A suite of resources from NHS Resolution’s Practitioner Performance Advice service will help healthcare leaders make the right decisions on exclusions, to ensure patients and staff are protected from harm, and that doctors and dentists are treated fairly, in line with a just and learning culture.
Exclusion is designed as a short-term, temporary measure to remove a practitioner from their usual place of work until the nature and cause of a performance concern are understood and while an investigation is carried out.
The resources published today will support decision-makers across the healthcare system in managing the exclusion of practitioners. The materials include an exclusions flowchart to ensure compliance with good practice, a recording template for the formal exclusion of a practitioner to capture and record decision making, and an exclusion case studies learning pack containing a series of illustrative case studies based on cases which Practitioner Performance Advice have advised on. It also includes a template letter for exclusions to be used when communicating with a practitioner who has been excluded.
A short paper entitled Insights from 10 years of supporting the management of exclusions in England which is also published today draws on 10 years of experience and expertise in supporting the management of exclusions across England. It provides an informed analysis and shares learnings in order to promote best practice.
Almost all of the exclusions were doctors and on average there were 136 exclusions a year. The review of cases concluded that there has been a decrease in exclusions, especially over the last three years, and the proportion of exclusions ending in dismissal has also fallen.
The analysis found that male, middle-aged doctors are significantly more likely to be excluded, as were those from a black overseas or black British background.
Our learning from exclusions resources and information supports decision-makers in the health system to ensure that their decisions are fair, appropriate to individual circumstances, and are in the interests of patient safety, whilst continuing to support practitioners. We will be using our data to publish annual reports on the use of exclusion to share learning with the NHS and wider health system. We have also commissioned further research to better understand the lived experience of practitioners when their employers raise concerns about them.
Vicky Voller, NHS Resolution’s Director of Practitioner Performance Advice and Primary Care Appeals
We welcome the detailed guidance developed by the Practitioner Performance Advice service to help the system manage concerns that arise in relation to employed doctors and dentists. The flow charts and template letters are helpful resources for medical directors and if used would help medical directors follow due process when navigating these complex issues.
Professor Stephen Powis, NHS Medical Director
Exclusion is by its very nature an emotive and stressful event for a doctor or dentist. We recognise that the safety of patients is paramount but support Practitioner Performance Advice in its aim to ensure that exclusions should be managed fairly, efficiently and compassionately.
Dr John Holden, Chief Medical Officer at MDDUS
We welcome these supportive resources that will help upskill staff to make effective decisions around the exclusion process. These new tools will be exceptionally helpful for employers. It will help them to take appropriate decisions and make the best choices for patient and staff safety, ensuring that doctors and dentists are treated with dignity.
Paul Wallace, Director of Employment Relations and Reward at NHS Employers
Notes to Editors
- The legitimate reasons for exclusion are limited to those in the Maintaining High Professional Standards (MHPS) framework. It provides a framework for the handling of concerns about doctors and dentists and any pharmacists who fall under the MHPS. The MHPS framework is mandatory for non-foundation trusts and its use is encouraged in all organisations who deliver NHS care. In the independent sector, The Medical Practitioners Assurance Framework published by Independent Healthcare Providers Network, references MHPS and as far as possible mirrors the arrangements for handling concerns.
- The Insights from 10 years of supporting the management of exclusions in England paper is just one of a number of papers NHS Resolution has published to share learnings from the data we hold on the management of practitioner performance concerns in the healthcare system.
- The report analyses data from 1359 exclusion cases between 2009 and 2019 and undertakes a deep-dive into 43 randomly selected cases. 97% of the exclusions were doctors and only 3% dentists.
- The average of 136 exclusions a year means that there were 1.2 exclusions per 1,000 doctors.
- The report was supported by research commissioned from the University of Plymouth to understand if there are any patterns in exclusions and if anything can be done to improve how exclusions are managed. We are very thankful to Dr Marie Bryce, Dr Nicola Brennan and Josephine Cockerill of the Faculty of Health, University of Plymouth for conducting the research.
- The publication of the Insights from 10 years of supporting the management of exclusions in England paper follows publication of the Government’s response to the independent inquiry report into the issues raised by former surgeon Ian Paterson.
