title: Doctors with problems in an NHS workforce.
abstract: OBJECTIVE
  To describe the incidence, nature, and implications of serious disciplinary problems among the medical staff of a large NHS hospital workforce.
  
  
  METHODS
  Descriptive study with analysis of case records.
  
  
  METHODS
  Northern Health Region, an administrative area within the NHS covering a population of three million.
  
  
  METHODS
  Forty nine hospital doctors: 46 consultants and three associate specialists.
  
  
  METHODS
  The nature of the problems encountered within the doctors' practice, and the types of action taken by the employing authority.
  
  
  RESULTS
  Over a five year period concerns serious enough to warrant the consideration of disciplinary action were raised about 6% of all senior medical staff (49/850). Ninety six types of problem were encountered, and were categorised as poor attitude and disruptive or irresponsible behaviour (32), lack of commitment to duties (21), poor skills and inadequate knowledge (19), dishonesty (11), sexual matters (seven), disorganised practice and poor communication with colleagues (five), and other problems (one). Twenty five of the 49 doctors retired or left the employer's service, whereas 21 remained in employment after counselling or under supervision.
  
  
  CONCLUSIONS
  Existing procedures for hospital doctors within the NHS are inadequate to deal with serious problems. Dealing with such problems requires experience, objectivity, and a willingness to tolerate unpleasantness and criticism. Because most consultants' contracts are now held by NHS trust hospitals, however, those who had developed skill over the years in handling these complex issues are now no longer involved.
authors.affiliation: Northern and Yorkshire Regional Health Authority, Newcastle upon Tyne.
authors.forename: L J
authors.initials: LJ
authors.lastname: Donaldson
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004647:Employee Discipline / Q000706:statistics & numerical data*; D004739:England; D006801:Humans; D007400:Interprofessional Relations; D008318:Malpractice; D008505:Medical Staff, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D010817:Physician-Patient Relations; D017406:Sexual Harassment; D013222:State Medicine / Q000592:standards*