The NHS Resolution Practitioner Performance Advice service’s (PPA) guidance and resources clarify how medical practitioners should be excluded under the MHPS (Maintaining High Professionals Standards in the Modern NHS) framework, and how you can best handle concerns about doctors and dentists.

The new guidance follows on from the Paterson Inquiry, which recommended that when a hospital investigates a healthcare professional’s behaviour, any perceived risk to patient safety should result in the suspension of that healthcare professional. Below we summarise how healthcare employers can improve their processes for investigating and excluding professionals.

Opportunities for improvement

The analysis identified key areas that employers should focus on:

• Your decision to exclude should be guided by
  • (1) legitimate reasons for exclusion in MHPS and
  • (2) a full exploration of the possible alternatives to exclusion.
• Documenting all decisions: Maintain a full and up-to-date record of decisions throughout the process of managing concerns about a practitioner, including for the decision on whether to exclude or not.
• Keeping exclusions under review: Review an exclusion regularly or as soon as circumstances change. This is to ensure it is not maintained any longer than is necessary or fair.
• Supporting the practitioner: Manage all exclusions fairly, efficiently and compassionately. Whilst the safety of patients remains the paramount concern, it should not be forgotten that exclusions are associated with emotional and psychological costs for the practitioner too.

How the analysis was undertaken

The new guidance and resources have been informed by the analysis of 1359 exclusion cases in England between 2009 and 2019. 97% of exclusions involved doctors and there were 1.2 exclusions per 1000 doctors.  The number of exclusions were decreasing and the proportion of exclusions ending in dismissal had fallen. However, some groups were significantly more likely to face exclusions – the groups identified were males, aged between 55-64, working as consultants, and of black ethnic origin.

43 of those 1359 cases were analysed in depth. This analysis highlighted that how the exclusion is managed can impact on the outcome of the exclusion and the likelihood of the practitioner returning safely to practice.  

New resources to help you with the exclusions process

The PPA have created a number of resources which make it easier to comply with the framework and use best practice during exclusion cases:

• an exclusions flowchart to ensure compliance with good practice
• a recording template for formal exclusion of a practitioner
• a template letter for exclusions, and
• an exclusions learning pack (with case studies).

What to take away

When considering exclusion under MHPS, you need to demonstrate a very clear, balanced and proportionate decision-making process which considers all the available alternatives and recognises the significant impact of exclusion on a practitioner.

If there is clear evidence that an individual’s ongoing presence in the workplace might involve risks to the interests of patients or other employees, or potentially impede an ongoing investigation, you can take the exceptional step of full exclusion. However, any decision to exclude must be fully documented and subject to regular review.

How Capsticks can help

We frequently advise NHS trusts on handling serious concerns involving doctors and the MHPS process. If you would like to find out more about how we can support your organisation, please get in touch with Andrew Rowland, Victoria Watson or John Hatton, to find out more about how Capsticks can help.