The Inquiry recommends that:
• There must be sustained investment in leadership development for doctors at all career stages. Improvements discussed in the Medical Management and Leadership chapter should continue. The Department should establish a dedicated regional programme to strengthen medical leadership and management. This programme should focus on all aspects of medical management and leadership; aid continuous development and provide opportunities for ongoing challenge.
• The Trust should continue to develop its medical managers and leaders ensuring that roles and responsibilities are clear and there is sufficient time allocated to perform the roles.
• Within the Trust there must also be access to ongoing training and development for all medical leaders. Leadership programmes for all doctors, medical managers and clinical leaders must be developed and sustained. Such programmes should be clearly linked to wider organisational development programmes to foster shared decision making across professional boundaries.
• The work done in relation to improving understanding of the different approaches to managing doctors in difficulty and the wider training on the MHPS framework put in place at the Trust should continue.
• While the MHPS framework exists in its current form, the Trust should consolidate the work undertaken to date and develop a protocol to address the recommendations listed at the end of the MHPS chapter.
• The work relating to redevelopment of the MHPS framework in Northern Ireland carried out by the Department should continue at pace as it is long overdue. The Inquiry endorses the recommendations made by the Department's review group, advocating a completely new approach to replace the MHPS framework.
• The Department should continue to invest in and enhance regional working groups for Medical Directors and other senior medical managers. These groups should provide expertise in relation to mechanisms for dealing with doctors in difficulty and difficult doctors. The groups can share case studies and best practice. The remit of these groups should include an emphasis on the use of external resources such as Practitioner Performance Advice (PPA), as well as how to develop and use robust internal processes. Such processes must encompass the need for any necessary support for practitioners, integrate with and link to all current processes that relate to how concerns about medical staff are addressed.
• All doctors and doctors in training need to be made aware of current processes and receive mandatory training in this area.
• Doctors must be involved in the management and leadership of services and in strategic planning for the future. There must be targeted funding and oversight from the Department. In the interim the Trust must ensure its medical staff is involved in the management and leadership of its services.