All practising GPs must be on the National Performers List. This includes locums, employed sessional GPs and GP Trainees. If you were formerly on a PCT’s Performers List, you will have automatically been transferred onto the National Performers List – you don’t need to do anything further at this time.
The instructions on how to join the National Performers List can be found on the NHS England’s National Performers List website.
Now that there is only a single National Performers List, application for locums should be easier as you will send the application to the area team covering the area where you live and you won’t have to reapply if you move. The bottom line is that all GPs must be included on the National Performers List before starting to work as a GP of any kind, including being a locum in England.
The NHS (Performers Lists) Regulations (2013)
The NHS (Performers Lists) (England) Regulations (2013) came into force on 1st April 2013. They set out all the criteria necessary for a GP to be included on the Performers List and the information that a GP has to produce when applying to be on a Performers List (regulation 4). We would recommend that all GPs about to apply or reapply to join the Performers List familiarise themselves with the regulations (see link above) because it would be impossible to adequately summarise all the criteria and pieces of information required here.
Regulations 7 and 8 set out a number of grounds on which an application may be refused or deferred. Under certain circumstances, NHS England (the Board) has the right to put conditions on inclusion on the Performers List (regulation 10). An example of such a condition could be that a GP undertakes a period of supervised practice or undertakes specific further training or retraining. It is likely that the Board will set a deadline by which the conditions must be satisfied and then a date for review. Regulation 11 sets out what the Board can do in the event that a GP fails to comply with any conditions that have been set. This can be as harsh as to remove the GP from the Performers List – a GP cannot work as a GP in any setting that impacts on patient care if he or she is suspended or removed from the Performers List.
The Board has an obligation to tell an applicant, within 7 days, about the decision it has made regarding inclusion on the list; whether it is to include, to defer of refuse inclusion, or put conditions on a GP’s inclusion. If it isn’t simply to include the GP, the Board must also give the reasons for that decision (regulation 18).
As always, we are here to help if you can’t understand the requirements relevant to your circumstances.
Having been accepted onto the Performers List there are a number of other very important requirements with which a Practitioner on the Performers List must comply (regulation 9). Below are a few examples:
- Changes to personal circumstances. – It is important that all GPs keep the Board, through the Area Teams, up to date with personal information. Indeed, regulation 19 is very clear that you must update the Board within 28 days of changing your address (‘unless it is impracticable for the practitioner to do so’). Should you wish to withdraw your name from the Performers List you must give at least 3 months’ notice, for example, if you wish to retire.
- GP Appraisal – All GPs must participate in the appraisal system established by the Board (regulation 9 – (10)) and the Board has stipulated that this is done annually.
- Criminal offences or investigation by regulatory body etc. – It is vital that, within 7 days, a GP notifies the Board if he or she has been convicted of a criminal offence or is under investigation by the GMC even though the GMC is likely to inform the Board and ask for further information about the doctor. This also applies if the offence relates to being a director of a body corporate. As more and more GPs are directors of companies, it is crucial that this is remembered also.
The full list of obligations are set out in regulation 9 but we would like to bring to your particular attention paragraph 9 – (2) (j). This paragraph specifically intructs a Practitioner that he or she must inform the Board (through the Area Team) if he or she “becomes the subject of any investigation by any regulatory or other body” e.g. the GMC. As more and more complaints are now made against the medical profession directly to the GMC resulting in a full investigation this is particularly important to note. Unfortunately notifying the Board is often forgotten by GPs who are already finding themselves in a difficult position with the police or GMC. As a result of failing to inform the Board of the circumstances, find themselves subject to a breach of contract notice as well.
Notifying the Board
All notifications to the Board, regarding changes in a GP’s circumstances, are done by contacting the Area Team. GPs working in Bedfordshire, Luton and Hertfordshire (and also GPs working in Milton Keynes and Northamptonshire) must contact the Hertfordshire and South Midlands Area Team on 01707 390855 or write to NHS England, Hertfordshire and South Midlands Area, Charter House, Welwyn Garden City, Hertfordshire, AL8 6JL.
Suspension is dealt with under regulation 12. GPs must not work in any environment which impacts on patient care if he or she has been suspended. There are two main reasons why a GP might be suspended from the Performers List:
- Performance concerns or alleged criminal activity – If the Board considers that a GPs performance or alleged criminal activity might be putting patients or members of the public at risk, it has the right to suspend a GP from practising pending the outcome of further investigation or the decision of a court.
- Ill health – A GP may also be suspended if there are concerns that his or her health might be impairing performance thereby jeopardising patient care or if the Board considers that working in the stressful environment of general practice could be exacerbating the doctor’s ill health. For more information about supporting ill doctors please go to the Support and Counselling page.
The process – Normally, if the Board is to hold a suspension hearing it must notify the doctor of the allegations against him. It must give the GP two working days’ notice of that hearing and invite the doctor to the hearing to put his or her case (regulation 12 – (2)). However, the Board has powers (under regulation 12 (6)) to suspend a doctor with immediate effect if it considers it necessary to do so for the protection of patients or members of the public. However, the Board must review the decision within two working days of the beginning of the suspension and give the GP the opportunity to put his or her case at an oral hearing (regulation 12 (7)).
Suspension from the Performers List is a neutral act. It is always pending the outcome of an investigation or the decision of a court, regulatory or other body; for example, the Board may suspend a GP pending the outcome of an investigation being carried out by the GMC. As such, GPs usually get paid nearly all their usual NHS income during the suspension (see below). Suspension cannot be longer than 6 months without review and if the Board wishes to extend the suspension it must apply to the First-tier Tribunal before the six month period is up.
National policies and procedures have been approved to ensure that GPs facing performance hearings are dealt with fairly and openly and that they have every opportunity to appeal.
Removal from the Performers List
The Board has the power to remove a Practitioner from the Performers List (regulation 14). There are a number of circumstances when the Board must remove a practitioner. For example, when he or she has been convicted of murder or is no longer registered with the Practitioner’s relevant body. However, there are a number of other circumstances when the Board may remove a Practitioner (regulation 14 (3)). These include when he or she has been convicted of a criminal offence or the Practitioner’s performance has been deemed prejudicial to the efficiency of the services which those included in that Performers List perform;
Regulation 14(5) also gives the Board the discretion to remove a Practitioner if he or she cannot demonstrate he or she has ‘performed the services’ during the preceding twelve months. There are strict criteria surrounding the decision to remove a Practitioner, which the Board must adhere to (Regulation 15).
Support from the LMC
We would strongly recommend that every doctor faced with a notice of a suspension hearing calls the LMC Ltd on 01438 880010 for advice. If appropriate, we will do everything possible to make sure that a GP is supported at a hearing. Further, investigations following a suspension are often protracted and extremely stressful and, therefore, the LMC Ltd has the necessary processes and personnel available to offer pastoral support. This doesn’t mean that we uphold or condone poor performance or professional misconduct in any way, but we do support an individual going through performance or conduct procedures to ensure that they are dealt with fairly.
Payments to suspended medical practitioners
Because suspension is deemed a neutral act, there are specific regulations pertaining to payment for GPs who have been suspended, these can be found in regulation 13. There are also details about appealing a decision not to pay a suspended practitioner.
In general a GP can expect to receive 90% of what his or her monthly drawings were at the time of suspension provided all of the criteria set out in the regulations apply; this also applies to locum GPs. We would strongly advise any GP facing suspension to contact us on 01438 880010 to ensure full support during the suspension hearing and investigations and also to ensure that they receive appropriate payment during the suspension.
Unfortunately, if an Interim Orders Panel (IOP) decision or investigation carried out by the GMC results in suspension from the GMC register, the Board must remove the practitioner from the Performers List (regulation 28) and this may jeopardise payment to the GP. This does not apply to GPs suspended on the grounds of ill health.