A Medical Council performance assessment is the Council's competence review of a doctor under section 36 of the Health Practitioners Competence Assurance Act 2003 (the HPCA Act). It is not a disciplinary hearing. It asks one question: does your practice meet the standard required of a doctor in your scope? Assessors appointed by the Council review a sample of your records, discuss cases with you, can observe you with patients, speak to people you work with and can set written components, then report to the Council. The Council then decides whether no concerns remain, whether you should complete a programme it sets with a supervisor, or whether conditions should be placed on your scope of practice. You prepare by understanding the standard, reflecting on your own cases and organising your evidence, never by changing your records.
Why the Council orders one
The Council can order a performance assessment whenever it has reason to believe a doctor's practice may fall below the required standard of competence. The concern can reach it in several ways:
- An employer's notification. An employer must tell the Council when a doctor resigns or is dismissed for reasons relating to competence (section 34 of the HPCA Act).
- A notification from a colleague or a patient. Another practitioner can report a concern that your practice is below the standard, and a patient or their whānau can complain.
- A referral from the Health and Disability Commissioner. After a complaint, the Commissioner can refer the matter to the Council, which can then order an assessment.
- A Professional Conduct Committee recommendation. A Committee can recommend that the Council review your competence; the guide to how a Professional Conduct Committee process runs explains when it does.
The guide to what happens after a notification to the Medical Council explains how the Council chooses between the competence, health and conduct routes in the first place.
Who carries it out
The Council appoints the assessors and tells you who they are. They include doctors who practise in your field, so the assessment looks at the work you do rather than medicine in general. If you know an assessor, or there is a reason one should not assess you, tell the Council in writing straight away.
The assessors measure you against Good medical practice and the Council's statements, and against what a reasonable doctor in your scope and setting would do. The guide to how Good medical practice is used in a Medical Council investigation shows how the standard is applied to a concern.
What happens, step by step
- Notice of the assessment. The Council writes to tell you it is ordering a performance assessment, why, and what it will cover. You can respond in writing to the reasons it gives.
- Information about your practice. You are asked for a description of your practice: where you work, the patients you see, your hours, your colleagues, your continuing professional development and any audit or peer review you take part in.
- Records review. The assessors select records of patients you have seen and read them for history, examination, reasoning, management, follow-up and how the record itself is kept.
- Case-based interviews. The assessors take cases from your own records and ask you to explain your reasoning: what you considered, what you ruled out, why you chose that management and what you would do if the patient returned.
- Observed practice and colleague interviews. With patient consent, the assessors can observe consultations. They can also speak to colleagues, nurses and practice staff about how you work. Some assessments include written components.
- The report. The assessors write a report on whether your performance meets the required standard, with their reasons. You are given the report and the chance to comment before the Council decides.
- The Council's decision. The Council decides the outcome, tells you in writing, and sets out what it will tell your employer and what appears on the register.
How to prepare without changing your records
- Get advice first. Speak to the Medical Protection Society or a lawyer as soon as the notice arrives. They can tell you what to send, what to say about the reasons the Council gives, and what support you can bring on the day.
- Read the standard. Read Good medical practice and the Council's statements that touch your work, such as those on records, consent and prescribing, and note where your practice fits them and where it does not.
- Review your own cases. Read a sample of your recent records as an assessor would. Write down, on a separate sheet, what you would record differently now and why. That sheet is reflection; the record stays as it is.
- Practise explaining your reasoning. Ask a trusted colleague to take you through two or three of your own cases and question your decisions. The case-based interview tests reasoning aloud, which is a different skill from the reasoning itself.
- Organise your evidence. Continuing professional development records, audits, peer review, supervision, changes you have made since the concern was raised, and dated certificates for courses completed.
- Look after your health. An assessment is stressful. If your health is affecting your work, say so to your adviser; the Council has a separate health route, explained in the guide to the health process under the HPCA Act.
The outcomes
After reading the report and your comments, the Council can decide that your practice meets the standard and close the matter. If it does not, the Act lets it order a competence programme, require you to pass an examination or assessment, place conditions on your scope of practice, or arrange counselling or assistance for you. A competence programme is a structured plan the Council sets: named objectives, a supervisor or mentor, a timeframe, regular reports to the Council and a final review. The Council's own documents may use a different name for it; whatever the name, it is a plan you must complete to the standard set.
If the Council has reason to believe your practice poses a risk of serious harm while the assessment or programme is under way, it can suspend your practising certificate or impose conditions in the interim. You are entitled to be heard before that happens. The guide to interim suspension and conditions on practice explains the risk test. If a programme is not completed to the standard set, the Council can take further steps, including conditions or suspension. The guide to what happens in a competence review covers the same process for every profession.
Where remediation fits
An assessment looks at your practice now, so what you have done since the concern was raised counts. Courses completed before the assessment, with dated certificates in your evidence, show that you have already worked on the areas the Council named. Ensuring Clinical Competence and Patient Safety covers clinical reasoning, safety-netting, follow-up and knowing the limits of your competence. Documentation for Healthcare Professionals covers what a record must show, which is the first thing the assessors read. Insight for Fitness to Practise covers how to show you understand what fell short, and Remediation for Fitness to Practise covers how to build the plan of evidence the Council looks for.
Each course is NZ$200, takes 2 CPD hours, is self-paced with immediate access, and ends with a dated certificate issued by Healthcare Ethics Courses that you can submit to the Council or put in your remediation plan. The remediation courses for doctors facing a Medical Council investigation are listed on one page, and the Council and Board investigation process explained shows where each sits. The guide to showing insight and building a remediation plan explains how to present the certificates with the rest of your evidence, and the guide to how to write a response to a Council or Board notification covers your written response to the Council's reasons.
Sources and further reading
- Medical Council of New Zealand: Good medical practice, the Council's statements and its pages on performance assessment.
- Health Practitioners Competence Assurance Act 2003: the competence review provisions from section 36, and section 34 on employer notifications.
- Health and Disability Commissioner: how a complaint about a doctor is assessed and referred to the Council.
Frequently asked questions
Is a performance assessment a disciplinary process?
No. A performance assessment is the Medical Council's competence review under section 36 of the HPCA Act. It asks whether your practice meets the required standard, not whether you are guilty of misconduct. Conduct concerns go to a Professional Conduct Committee, which is a separate process. An assessment can lead to a programme or conditions on your scope of practice, so treat it with the same care, take advice and prepare your evidence.
What do the assessors look at?
A sample of your clinical records, your reasoning in cases taken from those records, and how you work with patients and colleagues. With patient consent they can observe consultations, and they can speak to people you work with. Some assessments include written components. They measure what they see against Good medical practice, the Council's statements and what a reasonable doctor in your scope and setting would do.
Can I improve my records before the assessment?
No. Do not add to, rewrite or tidy any record once you know an assessment is coming. The assessors read the records as they were written. A later note that is not dated and marked as a late entry raises an honesty concern, which is more serious than the competence question. Write your reflections on a separate sheet: what you would now record differently and why. That shows insight without changing the record.
What is a competence programme?
It is a structured plan the Council can order after an assessment: named objectives, a supervisor or mentor, a timeframe, reports to the Council and a final review. You can keep practising while you complete it, with or without conditions on your scope of practice. If it is completed to the standard set, the Council can close the matter or lift the conditions. If it is not, the Council can take further steps.
Should I contact the Medical Protection Society before the assessment?
Yes, as soon as the notice arrives. The Medical Protection Society can tell you what to send the Council, how to respond to the reasons it gives, what support you can bring on the day and whether a lawyer should be instructed. A response to the Council that no adviser has read is an avoidable risk. Healthcare Ethics New Zealand offers remediation courses and does not give legal advice.