Patient safety and public protection remain our paramount concerns. But we understand that healthcare practitioners can face significant challenges in their work and may, at times, experience uncertainty, anxiety and pressure.
Where any performance concerns arise they must be managed and appropriate action taken to protect patient safety. Concerns must be considered on the individual circumstances of the case
Our aim is to help ensure that concerns raised about an individual doctor, dentist or pharmacist are managed and resolved in a fair, proportionate and timely way. Where procedures relating to the management of concerns cannot be taken forward or are delayed, the practitioner must be kept informed and the decisions taken must take into account the welfare of the practitioner.
We believe that organisations should foster a just and learning culture which balances fairness, justice and learning when things have not gone as planned. For more information on this please see NHS Resolution’s ‘Being fair’ publication.
A new or returning practitioner or one operating outside of their normal scope of practice has a responsibility to confirm they are competent to perform the tasks they are being asked to perform. It may sometimes be appropriate for there to be a degree of reskilling, supervision and assessment to provide assurance that a practitioner is performing at the expected level.
We’ve put together some frequently asked questions in order to help healthcare practitioner’s understand what our service does and does not do.
What help can Practitioner Performance Advice offer me directly?
Whilst our services are aimed primarily at healthcare organisations, we also welcome contact from individual practitioners who may be seeking advice about performance concerns or might wish to know more about the services we provide.
We can assist practitioners contacting us in a number of ways, for example, by:
- Providing general advice where a practitioner may be concerned about some aspect of their own health or clinical practice, or wishes to access advice about rebuilding their skills after a career break.
- Providing general information to help a practitioner better understand some of the procedural requirements that may inform a healthcare organisation’s management decisions about an individual practice.
- Responding to a request for information, for example, if a practitioner wishes to check whether they are, or have been, the subject of a case at Practitioner Performance Advice.
- Providing information about Practitioner Performance Advice’s range of services.
Concerns have been raised about me – what avenues of support are available to me?
We recognise that where concerns have been raised about a practitioner’s work, this can be a very stressful experience for the individual concerned. We are committed to ensuring the services we offer and the way we deliver our services are sensitive to the impact on the individual about whom concerns have been raised.
Whilst Practitioner Performance Advice cannot act as a practitioner’s advocate (nor do we act as the healthcare organisation’s advocate), we always recommend that practitioners access appropriate and timely professional support through their defence organisation or other representative body. We would also encourage practitioners to draw on personal support that is available to them, for example, through friends or family.
The practitioner’s General Practitioner can also be an important source of support.
It also worth remembering that support is available through the healthcare organisation, for example through its local occupational health and counselling services. More avenues of support may be available locally or accessed through the relevant Royal College.
We can also signpost practitioners to other possible avenues of advice and support –please get in touch with our Adviser team if you would like to explore options.
What is the service’s approach to giving advice?
The following principles guide our approach to giving advice to healthcare organisations:
- We are an advisory body and do not act for the healthcare organisation or the practitioner. In all cases, our role is to provide impartial and expert advice which is aimed towards supporting the local management and resolution of performance concerns.
- In all cases, patient safety and public protection are our paramount concerns.
- Whilst the advice we offer is based on the description of concerns and other information presented to us by the healthcare organisation, we will seek to clarify, understand and, where necessary, challenge the course of action or options being contemplated by the healthcare organisation and how the information available to them may be appropriately
used to inform their decision making.
- The advice we provide and options we suggest are underpinned by a clearly explained rationale, with reference to relevant local procedures, national frameworks, policy and guidance as appropriate. We draw on our experience of what is realistically likely to work in the often complex context in which the practitioner and healthcare organisation operate.
- Our advice, and the accompanying rationale for that advice, is always confirmed in writing.
- We support open and constructive dialogue between individual healthcare organisations and practitioners where concerns have been raised about an individual’s practice.
We are not a decision making body. In all cases, any decisions about the ongoing management, employment or contractual status of the practitioner rests solely with the healthcare organisation.
What is professional support and remediation?
Through our professional support and remediation, Practitioner Performance Advice offers a wide range of bespoke action plans aimed at supporting healthcare organisations and practitioners to help individual practitioners return to safe and effective practice.
Structured action plans are developed following a review of the particular circumstances of each case, taking into account any development needs in areas such as leadership, patient or colleague interaction or other behavioural issues, in addition to supporting the development of clinical knowledge and skills.
Does Practitioner Performance Advice conduct investigations into specific incidents or events?
Whilst we do not offer an investigation service ourselves, we regularly advise healthcare organisations on good practice when carrying out investigations.
We also deliver skills-based workshops on conducting and managing investigations to a range of clinical and managerial audiences.
What is the difference between Practitioner Performance Advice and my professional regulator (i.e. General Medical Council, General Dental Council and General Pharmaceutical Council)?
The focus of our input is to support the local management and resolution of performance concerns raised about a practitioner in the context of their employment. We provide advice to the healthcare organisation to inform their decision making, and do not have any regulatory function. By contrast, healthcare regulators and their relevant committees have statutory powers
to investigate and take action where there are concerns about the fitness to practise of a registered practitioner.
Practitioner Performance Advice work in partnership with healthcare regulators to ensure that our respective roles and activities are clear and to help ensure effective channels of communication exist at both national and local levels. It should be noted that Practitioner Performance Advice currently provides a specialist service to the General Dental Council (GDC) under contract – however, this is a discrete service to inform the GDC’s decision making processes and is distinct from the core services we provide to healthcare organisation as described earlier in this document.
How does Practitioner Performance Advice use the information it holds about me?
We will not normally share details of a case (or even confirm that Practitioner Performance Advice has a case in relation to a practitioner) other than with the healthcare organisation or the practitioner themselves. There are, however, some limited circumstances where it may be necessary to disclose information to another party such as where there is an overriding public interest or where we are otherwise legally obliged to do so.
How does Practitioner Performance Advice deal with concerns raised by a whistleblower?
Practitioner Performance Advice can sometimes receive unsolicited expressions of concern about a practitioner, who may or may not be the subject of an Practitioner Performance Advice case.
These concerns might be raised by colleagues, patients or members of the public. In addition, we may receive information from a practitioner who has concerns about their healthcare organisation.
Where the individual raising the concerns is regarded as a ‘whistleblower’, we will advise them on directing their concerns to the relevant prescribed person or body and in a manner that is consistent with our overriding duty towards patient safety and public protection.
Your case and how we handle cases
Why has my employer/contracting organisation contacted Practitioner Performance Advice about me?
We are usually contacted by a healthcare organisation where they have concerns about an individual’s practice and are seeking expert advice to help them determine the way forward.
Healthcare organisations seek our advice on a wide range of matters, including concerns about individual practitioner behaviour, clinical practice, conduct, health working in teams and/or working environment, and its relationship with the individual practitioner’s performance. We are usually contacted by a senior member of staff, such as the Medical Director, Director of Human Resources or relevant Clinical Director – someone who understands the complexity and nature of any reported concerns and can commit to organisational action. If you have any queries about why your healthcare organisation has made contact with us, it is always advisable to speak to them directly in the first instance, and to familiarise yourself with your organisation’s local procedures on managing performance.
Exclusions, suspensions and restrictions
We will also usually be contacted for advice where a healthcare organisation is considering excluding, suspending or restricting a practitioner’s practice. Where patient safety is considered to be at risk or where there are allegations of serious misconduct, it is important for healthcare organisations to be able to take appropriate steps so that the situation can be thoroughly and promptly investigated.
However, we also recognise that such mechanisms should not be used without sufficient justification, as to do so can have an adverse impact on the practitioner, the wider team and the provision of clinical services.
For these reasons, we work with healthcare organisations to help them consider the options available to them to understand and address the concerns, and to help ensure that their decisions are reasonable and proportionate to the circumstances. Where exclusion, suspension or restriction is thought to be appropriate, we will continue to work with the healthcare organisation to routinely monitor the position and advise on good practice, taking account of local and national policy requirements.
Further information and resources about exclusion, including our paper Insights from 10 years of supporting the management of exclusions in England, are available from our Exclusions webpage.
Circumstances where healthcare organisations are required to contact Practitioner Performance Advice for advice
There are some limited circumstances where an NHS organisation is required to contact Practitioner Performance Advice for input. These include circumstances where:
- The concerns relate to an employed doctor or salaried dentist and formal exclusion is being considered; or
- A healthcare organisation is considering taking action in relation to a employed practitioner under the capability procedures set out in Part IV of Maintaining High Professional Standards in the Modern NHS (applicable in England), or Part IV of Maintaining High Professional Standards in the Modern HPSS (applicable in Northern Ireland) and is asked to consider whether an assessment should be undertaken; or
- An NHS body based in England is seeking the issuing of a Healthcare Professionals Alert Notice.
We strongly encourage healthcare organisations to inform the individual practitioner about whom advice is being sought that Practitioner Performance Advice has been approached, except for very limited circumstances (for example where this would compromise the local investigation process of the healthcare organisation).
Who in the service will be dealing with my case?
Practitioner Performance Advice has an established team of Advisers, comprising senior staff from a variety of clinical, legal and managerial backgrounds with considerable experience of handling concerns raised in relation to professional practice. In each case, Practitioner Performance Advice’s input is overseen by a designated Adviser, who oversees the provision of our services throughout the life of the case.
The Adviser will provide telephone or face-to-face advice and will always confirm their advice in writing to the healthcare organisation.
Our Adviser team members are aligned regionally to specific trusts and NHS regions across England, Wales and Northern Ireland.
We also have a dedicated team of Assessment & Remediation staff with expertise in the methods and processes which underpin the delivery of our assessments and other specialist interventions. In each case where we are carrying out a specialist intervention, the Assessment & Intervention team will act as the key point of contact to share information and guide the practitioner and healthcare organisation through our processes.
I would like to speak to someone about my case. Who can I contact?
If you need to speak to someone at Practitioner Performance Advice about your case, the best person to get in touch with is usually the Adviser allocated to your case. Each case has an allocated case number and it is helpful if you have your case number to hand if you know it. You can arrange a time to speak with them by contacting Practitioner Performance Advice on 020 7811 2600 or via nhsr.Advice@nhs.net.
If your query relates specifically to the management of your assessment or other intervention, please contact the named member of our Assessment & Remediation team handling the matter either through the contact details provided to you, or by calling us on 020 7811 2600 or emailing us on nhsr.Advice@nhs.net.
Can you make decisions about my employment or practice status?
No. As mentioned earlier, we are an advisory and not a determining or regulatory body. Any management decisions, including in relation to your employment or practice status, rest solely with your healthcare organisation. Practitioner Performance Advice’s advisory role applies to all of our casework functions, including our Assessment & Remediation services. Where we have undertaken an assessment of a practitioner, the assessment report which follows is advisory and the opinions expressed are aimed at providing an independent view on a practitioner’s performance in order that a clear and informed way forward can be identified to support the resolution of the case.
In making any decision about an individual’s employment or practice status, the healthcare organisation may have regard to our advice alongside any other information which it considers to be relevant, including submissions from the practitioner and/or their professional representatives. The healthcare organisation is not bound by our advice. It therefore follows that, having considered and weighed up all the relevant information available, the healthcare organisation may decide to take a differing view to that expressed by us.
Do I have a right of reply in relation to the concerns that a healthcare organisation has about me?
We always encourage open and constructive dialogue between a practitioner and their healthcare organisation about any concerns raised. As such, it is always advisable for a practitioner to share their comments directly with their healthcare organisation to help inform the local management of the case. We do not test the veracity of the information provided to us by either the healthcare organisation or the practitioner, nor can we be the judge or arbiter where there are conflicting views.
We can however advise on options available to clarify the concerns as well as to facilitate discussions between the parties involved to help towards a resolution. It is important to remember that any decision affecting an individual’s practice or employment status rests with the healthcare organisation based on the information available to it, including information provided by the practitioner themselves.
I have a concern about my employers handling of my case. Can Practitioner Performance Advice help?
If you have concerns about your healthcare organisation’s handling of your case, it is important that your healthcare organisation is made aware of your concerns. Whilst Practitioner Performance Advice is unable to arbitrate on such matters, we can, where appropriate, facilitate discussion between you and your healthcare organisation in an effort to support a constructive dialogue about the issues of concern.
You should also discuss your position with your representative of your trade union or defence organisation if you are a member.
My employer has referred me for an assessment or other intervention. What does this mean?
In some cases, a healthcare organisation may seek our view on whether an assessment of a practitioner’s practice would be helpful in clarifying and managing performance concerns in order to move the case to a resolution.
Our assessments are aimed at:
- Supporting the implementation of evidence-based, timely and fair management solutions to resolve concerns about performance.
- Enabling practitioners to return to safe and effective practice, where appropriate.
- Helping to ensure public protection and patient safety.
Healthcare Professionals Alert Notice service (HPANs)
A Healthcare Professionals Alert Notice (HPAN) has been issued in relation to me. What does this mean?
Since April 2013, we have been responsible for issuing HPANs. The HPAN system is used to inform NHS bodies and others of healthcare professionals whose performance or conduct gives rise to concern. HPANs are usually used whilst the relevant regulator is considering the concerns, and are aimed at providing an additional safeguard during the pre-employment checking process.
HPANs are issued where the information provided toP ractitioner Performance Advice indicates that patients or staff may be at significant risk of harm from inadequate or unsafe clinical practice or from inappropriate behaviour and/or there is a risk that an individual may pose a threat to patients or staff because their conduct compromises
the effective functions of a team or local primary care service.
The HPAN system may also be used to notify NHS bodies and others of a bogus healthcare practitioner.
I would like to provide feedback on my experience of Practitioner Performance Advice. How can I do that?
We are committed to the continuous improvement and development of our services and we always welcome feedback – whether it relates to what we do well or where we can improve. You can provide feedback at any time to the person dealing with your case. We may also contact you to request feedback as part of the routine evaluation of our services.
If you are still not satisfied with the response you have received, you can raise your concerns through our formal complaints process or provide general feedback or suggestions about our services by contacting us at nhsr.Advice@nhs.net.
If you have a question which is not answered here or would like some more information about our work, please contact us by emailing us at nhsr.Advice@nhs.net or calling us on 020 7811 2600.
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