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WHO CORE COMPETENCIES

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									    Needs and
    demands of
   professionals


     Dr. Ewan Macdonald
Division of Occupational Health
 Department of Public Health
    What do Professionals
           Need
•   To be competent
•   To be confident
•   To be capable
•   To be consistent
•   To be coherent
•   To be communicators
•   To be caring
•   To have capacity
•   To be conscientious
    What do Professionals
           Need
•   Mission
•   Marketability
•   Money
•   Maintain registration
The General Medical
Council UK
The GMC comprises 104
members:
• 54 elected by the profession
• 25 appointed by the University
  medical schools and
  postgraduate institutions
• 25 lay people nominated by the
  Privy Council
The GMC
The GMC’s functions:

• To keep up-to-date registers of qualified
  doctors
• To promote high standards of medical
  education
• To guide doctors on standards of
  conduct, ethics and performance
• To deal firmly and fairly with doctors
  whose fitness to practise is in doubt
GMC - Fitness to practise


      Complaints and
       information




Conduct   Health Performance
Performance
procedures
- the law

The Medical (Professional Performance)
  Act 1995
• Gave GMC power to require assessment
• Gave assessors access to medical records
• Enables CPP to impose sanctions on
  doctors
Performance
procedures
- standards of performance
expected of doctors

• The specific standards which
  apply to practice in the doctor’s
  specialty
• Advice in “Good Medical
  Practice” on the duties of doctors
Standards of
performance
- “Good Medical Practice”
Examples:
“As a doctor you must:
• make the care of your patient your first
  concern
• treat patients with consideration and
  courtesy
• work with colleagues in ways that best
  serve patients’ interests
• recognise the limits of your
  competence
• keep your knowledge and skills up to
  date”
   Good Occupational Health
   Practice -Communications

• Providing patients with
  information to protect
  themselves against occupational
  risk
• Advising on control measures
• Advising on health surveillance
• Encouraging employers to
  accommodate workers with
  disability
• Advising employers on
  statutory and other requirements
Performance
procedures - serious
deficiency
“Seriously deficient performance is a
departure from good professional
practice - whether or not it is covered by
specific GMC guidance - sufficiently
serious to call into question the doctor’s
registration; that is, a repeated or
persistent failure to comply with the
professional standards appropriate to the
work being done by the doctor or with
the GMC’s guidance in Good Medical
Practice, particularly where this places
patients or members of the public in
jeopardy.”
The GMC’s Fitness to
practise procedures in
perspective
• 190,000 registered doctors
• About 3,500 complaints per annum
• About 300 conduct cases per annum
• About 120 new health procedure cases
  per annum
• 120 performance cases so far, and
  over 60 potential cases in screening
  process
Performance
procedures
- Committee on Professional
Performance
Functions:
• Assesses complaints about the doctor
• Decides formally whether doctor’s
  performance is seriously deficient
• If so, it can
   – impose conditions on registration
   – suspend registration
• It can also direct doctor to be assessed
Performance - examples
Case A:
A series of complaints are received about
a general practitioner, qualified for 25
years: the complaints suggest that:
He has refused to visit a number of
patients whose histories and symptoms
clearly indicated that visits were
necessary.
He prescribes erratically, often on the
basis of inadequate information. In one
case this has led to a serious adverse
reaction.
Case notes, when present, are scanty and
often incoherent.
The doctor also shows a difficulty in
completing death certificates and
cremation forms.
Performance - examples
Case B:
Complaints are made to the local NHS
Trust about the circumstances in which
two patients of a surgeon have died
within a few days of ‘routine’ surgery.
This prompts a comparison of the
surgeon’s mortality rates with those of
five colleagues working in the same field.
That comparison reveals an alarming
discrepancy: the doctor’s rate is about 5
times higher than that of any of her
colleagues.
There are also complaints about the
surgeon’s frequent use of out-of-date
techniques, and concerns have been
expressed by junior doctors and general
practitioners about standards of post-
operative care.
Performance - examples
Case C:
A consultant paediatrician displays
clumsiness in carrying out practical
procedures.
Also the doctor habitually refuses to
listen to patients or colleagues, and
responds aggressively to expressions of
concern.
Time management is a major problem,
with no sense of urgency when
responding to requests for help from
anxious juniors.
Despite offers of counselling, Dr C
refuses to accept that there is a problem.
(Subsequent assessment reveals
underlying deficiencies in his basic
knowledge and skills.)
Performance
procedures
- key principles
• Effective 1 July 1997
• Protection of public is primary
  aim
• Rehabilitation where possible
• Centre on a comprehensive local
  assessment
• No referral to Committee if
  doctor co-operates and public not
  at serious risk
• Hearing by the Committee on
  Professional Performance (if
  required)
Complaints received by
   the GMC about
    Occupational
     Physicians

• Confidentiality and
  Ethics
• Communications
• Competence
Performance - types of
case


• Patterns of seriously deficient
  performance
• Deficiencies of
  –    knowledge
  –    Skills(eg communications)
  –    attitudes
Performance
procedures
- Stage 2: assessment
• The GMC invites doctor to agree to
  be assessed
• Trained assessors 2 professional,1
  lay assessor
• Assessment based on Good Medical
  Practice
• Peer review –standard approach
• What does the doctor do in practice?
• Tests of knowledge and clinical skills
• Principle of triangulation – standard
  is public safety
Performance
procedures
- Stage 2: assessment

• What if the doctor refuses to be
  assessed?
• What is the goal of the assessment?
• On what basis are the assessors for each
  case chosen?
• What if the doctor at first agrees to be
  assessed but then does not co-operate
  with the assessment?
       WHO CORE COMPETENCIES

• Identification and assessment of risks from health
  hazards in the work place

• surveillance of workers’ health based on legal
  requirements, the magnitude of occupational risks
  to workers’ health or by voluntary agreement

• Surveillance of factors in the working
  environment and working practices which may
  affect workers’ health

• Advising on the occupational health, safety and
  hygiene, ergonomics and on individual and
  collective protective equipment

• Organizing first aid and emergency treatment

• Advising on the planning and organization of
  work including the design of workplaces, the
  choice, maintenance and condition of machinery
  and other equipment, and on substances used in
  work
• Participating in and guiding the process of
  formulating HES policy based on sound ethical
  principles

• Promoting the adaptation of work to the worker;
  assessing disability and fitness for work;
  promoting work ability

• Advising on fitness for work and adaptation of
  work to the worker in the special circumstances of
  vulnerable groups and specific legislation, for
  example the EU Directive on Protection of
  Pregnant and Lactating Mothers 92/85/EC

• Collaborating in providing information, training
  and education in the field of occupational health,
  safety and ergonomics to management and the
  workforce




                 WHO core competencies
• Contributing to scientific knowledge regarding
  hazards to health and safety at work, by research
  and investigation into health and work ability
  problems at work, following the ethical principles
  attached to research work and to medical research
  and including an evaluation by an independent
  committee on ethics

• Advising on, supporting and monitoring the
  implementation of occupational health and safety
  legislation

• Recognizing and advising on hazardous exposure
  in the general environment arising from industrial
  from industrial activities

• Participation in workplace health promotion
  programmes

• Management of the OHS

• Working as part of a multidisciplinary service



                WHO core competencies
Needs and demands of
    Occupational
     physicians
• Maintain and develop competencies
• Perform consistently well
• Meet needs of workers and
  enterprises
• Adapt to new hazards
• Influence employers and legislators
• Maintain their fitness to practice
• Meet requirements for
  REVALIDATION and continuing
  registration
Demands on Schools of
Occupational Medicine
• Meet needs of society-teach the
  relevant competencies
• Produce competent doctors who can
  perform well
• Maintain and develop their
  competencies
• Provide appropriate training,
  specialist,non-specialist,and
  CME/CPD
• Enhance communication
  performance –not just what they
  know, but what do they DO

								
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