I have not had many occasions where sacking someone was my prime objective, taking disciplinary action was also a rarity. Although I was accused of being soft, I personally found a quiet firm chat usually did the trick. Nevertheless, I can think of two practice managers who were sacked for theft, and one attempt to dismiss a practice manager for poor performance. Looking at some of the CQC inspection reports and the performance of not just staff but doctors as well, I wonder how long it will be before a practice manager and the ‘responsible’ manager can be sent packing?

Who is actually in charge?

In medical practices, the registered manager is legally responsible in the eyes of the CQC. If the CQC issued a damning report, it might take steps to suspend the practices services. The practice might be taken over by the local team of NHS England, but does it take over the same doctors and staff, or put a new manager in? Are these doctors and staff going to be left with a blot on their career? Perhaps the next appraisal should look at the issues raised? Having said that what if the appraisal itself is an issue?

What happens at next appraisal?

Appraisals were introduced to monitor performance and encourage development, but what happens to appraisals in practices where the CQC has been critical? Are doctors and staff being asked to explain what part they had in any negative findings by the CQC at their next appraisal? The Reports of the CQC are public, and where the CQC revisits again the reports are published. But then what happens? Is there an annual appraisal? Does it cover issues raised at inspection? Is training being provided for those practices, or is it simply being left to the practices that are found to be inadequate to pull up their imaginary socks?

Dismissing a doctor?

Dismissing a doctor that is self-employed and a member of a partnership is difficult. The partnership agreement may provide for a dissolution process but not a dismissal as such. It may also limit where a doctor can set up his or her practice. So the GP could still practice elsewhere but possibly not nearby. NHS England can take steps to remove a GP from the Performers List but as seen in the past this process takes time. The need to strike a doctor off the GMC Register is rare, but if a GP has failed to manage a medical practice safely what penalty is there if any?

Disciplining a Practice Manager

GP Practice Managers or Salaried GP’s could be subject to a dismissal process. However, what ‘failure’ could be personally directed t a manager or staff? Is the employer not responsible? The power to close down a practice or to impose a new regime, new doctors, and new staff, could have far-reaching effects. Bear in mind the shortage of GPs, and the cost of employing locum GPs, or engaging salaried doctors, it is unlikely there would be any significant improvement in a failing practice. So in a blameless open culture is sacking the solution? What do you think? Are there any lessons you can share?