We may assess a doctor’s performance at any time.
This could be in response to a concern or complaint raised by:
- a patient
- a colleague
- an employer
- the Ministry of Health (MOH)
- the Accident Compensation Corporation (ACC)
- the Health and Disability Commissioner (HDC)
In conducting a performance assessment, we consider whether the doctor’s practice meets the required standard of competence.
Prior to ordering a performance assessment
We will consider:
- Is a pattern of conduct emerging that may indicate wider competence issues?
- Was a particular incident a serious departure from accepted standards?
- Has the doctor since put in place systems or undertaken education to prevent a similar occurrence in the future?
- Was there a distracter in the doctor’s life at the time of the concern or incident.
A distracter may include health, financial or personal issues, leading to increased stress, and impacting on the doctor’s ability to perform at their usual standard.
If there appears to have been a distracter, we will consider:
- whether this still exists, and
- referral of the doctor to our Health Committee is necessary.
What happens during the assessment
The performance assessment process is a broad based assessment covering a number of areas of the doctor’s practice. The performance assessment is a practice visit by two medical members and a lay member, who form the performance assessment committee (PAC). The PAC visit usually takes place over the course of 1 – 2 days at the doctor’s practice, and can involve reviewing the doctor’s medical records, patient consultations, prescribing practices, surgical skills, clinical knowledge, communication skills with patients and peers, and practice systems within their workplace.
The PAC then prepare a report on its findings which is reviewed by our Medical Adviser and provided to the doctor for comment, before being considered at a Council meeting. The PAC report details observations made of the doctor’s practice and whether or not the doctor meets the required standard of competence for their scope of practice.
When considering the report of the PAC, if we consider the doctor has met the required standard of competence we may choose any of the following options:
- no further action
- a report about the doctor’s practice is requested at a given time in the future
- to make a recommendation for further action of an educative nature based on the PAC’s findings.
The performance assessment process is intended to be educational, not disciplinary.
If Council considers that the doctor has failed to meet the required standard of competence it may make one or more orders under section 38(1)(a) of the HPCAA. These may include:
- that the doctor undertake a competence programme (commonly in the form of a 12-month ‘educational programme’)
- that one or more conditions be included on the doctor’s scope of practice
- that the doctor sit an examination or under-take an assessment specified in the order
- that the doctor be counselled or assisted by 1 or more nominated persons.
If Council has serious concerns about the doctor’s practise of medicine, it may propose interim suspension of the doctor’s practising certificate.
For the best educational outcome, our experience has shown that it is important that the doctor is involved and engaged with us throughout this process. The outcome of a performance assessment is not public information, unless it leads to restrictions, conditions or suspension of a doctor’s practice.
We have to make known, to the doctor, all the relevant information we have about their competence.
If, following a review under section 36 of the HPCAA, we decide that a doctor does not meet the standard of competence needed within their scope of practice, we will often make the doctor complete a 12 month educational programme.
The educational programme focuses on the shortcomings identified in the doctor’s PAC report. An educational supervisor (who is a specialist working in the doctor’s area of medicine, is in good standing with Council, and has held teaching roles in the past) is appointed to help the doctor to meet the requirements of the educational programme. Reports about the doctor’s progress in the educational programme are provided to us every month.
Who do we have to tell about our concerns?
If we believe that a doctor poses a risk of serious harm to the public we have a legal duty to tell:
- the Accident Compensation Corporation (ACC)
- the Director-General of Health at the Ministry of Health
- the Health and Disability Commissioner
- any person or organisation who we know is the employer of the doctor.
Performance assessment publications
We have several publications that are written for doctor’s undergoing a performance assessment that offer detailed information of the process.
Download What you can expect: the performance assessment (Nov 2005, 264 KB)
Download Handbook for doctors having a performance assessment (Thursday, 12 April 2012, 1 KB)
Download Assessing doctors performance (2005, 7.5 MB)
Assessing doctors’ performance by Dr Ian St George, a former Council medical adviser outlines the practise and theory of undertaking performance assessments of doctor. Covering topics as diverse as, ‘How to identify an underperforming doctor’ to ‘Assessing the doctor who practises complimentary and alternative medicine (CAM)’. This book is must read for every doctor who seeks to avoid diminishing performance and professional isolation.