The long-awaited report of the Tackling Concerns Locally (TCL) working group has now been published and its recommendations endorsed by the DH. TCL was one of seven working groups set up to carry forward implementation of the programme of reform of professional regulation set out in the White Paper Trust, Assurance and Safety. TCL was charged with considering how local systems could be strengthened to enable healthcare organisations to identify those whose performance gave cause for concern and how to handle those concerns.

The TCL sub-groups made various recommendations on clinical governance, information sharing and the Performers List System.
The TCL group recommended that the Performers List System should be retained but recommended various improvements. We can expect to see amendments to the NHS (Performers Lists) Regulations 2004 (The Regulations) later this year, to come into effect in 2010, barring any unforeseen delays, and revised guidance.

It is recommended that:

  • There should be more national guidance to ensure consistency of approach.
  • Once a performer is on a list, a PCT should promote access to training, appraisal and reskilling.
  • The Regulations should make it clear that practitioners have a duty to report clinical negligence claims relevant to performance.
  • PCTs should be able to suspend immediately (rather than on 24 hours notice).
  • A practitioner should have the right of appeal against suspension.
  • Where a PCT decides to remove a practitioner, it should, as a matter of routine ask the FHSAA to consider national disqualification.
  • Conditions should be attached to unsuitability cases.
  • PCTs should have the power to issue warnings.

The above are but the headline changes. The full report, which includes recommendations on clinical governance and information sharing, can be found here.

It is hoped that the wide ranging recommendations of the TCL will see more robust processes in place, greater sharing of information and speedier resolution of investigations. This should eliminate some of the more recent headlines about performers being suspended from lists for excessive periods at great cost to the PCT and delay in taking action against rogue practitioners because organisations are unclear as to the action they can take.