Managing Performance Concerns

The College is committed to supporting employers in resolving concerns about the clinical performance of an individual surgeon or surgical unit. Through the Invited Review Mechanism, the College can provide a fair independent and professional review process to determine whether there is a cause for concern and make recommendations for improvement. The College believes that action should be taken locally at the earliest possible stage with the aim of remedying problems before they affect fitness to practice or impact on patient safety.

Concerns about performance may be highlighted from a number of sources including; local clinical governance process, the appraisal process, by other members of the surgical team or through surgical outcome data. The College recommends a staged and proportionate response to investigating concerns, considering both the individual and the environment within which they work. 

Employers will already have pathways for dealing with performance concerns. The Invited Review Mechanism (IRM) is provided to support, but not replace existing procedures for dealing with such issues.

‘The IRM has an important role in maintaining standards and supporting surgeons. This role is likely to expand with issues caused by revalidation’. Consultant ENT Surgeon, Clinical Reviewer for the IRM

The IRM provides a service that covers all surgeons working in the NHS and private sector in England, Wales and Northern Ireland.

Managing performance concerns – the individual

The College has several services that are offered under the Invited Review Mechanism to assist employers:

Individual Reviews assist hospitals in identifying whether there is a case to be answered with regard to alleged inappropriate or unsatisfactory surgical performance of a surgeon.

Case Note Reviews provide an independent expert opinion on whether the management of a specific case or series of cases has met the required College/Specialist Association standards.

Working with employers and National Clinical Assessment Service to provide advice and guidance on the development of further training and remediation programmes. This service aims to facilitate surgeons in their return to unsupervised clinical practice safely and without unnecessary delay.

Through its commitment to supporting Trusts and external agencies in dealing with performance concerns, the College will under certain circumstances identify an individual to act as  Independent Assessors.

Managing performance concerns – the service

Service Reviews provide an independent expert opinion in relation to concerns about a specific surgical department/unit.

The review mechanism is a flexible one, and the College will work with the commissioning hospital to develop the appropriate terms of reference.