How to approach this module

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 to 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 ambit.



If not, are you an NHS consultant working without junior staff?



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 category.



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 and clinical tutor have key roles.



If not, are you a specialty doctor, associate specialist, staff grade or locally employed ‘trust grade’ or similar (non-consultant career grade)?



Where do you get to review your performance? Is there regular and comprehensive supervision? Is there a good appraisal system?

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.



© 2020 Royal College of Psychiatrists