Thursday, 19 April 2012

Doctors4Justice won change in Code of Practice for medical locums with REC

In 2009 Doctors4Justice campaigned for changes in policies regarding locum doctors.

REC (Recruitment and Employment Confederation) is confederation of employment agencies. There are different sectors corresponding to different industries. Medical Sector Group had Code of Practice for locum doctors which reflected in a number of ways what Department of Health produced in their own Code of Practice in the Appointment and Employment of HCHS Locum Doctors produced in August 1997.

Dr Helen Bright complained that the code of practice had a number of sections which were problematic and unlawful. For example in 4. c of Medical Sector Group Code of Practice it was stated:

in recruiting doctors the agency shall ensure that every effort has been made to obtain work assessment form from doctor's most recent assignment. Doctors who refuse to supply a copy of their most recent work assessment report should not be supplied to an assignment.

So, the only thing employer had to do is to withold the assessment form for right or wrong reasons and livelihood of doctor was ruined. Civil rights of locum doctors were thrown out of the window.

Some doctors work in situations where it is not possible for other doctors comment with confidence on their work because they have not observed it. For example, other doctors may not have seen the work of the locum doctor with patients to know about his/her clinical skills yet they would have been asked as clinical/medical directors to complete the work assessment form for locum doctors. Clinical directors and medical directors did not want to spend days investigating the performance of locum doctors so the easiest thing to do was not to give work assessment forms to medical locum agencies.

Section 4d of Code of Practice for Medical Sector Group:

In recruiting doctors the agency shall ensure that:

each doctors professional references are satisfactory and current. (i.e. at least one reference must be from the most recent employer).

There were instances when medical directors provided inaccurate references for locum doctors. For example, a reference could truthfully state that there have been complaints against the locum doctor but omit to say that these complaints were not investigated. Locum doctors were expected to allow locum agencies to distribute such inaccurate information to their potential future employer. It breached Data Protection Act 1998. Processing of personal information should be fit for purpose and data should be accurate.

Section 4a:

In recruiting doctors agency shall ensure that:

each doctor is registered with General Medical Council and that he/she is required to declare any pending proceedings by the GMC against him/her at the time in the future. The agency should check that the doctor has not been suspended, or is only permitted to practice under prescribed conditions.

Doctors were expected to report any pending proceedings before the General Medical Council. However, for many months GMC could investigate and doctors would not have the slightest idea as they have not been informed of the complaints by anyone including GMC and did not even know at the time there would be any proceedings.

The effect of placing conditions on doctors practice or mere mention of past GMC hearings had devastating effect on job prospects of locum doctors. NHS refuses to employ doctors who have any difficulty with GMC if they have the choice of doctors who do not have such a problem. Any prospective and current employer would be informed of allegations before GMC even if these allegations are not true.

n 2009, REC changed their policy to a common policy for all recruitment agencies which appears to be fair and is in keeping with the law.

DoH has continued to deny to present day that there has been anything unlawful about their policy Code of Practice in the Appointment and Employment of HCHS Locum Doctors published in August 1997.

The General Medical Council's Fitness to Practice: Referring Complaints to Local Procedures policy maker was contacted by Dr Helen Bright but GMC were not able to state that day or for several more days if their policy on investigation of locum doctors was still the same.

GMC policy stated that if GMC received complaints about locum doctors they had to investigate them. Complaints about doctors in substantive NHS posts were referred to local procedures.

GMC described locum doctors as peripatetic locums stressing movement from place to place. Locum doctors have to travel to comply with their work assignments which could be all over the country. GMC placed locum doctors on the same list as those who committed crimes (paragraph 14). It is a bit like Roma people were criminalized in 1530 by Egyptians Act leading to their expulsion from England. Here is part of GMC's paragraph 14 of their policy Fitness to Practise: referring Complaints to Local Procedures:

The GMC's core statutory role means that there will be many categories of case where it is immediately clear that we will need to investigate. These cases include:

e) cases involving peripatetic locums

So, if any rubbish complaint reaches GMC about a locum doctor their livelihood can be destroyed because of their status as a locum doctor. That is not in public interest.

Department of Health dislikes agencies as they charge commission and NHS has to pay it and they have not planned for such expenses.

Human being can have poor anger management. When expectations are not met the result could be anger against locum doctors. Expectations are that locum doctors should have no opinions, not criticize anyone or any practice, work for far less money, not work through agencies which charge commission and leave the country preferably as soon as possible. The majority of locum doctors are from ethnic minorities.

Destroying locum doctors careers through sham peer reviews by regulator (GMC) who placed either punitive conditions on doctors' practice preventing locum doctors obtaining any employment led to loss of lives in a situation where there is already established fact that there is shortage of doctors. Some doctors were simply suspended and then erased having never harmed anyone.


Anonymous said...

There is historic bias and mind set against locum doctors. Many people naively believe that locum doctors are not good or only work for money. Whether it may be true in some cases, majority of doctors work flexibly because of personal reasons such as family commitment, need career breaks and above all they don't want to get involved in day to day interference by Managers. In this current climate of job redundancies, Locum doctors have to work hard to prove they are worthy. Its risky as they have to have updated Enhanced CRB clearance, CPD, References and no job guarantees.

GMC should consider to destigmatize these doctors and disclosure about investigations should only be provided to prospective employers after seeking comments from doctors and to ensure if there is a real possibility of a case to answer. Malicious/vexatious complaints are quite common against whistleblowing doctors and if the GMC simply disclose such complaints without proper home work, it is not only the breach of Data Protection Act, its potentially damaging to doctors' career as the complaints despite being proved false, will nevertheless have ever lasting effects for future job prospects especially if its about doctors' character.

I suggest, GMC should take into account these suggestions and application forms by the GMC/NHS Managers/DH/Trusts should make relevant changes about disclosure questionnaire and only suspension,conditions/sanctions,undertaking, warnings,dismissal should be asked and if a doctor has been subjected to any kind of fitness to practise/disciplinay proceedings and cleared, he/she must not be asked to provide details as its fundamentally against the core principle of the English Law which prides itself to be innocent unless proven guilty

Doctors4Justice said...

UK NHS doctors have primitive attitudes to contract workers who appear to undercharge considering the risks they are taking with their careers.