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Managers have been advised to crack down on GPs who are too ‘agreeable' and have ‘a desire to do well', in new NHS advice on how to performance-manage practices.

The National Clinical Assessment Service says managers should intervene early to tackle ‘behavioural difficulties' in all healthcare practitioners, including those who follow guidelines too rigidly or try to please patients.

NCAS assesses complaints from managers about GPs, and has issued the new guidance this month to help assist PCTs to deal with problems with healthcare practitioners.

The good practice guide on behaviour and conduct says agreeability in healthcare practitioners was as difficult a problem as rude or aggressive behaviour, even though it admits this may be ‘counterintuitive'.

The guidance says: ‘Practitioners who are agreeable may also present behavioural difficulties.

‘A practitioner's desire to do a job well and particularly to please their patients, may at times border on an overly fixed or rigid approach that means their behaviour can cause conflict and tension with others.

‘This may include for example prescribing antibiotics that patients request against local and national guidance or doggedly rebooking follow-ups with medical staff when trust policy is for nurse follow-up or discharge back to primary care from hospital.

‘Recognising the behavioural markers and dealing with concerns early on may prevent escalation to a serious problem.'

Dr Pauline McAvoy, interim medical director of NCAS, told Pulse:  `We do find that this applies to GPs who have difficulty being assertive with patients and who might be more likely to give in to a patient's wishes rather than follow best clinical practice, in order to avoid a confrontation - an example might be a GP prescribing unnecessary antibiotics.'

She said that dealing with any type of behavioural concern could be difficult for the responsible manager and practitioner involved but there were different tools available to approach different kinds of behavioural concerns. 

She said: `For example, we might recommend that a practitioner with overly "agreeable" behaviour has assertiveness training to help them learn that saying no to a patient need not be a confrontational act.'

According to NCAS, one-fifth of GP referrals to NCAS include concerns about behaviour (excluding misconduct). This figure is based on 1200 GP cases logged on the NCAS database from December 2007 to end of March 2012.

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