Practitioner Performance Advice has published a revised Fairness and Proportionality Framework as well as new case studies and an Insight publication, to support the local management of performance concerns.
On this page you can find details about the following resources which we encourage healthcare organisations to use and share with colleagues:
The Fairness and Proportionality Framework which we originally published in 2025 has been updated to reflect what organisations told us would be useful.
The revised resources have the same five Principles to guide case management but the format of the Framework has been amended based on feedback from stakeholders who took part in the evaluation. Detailed findings from the evaluation are detailed in our Insight publication.
The Framework and accompanying resources were developed to support organisations to identify the key considerations to promote fairness, proportionality and consistency in decision making when managing and resolving performance concerns. The resources are intended to sit alongside local and national performance management policies for all staff groups to help inform the fair and proportionate management of concerns.
Our evaluation has demonstrated that the Framework is valued as a resource that supports good case management. The evaluation reflects our commitment to ensuring that the Framework evolves with practice and remains trusted and meaningful.
We adopted a collaborative approach to reviewing its effectiveness, involving healthcare organisations, national bodies, practitioner representative organisations, and colleagues across Advice, and we are grateful for the contributions.
A number of questions arose during the course of our evaluation which we thought helpful to include within the Insight and the refreshed resources. These relate to aspects of performance management processes and to the use of the Principles and Framework.
The Principles and Framework
Download the Principles and Framework
The Framework addresses five key areas (“the Principles”) in case management which are equally applicable to cases managed in all care settings, irrespective of the role, grade, specialty or protected characteristics of the individual.
It is intended to be an integral part of documented local case management. The overall goal is to improve the handling of performance concerns locally by promoting fairness and proportionality in decision making, helping to ensure concerns are resolved consistently, efficiently at the earliest possible stage.
It may be adapted for use by individual organisations and consideration should be given to how and when it is implemented, as well as how it works together with other local processes. However, we advise that the overall five Principles are not changed.
The framework provides a useful checklist to ensure important steps are not missed.
Responsible Officer
Medical managers dealing with concerns are signposted to the framework when they request support with a case.
Head of Professional Standards
The 2025 version is still accessible and can be used alongside or instead of the refreshed resource. We heard in the evaluation that an audit tool to use for case reviews or look back exercises may be helpful and the level of detail that is included in the original Framework may be helpful to organisations for that purpose.
There is no mandatory requirement to use the resources but we hope that using it will promote fairness and proportionality when gathering information and will enable fully informed decision making.
Case studies
We have provided case studies to demonstrate how using the resources could positively influence case management. You may wish to discuss these in small groups within your organisation.
Download our new Fairness and Proportionality case studies pack
This pack includes an example provided to us by an organisation and demonstrates how resources informed their management of a performance concern. We are grateful for their contribution.
Download our original Fairness and Proportionality case studies pack.
This pack includes four fictional case studies to demonstrate how using the checklist could positively influence case management. Please read each case study carefully and consider the different outcomes with and without the use of the Framework, including the impacts on the individual, their team and patient care.
Insight publication
Our latest Insight publication presents the findings from an evaluation of the Principles and Framework for Fairness and Proportionality, highlighting how it has been used in practice, what difference it is making, and how the revised resources respond to what organisations told us they need.
Our previous Insight publication provides more information on why and how the Framework was developed, the anticipated benefits and future evaluation.
Please see our Insight in Practice webpage.
Using the resources
Organisations are encouraged to:
- Use the revised resources and share them with colleagues.
- Look at the Insight to see examples of how others have used the resources e.g. reflecting principles in local policies and using the tool to audit cases.
- Review the case studies to see how the resources and principles can be applied in practice.
Acknowledgements
Significant contributions were made to the original development of the resources, and the evaluation which has informed the refreshed resources. We are extremely grateful to everyone who added their input to this work.
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