Coaching for established practitioners: case study

Experienced GP

Like all the case studies on the site, this case is fictitious but based on situations in which the CDU may become involved.

Dr SQ had been in a small general practice for 30 years and was well liked by his patients. For over 20 years his wife had acted as receptionist/practice manager and they had made a good team. However sadly his wife had died some five years previously and he had found the practice increasingly difficult to manage with a series of locums. He had employed a succession of senior receptionists but they had not been able to greet the patients by name as his wife had. The practice had always prided itself on the personal service it offered to patients and Dr SQ frequently saw patients who knocked on his door at weekends, even though he had opted out of out-of- hours. As the practice only had 2,500 patients he wrote most of his patient records by hand but prided himself that his patients with chronic disease were well cared for.

In the years after his wife's death, Dr SQ found work increasingly demanding and seldom got home before 10pm as he now typed all his referral letters himself. He began to resent the constant requests for visits and help out of hours.

Dr SQ was devastated to hear from the PCT that they had had a formal patient complaint about failure to visit and also a complaint from a visiting district nurse who said that his treatment of a terminally ill cancer patient was inappropriate. The PCT was also concerned that he was unable to demonstrate any QOF targets.

At first Dr SQ was hurt, angry and indignant and refused to agree to meet with the PCT. He had always thought of himself as an autonomous independent contractor and failed to realise that the PCT were responsible for the quality of the care he gave his patients. He was then asked to make an appointment with occupational health, to which he agreed and hoped that when his medical was all clear that that would be the end of it. Instead the medical adviser to the PCT, himself a local GP, came and saw Dr SQ in his practice. He listened to Dr SQ's story, was shown round the practice and reviewed the notes of some recent patients with Dr SQ. The medical adviser explained to Dr SQ that although no-one doubted his commitment and dedication to his patients, she had found during the case reviews that Dr SQ was out of date with some of his clinical care and described some examples including a patient with diabetes not offered retinopathy screening and another with angina who had not been fully investigated.

Dr SQ was 64 years old and did not want to retire but in order to stay on the PCT Performers List, the medical adviser explained that the PCT would need to be satisfied that Dr SQ had brought his clinical knowledge up to date and started to modernise his practice. He was given the option of an NCAS referral or referral to the Oxford Deanery Career Development Unit.

Dr SQ was referred to the CDU and an experienced CDU coach visited him in the practice. The report from the PCT had summarised the issues of concern and together the CDU coach and Dr SQ came up with a plan to address each issue. The plan included some reading and courses to update Dr SQ's clinical knowledge and it was agreed that he would demonstrate his competence by sitting and passing the GP Summative Assessment MCQ. The plan also included recruiting a senior GP trainer to shadow him at work and for Dr SQ to visit his training practice on alternate weeks for half a day. The objective was to allow Dr SQ to see how his own practice compared to a modern training practice and to come up with a development plan to take his practice forward.

This Performance Improvement Plan was costed and sent to the medical adviser at the PCT, who had been appointed as Dr SQ's case manager. The PCT agreed to support the plan financially and offered to pay for a locum to cover Dr SQ when he visited the training practice.

Dr SQ enjoyed the weekly contact with his remedial trainer and became motivated to study and update his clinical knowledge. He felt a real sense of achievement when he passed the MCQ and this gave him confidence to think positively about his practice development. He eventually produced a plan for his practice which included employing the young locum, who had been working in his practice, for 3 sessions a week who would be responsible for setting up a new computer system. This was helped by the PCT who provided the finance for the IT purchase. Much of the extra expense would be compensated for by the expected QOF income and it allowed Dr SQ to have a day off each week.

Some months later, Dr SQ felt that life had improved. He no longer worked such long hours, felt much less isolated and had made time to go to local GP study days.