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Unfair disciplinary procedures in NHS Trusts must be tackled to aid shift to open learning culture

Inconsistent and unfair disciplinary procedures in NHS Trusts across England must be addressed if we are to make a shift from a culture of fear in healthcare, to one of openness and learning, the Medical Protection Society (MPS) said today.

In its ‘Getting it Right’ paper, looking at disciplinary procedures involving hospital doctors, MPS said it had seen procedures ranging from the effective, to the frustrating, to the legally flawed.

It discusses procedures that are unnecessarily prolonged, cases where Trusts do not provide the doctor with sufficient information about the allegation in advance of the meeting, and cases where Trusts impose draconian measures preventing contact, meaning doctors are isolated from colleagues. MPS also raised concern about exclusion – rather than other less restrictive options – being the default when an investigation commences, regardless of the nature of the allegation.

The MPS paper said a debate was needed to ensure NHS employers, the National Clinical Assessment Service (NCAS), the GMC, the Government and medical defence organisations can all play their part in getting disciplinaries right. It warned that procedures lacking fairness not only affect the individual doctor but reinforce a culture of fear.

It set out four core principles that should underpin a good disciplinary process:

  1. Timeliness: proceedings should progress and conclude in a timely manner with delays kept to a minimum, to avoid doctors becoming demotivated, deskilled and resigning regardless of the investigation outcome
  2. Proportionality: a move to exclude or restrict a doctor from their duties immediately must be proportionate to the nature of the allegation
  3. Fairness: to have credibility proceedings should be conducted in a way that is fair and transparent to all parties
  4. Accountability: where a Trust is found to have behaved in a seriously wrong way during proceedings, a clear method needs to be established to hold them to account.

Dr Pallavi Bradshaw, Senior Medicolegal Adviser at MPS, said: “The Maintaining High Professional Standards policy sets out the steps Trusts should take when concerns are raised about the clinical practice of a doctor. How this policy is incorporated into individual Trust frameworks, and then implemented, has led to some misinterpretation and inconsistencies.

“Disciplinary proceedings have career-changing consequences for a doctor. A study of almost 8000 doctors by Imperial College London showed that 16% of doctors going through a local formal investigation experience moderate to severe depression and 13.5% experience anxiety. If disciplinaries do not follow due process they will also affect the culture of the organisation, and reinforce mistrust and fear across the wider healthcare profession.

“Disciplinary action should only be pursued in the most serious cases when other approaches have been exhausted. Decisions to exclude or restrict a doctor’s practice should be made after careful consideration, an open and full discussion with NCAS, and the rationale for the decision must be shared with the doctor and their representatives. It is not acceptable to keep mandating an extension of the exclusion and not consider alternatives.

“Those returning to work after restrictions of practice or exclusion should also have their return properly facilitated by the Trust.

“It is time for a debate on how best practice can be achieved, with consistency. Crucially, where a Trust is found to be lacking in the way they handle these cases, a clear and efficient method needs to be established to hold them to account.”

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