This page seeks to answer some of the most common questions that educators ask about the Professional Support and Wellbeing Service (PSW).
What is the Wessex Professional Support and Wellbeing Service (PSW)?
Please refer to the Wessex Professional Support and Wellbeing Unit (PSW) landing page.
Is there an information section which my doctor in postgraduate training and I can refer to?
Yes. Please refer to the Trainee information and Trainee FAQs pages.
What are the possible signs that a doctor is struggling?
The following points may be useful to bear in mind when you are thinking about a doctor in training who is giving you cause for concern:
Work-based: Absence from duty, persistent lateness, poor time management, backlog of work, failure to learn and change.
Clinical performance markers: Over or under investigating, poor decision-making, poor record-keeping, complaints, failure to follow guidelines, missed diagnosis.
Psychological/Personality: Irritability, unpredictability, forgetfulness, highly self-critical, perfectionism, arrogance, lack of insight, denial, risk-taking, impulsive.
Social: Isolation, withdrawal, poor personal interactions.
Cognitive: Memory problems, poor problem-solving, poor reasoning, poor decision-making, poor concentration, lack of attention, learning problems.
Language/Cultural: Poor verbal fluency, poor understanding.
This information has been adapted from the report, Practitioner Performance Advice (formerly the National Clinical Assessment Service, NCAS) meeting on Doctors in Difficulty: Firth-Cozens, 2004.
What are the principles that guide when a doctor in postgraduate training should be referred to the Wessex PSW?
When deciding whether to escalate a concern, it is better to react too soon and find on further enquiry that there is no problem, than to ignore problems, only to discover that they are serious and complex. In your encounters with trainees, keep in your mind at all times, ‘do I have a concern for this doctor and any forthcoming ARCP?’
There are three escalation levels for concerns:
Level 1: Educational Supervision
Level 2: Support network in Trust or Specialty
Level 3: Wessex PSW referral, with access to case manager, Specialist Support Group (SSG) or remedial training support
If you have a concern, then investigate it, in confidence, with a couple of colleagues who know the trainee, to gain a broader understanding of the situation. If concerns remain, and you are not the trainee’s educational supervisor, then you should make the trainee’s educational supervisor aware of your concerns (level one escalation).
Once informed, the educational supervisor should then formulate a (level two escalation) action plan; being sure at all times to keep the trainee informed of their concerns and involve them in the decision-making process. Concerns of this level should be discussed with the trainee’s local Foundation Programme Training Director, Specialty Training Programme Director, Director of Medical Education, or College Tutor.
Thereafter, unresolved concerns, or those likely to prove more challenging from the outset, should be considered for Wessex PSW referral (level three escalation).
For all escalation levels, it is very important, on an on-going basis, to document the concerns, actions and related correspondence. If you have any doubts about how to proceed then please contact the Wessex PSW for further advice.
What circumstances generally escalate to a level 3 concern?
Serious and/or repetitious performance problems (health, conduct or capability)
High level risk to patients and others (see the ‘Can you provide some examples of the risk assessment criteria for doctors requiring Wessex PSW support?’ question below)
– Require skilled and consistent approach
– May require targeted or remedial approach
– May need help with language and communication issues
– May have to be released from training
– Funding implications
Can you provide some examples of the risk assessment criteria for doctors requiring Wessex PSW support?
Health Issues:
Low Risk
Insight into difficulties.
Takes appropriate time off sick.
Insight into limitations caused by health issue.
Seeks help and advice appropriately (from own GP or occupational health or appropriate colleagues) and follows this advice.
Responds to concern raised by colleagues and modifies behaviour appropriately.
Complies fully with all treatment and reasonable adjustments to workplace roles/conditions.
Medium Risk
Limited insight into difficulties.
Continues to work whilst moderately unwell.
Limited awareness into limitations caused by health issue.
Seeks advice appropriately but appears reluctant to follow this.
Some appropriate response to concerns raised by colleagues.
Complies on the whole with all treatment and reasonable adjustments to workplace roles/conditions.
High Risk
No insight into health problem.
Continues to attend work even when obviously unwell.
No insight into clinical limitations caused by health issue; may jeopardise patient care.
Does not seek help or advice for health issue.
Unwilling or unable to respond appropriately to concerns raised by colleagues.
Does not comply with treatment or reasonable adjustments.
Capability:
Low Risk
Insight into capability issues.
Performance difficulties are not serious or repetitive.
Does not attempt to perform tasks when not capable.
Takes responsibility for the task, and ensures that it is completed under supervision or completed by an appropriate colleague.
Seeks advice and supervision appropriately.
Demonstrates expected improvement in areas of weakness.
Demonstrates the ability to learn from experience.
Medium Risk
Limited insight into capability difficulties.
May attempt to perform low risk or simple tasks when not capable, but then seeks advice and supervision.
Demonstrates some improvement in areas of weakness.
Demonstrates some ability to reflect and learn from experience, but there are still concerns in this area.
Repeated sick leave often of short duration and possibly associated with on-call.
Repeated avoidance of acute situations.
High Risk
No insight into lack of capability.
Performance difficulties are serious or repetitive.
Attempts to perform high risk task(s) when not capable.
Inability to communicate effectively.
Repeated inappropriate delegation of clinical responsibility.
Repeated inadequate supervision of delegated clinical tasks.
Ineffective ingrained clinical team working skills.
Does not seek appropriate advice or supervision, therefore putting patients at risk.
If unable to complete the task, does not ensure that it is completed by a colleague.
Seems unable or unwilling to improve in areas of weakness.
Does not demonstrate the ability to reflect and learn from experience.
May make formal complaints about colleagues who express concern about capability.
Conduct:
Low Risk
One episode of minor misconduct only (N.B. need to check that there have not been any episodes in previous posts).
Individual agrees when challenged that conduct was inappropriate.
Demonstrates remorse for misconduct.
Demonstrates the ability to reflect and learn from experience and there is no evidence of further misconduct.
Seeks advice appropriately on conduct and associated issues.
External factor present (family/financial/work related/evidence of stress).
Detailed work history available and no concerns.
Medium Risk
Two or three episodes of minor misconduct (check back to other posts).
Individual agrees when challenged that conduct was inappropriate.
Demonstrates appropriate remorse for misconduct.
Demonstrates the ability to reflect and learn from experience, but some very minor concerns about conduct may remain.
Sometimes seeks advice on conduct and associated issues.
High Risk
Repeated episodes of minor misconduct, or one or more episodes of serious misconduct.
Individual does not agree that conduct was inappropriate, or denies misconduct.
No expression of remorse.
Unable to demonstrate the ability to reflect and learn from experience.
Unable or unwilling to accept advice on conduct-related issues.
No external contributory factors.
Work history difficult to verify/previous concerns.
How do I refer a doctor to the Wessex PSW?
Please refer to the How do I make a referral? page.
Can doctors self-refer?
The Wessex PSW does not normally encourage self-referrals. The Wessex PSW framework relies on issues being addressed at a local level first.
A referral is better received from an educator on a doctor’s behalf as this provides a better structure for their support, and provides an opportunity to explore with them what it is that makes them feel the need to access Wessex PSW level support.
However, it is possible for doctors to self-refer for Wessex PSW support in rare circumstances where local level support is unsuitable or is unavailable.
What happens following a referral?
Referrals are screened and triaged by the Wessex PSW team, then allocated to a case manager.
The case manager will contact the doctor, usually by e-mail, and they will be offered an appointment to meet. This may be at the Wessex local office, or at another postgraduate education centre within Wessex, depending on where the case manager is based, or on a virtual platform and could include a trusted person the doctor wants to bring along.
COVID-19 arrangements – due to current social distancing requirements, most meetings are being held virtually.
The doctor will be given sufficient notice of the meeting and the meeting should usually take place during work time, to enable the department to make arrangements for the doctor to attend. The doctor should not have to use annual leave to attend Wessex PSW meetings.
Doctors do not have to engage with the Wessex PSW, but as the purpose is very much about supporting them to make progress with their training, they should be encouraged to do so. Their engagement demonstrates a professional commitment to their practice. If they do not engage, they may miss out on valuable Wessex support.
The case manager meeting is usually a 1:1 meeting (unless the doctor chooses to bring a trusted person with them), where they will have the opportunity to discuss any issues, and to raise any concerns they may have. The case manager will document the discussions, including a proposed individual support plan. This will be checked with the doctor to ensure that it is accurate.
It is usually advised that the information, documented during the 1:1 meeting, is shared with the referrer, and other people who may need to know the plan of support.
If the doctor is offered support for a specific issue, they will be advised how to contact their Specialist Support Group (SSG) member and they will be expected to make arrangements to meet with them.
The case manager will keep in touch with the doctor to monitor their progress. Further face-to-face meetings can be arranged as required. The doctor is strongly advised to e-mail their case manager with updates, and to let them know of any significant developments.
COVID-19 arrangements – due to current social distancing requirements, most meetings are being held virtually.
The case manager will support the doctor until their issues are resolved while they remain a doctor in Wessex. If they leave training and/or Wessex, their case will be closed.
When should Occupational Health be involved?
The Occupational Health service in each trust can advise on the impact of, work on health, and of health on work. It is important to take advice when a doctor’s health is considered to have the potential to negatively impact patient safety. Advice should also be sought in order to help decide on the appropriateness, and manner, of a return to work, after sickness absence.
If it is considered that a doctor’s health may be an issue for their work, it is best to seek advice early. Work in conjunction with the doctor, keep robust documentation and consult appropriate colleagues, in confidence, about your concerns.
Would I ever have to consider informing the next trust and/or HEE local office if a doctor who has had issues moves on?
Yes. There is a professional obligation to inform the next trust and/or local office if a doctor has unresolved issues, or issues that could re-emerge and might have an influence on their practice and/or training. This should be done with the doctor’s involvement, and ideally with their consent. The most appropriate people to inform would be the Director of Medical Education and Postgraduate Dean.
For further information, please refer back to Educator information.