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Identify your position within the profession and how that may
influence how you will approach this module.
Are you an NHS Consultant with junior staff accountable
you? YES / NO
You have managerial authority for these junior staff. It is your
responsibility to identify and address any performance concerns
that may arise.
You will also need to consider your peers.
Lead consultants and clinical and medical directors have
similar responsibility for the consultants in their
If not, are you an NHS consultant working without junior
You may need to guard against the risks associated with
professional isolation. Are there others in the multidisciplinary
team (MDT) who can tell you when you may be out of line? Do you
meet regularly with peers?
If you are a full-time medical director/responsible
officer then you already know that you fall into an unusual
If not, do you work outside the NHS in private practice
or at a private hospital?
There are some different checks, balances and procedures outside
the NHS. While NHS colleagues will be concerned that self-interest
will lead to concealment, private hospitals can be highly sensitive
about risks to their reputation and tend to be robust in dealing
with poor performance.
If not, are you a specialist trainee
or GP vocational trainee?
Most performance issues will be dealt with as aspects of your
training. Your educational supervisor, clinical tutor and training
programme director have key roles.
If not, are you a specialty doctor, associate
specialist, staff grade or ‘trust grade’ or similar (non-consultant
Where do you get to review your performance? Is there regular
and comprehensive supervision?
How have you been affected by revalidation?
If necessary, would you be able to raise concerns about the
performance of your consultant?
If not, are you a clinical academic?
Do you understand the requirements of research governance?
Are you professionally isolated?
Have you allowed sufficient time for the clinical aspects of
your post and the information needed for revalidation, e.g. where
are you holding your case-based discussions?
If not, are you working intermittently
as a locum?
Are you employed by an agency? If so what are their arrangements
for appraisal and revalidation? Or are you employed by a series of
Trusts/Health Boards (HBs)? If so what are your
arrangements for appraisal and revalidation?
If you are none of the above, you are either retired or you are
a rare individual indeed. I hope you enjoy this module.
This module is written with medical managers in mind. This
includes all consultants, unless you are working in relative
isolation. It aims to provide an understanding of the nature of
performance concerns, as well as preliminary guidance on how to
approach such concerns.