The role of the Performance Advisory Group (PAG)
From time to time you may come across the term PAG but may be unclear on its role and what it does.
NHS England through its Responsible Officers (RO) is responsible for managing performance concerns in primary care. The Framework for Managing Performance Concerns in Primary Care (The Framework) was drafted in 2013 and revised for implementation from 1st April 2015. It provides the overriding principles for how NHS England teams that support the RO should discharge their statutory functions and ensures that concerns are handled in a way that protects patients and the public, maintains high standards and is consistent and fair to performers. It supports the implementation of the National Health Service (Performers Lists) (England) Regulations 2013 and the Responsible Officer Regulations 2010.
NHS England South Central as an area has over 3200 GPs with a prescribing connection to Dr Shahed Ahmad as RO and Medical Director. In order to ensure Dr Ahmad carries out his role of RO robustly and to ensure compliance with the Framework, South Central operates two monthly PAGs; one for Bath, Swindon, Wiltshire and Gloucestershire the other covering the Thames Valley area. The role of PAG is to review all performance concerns or complaints that name an individual practitioner on behalf of the RO.
A performance concern relates to any aspect of a performer’s conduct or performance. These concerns may arise from a variety of sources and may present themselves in various ways – poor clinical performance, management or administration that may compromise patient care, breach professional boundaries with patients, colleagues or staff, not complying with professional guidelines or criminal acts. There may be single or multiple underlying causes for underperformance but the RO is responsible for ensuring that any concern regardless of how minor are reviewed and, if required, acted upon promptly, fairly and proportionately. The majority of concerns are resolved locally at PAG and closed without the requirement for any action. Research shows that the earlier a concern is identified and addressed, the more likely that a satisfactory and successful outcome will be achieved. It is important therefore to ensure that the process for identifying concerns is robust.
NHS England receives a number of complaints and concerns from many different sources including self-referrals from practitioners in difficulty seeking support. The majority of concerns raised do not need any formal action taken but PAG may signpost the performer elsewhere for support or recommend they under take reflection and discuss the concern in their annual appraisal. No matter how minor the concern it is essential that all concerns about a named performer are managed through PAG to ensure consistency and no decision about a performer are taking in isolation.
The Terms of Reference for the PAG are contained within the Framework. PAG is made up of a minimum of four people representing, Patient Safety, a Senior Manager responsible for performance, a GP and a Lay Member. The Local Medical Councils are also invited to attend PAG which brings benefits to all parties.
The PAG cannot take action under the Performance List (PL) Regulations but can make decisions on any other appropriate action that they believe may be required. These decisions may include referral to occupational health, action planning, remediation, support, undertakings or no action. If the PAG believes that action is required under the PL Regulations, they must refer the case to the Performers Lists Decision Panel (PLDP) but very few concerns require this level of escalation.
We full recognise that when a concern has been raised this may cause anxiety and distress to practitioners. We are committed to resolving concerns informally in the first instance when we are able to. We also are committed to supporting practitioners when remediation or other support is required and have good examples of working well with practitioners in difficulty to support them in their role.
PAG also considers concerns in relation to Dentists, Pharmacists and Optometrist although the membership varies for each speciality.
Further information is available at:
https://www.england.nhs.uk/wp-content/uploads/2016/02/toolkit-managing-performance-concerns-pc-feb16.pdf
https://www.england.nhs.uk/publication/framework-for-managing-performer-concerns/
http://www.legislation.gov.uk/ukdsi/2010/9780111500286/contents
http://www.legislation.gov.uk/uksi/2013/335/pdfs/uksi_20130335_en.pdf