Description

Can we realistically manage the poorly performing old

age psychiatrist? The simple answer is we have to, as now

the public identifies with Bernard Shaw’s observation. Clinical

governance is here as a vehicle to improve service quality

and minimise risk.¹ One important

component is self-regulation by the professions; currently

our right. But public confidence is low²

following high profile incidents, and our ability to self-regulate

is in question. We have time to improve things, but ignoring

the signs makes regulation by government an unattractive inevitability.

The track record is not impressive. Audit has been haphazard,

with little change in practice generated. Continuing professional

development has been optional; lack of sanctions reducing

its meaning. Measuring personal development is difficult,

so better methods reflecting reality are needed; which need

to be simple to collect and use. A central college-driven

system may be too adventurous. The trusts need mechanisms

via the medical and clinical directors whereby each consultant

is appraised and development plans created, matching the individual’s

needs to the organisation’s. This means appropriately using

study leave to influence the personal development process.

The college could assist appraisal processes by setting appropriate

standards, leaving the onus on the trust to ensure its specialists

are providing the most appropriate therapy. Most consultants

have not had formal appraisal and may resist; but perhaps

less so if appraisal were by fellow doctors, albeit those

in management positions.