complying with assessment, treatment or monitoring, or heeding advice to remain on sick leave.

27. In such a case, if a doctor has been referred by an employer/contracting organisation, the PHP Medical Director should alert the referring organisation to the concerns and advise them of necessary steps. Where referral to the GMC is indicated the PHP should follow up the case with the referring organisation and seek confirmation that the referral has been made and, if not, the PHP should refer directly to the GMC. Where there is no referring organisation, the Medical Director should refer directly to the GMC if necessary.

Disclosure for concerns about a doctor’s performance or conduct

28. Where there are allegations (at initial assessment of the doctor’s health or emerging during the course of the further assessment or treatment) about a doctor’s performance or conduct which may call into question their fitness to practise, the PHP Medical Director will take action as in the preceding paragraph. It may be helpful for a case conference to be arranged between the GMC, the PHP and referring organisation about the options for action in the case.  Where appropriate this will be an anonymous basis until the need for a GMC referral is agreed.

Sharing method development, policies and communications initiatives

29. The purposes of the methods employed by the PHP and by the GMC are distinct. However, as each organisation learns from the experience of providing assessment, monitoring and supervision of doctors, it will be useful to share methods (for example, case management and assessment), experience, expertise and plans for further development. Senior staff with lead responsibility for handling doctors with health concerns will meet regularly.
 
30. PHP and GMC will each share drafts of policies, procedures and proposed communications which have the potential to affect the working of the other.

Evaluation and research

31. Both organisations have evaluation and research programmes and areas of common interest which may benefit from a shared approach to research. Both organisations may seek opportunities for collaborative projects, and will keep each other informed about the progress of their respective research programmes.

32. The PHP and the GMC will share anonymised high level information about trends, concerns, approaches and initiatives, which are relevant to the shared aim of effective handling of doctors with health concerns in order to help the NHS and registered medical doctors to continue to provide high quality patient care.

Access to specialist expertise

33. Both organisations need access to specialist medical expertise. This includes mental health and addiction expertise, also for conditions where specialist assessment is required for a doctor with a new or chronic physical health problem that may adversely affect their ability to practise.

34. PHP and GMC will explore the appropriateness of building shared lists of suitable experts, working with the medical royal colleges, and provide access to appropriate support and training for such experts.

Review of the Memorandum of Understanding

35. This document will be reviewed within one year from the date of its agreement.