Tuesday, November 01, 2011

Complacency about medical suspensions

A senior advisor to the National Clinical Assessment Service (NCAS) is quoted in the BMJ as saying that "increasing numbers of managers are using suspension and exclusion appropriately". She comes to this conclusion from the latest NCAS half-yearly report on the use of NHS exclusion and suspension amongst doctors and dentists in England.

Although there are indications that figures may be starting to plateau, there has been a steady increase in doctors excluded and suspended per year from 140 in 2005/6 to 216 in 2010/11. This increase can't be totally explained by the increase in the workforce.

Despite duration of suspensions falling (see chart), the provisional figures for mean length of concluded episodes to March 2011 was 35 weeks for GP doctors and 21 weeks for hospital and community doctors and dentists. This is a significant period out of the working life of a doctor, although  the median is higher than the mean as the distribution is highly skewed towards shorter episodes. Just under half (49%) return to work with the same organisation, with or without restrictions.

There's no mention of how many of these exclusions/suspensions were unnecessary or could have been dealt with informally. There is concern about how fair procedures are  (eg. see my review of Wendy Savage's book and BBC Inside Out programme from last October at the end of this post). Doctors who are seen as "difficult" or "different" are particularly vulnerable.  Personal malice or professional jealousy may play a role in trumping up charges and these factors are very difficult to prove.

All suspension/exclusion cases need to be sanctioned by NCAS but this is usually a perfunctory matter. NCAS could intervene much more than it does at an early stage to help resolve cases informally (see previous post). Mistakes can also be made in formal procedures because of managerial over-reaction and misuse of authority.  Trusts can react autocratically to problems in arbitrary and capricious ways, as they serve their own idiosyncratic interests (see my BMJ letter). NCAS should have more of a role in countering these factors.


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