The following rules have been agreed as amendments to the guidance on prescribed connections to NHS England. They recognise recent and current arrival of doctors from Public Health England, Health Education England (HEE) and NHS Digital and will also provide improved future-proofing in the event of further inclusion of doctors.

• Doctors, directly employed by NHS England, working under a medical leadership contract or equivalent and directly accountable to the national medical director, will connect to the national medical director (Level 3 responsible officer).
• Doctors, directly employed by NHS England, under a medical leadership contract but who are not directly accountable to the national medical director, will connect to the regional medical director (Level 2 responsible officer) where they do most of their work, or, where this is unclear, where they have their GMC-registered address.
• Doctors, directly employed by NHS England, who are not connected to the national medical director (Level 3 responsible officer) and who report solely to a postgraduate dean, will connect to that postgraduate dean.
• Doctors, directly employed by NHS England, who are not connected to the national medical director (Level 3 responsible officer) or a postgraduate dean or a regional medical director (Level 2 responsible officer), will connect to the NHS England Level 1 responsible officer where they do most of their work, or, if this is unclear, where they have their GMC-registered address.
• General Practice specialty trainees (GPSTs) and other specialty doctors in training (DiTs) will connect to the relevant postgraduate dean (specifically within this rule, armed forces trainees will connect to the defence dean).
• Where a conflict of interest is identified between a doctor and their responsible officer as determined by these rules, the responsible officer at the next level will be the first port of call for identifying an alternative responsible officer.
• The national medical director (Level 3 responsible officer) may allocate a doctor to the NHS England responsible officer they deem most appropriate, including to themselves, depending on the individual circumstances.

The context and principles on which these rules are based are set out here, with Figure 2 now replacing the algorithm in the guidance paper Prescribed Connections to NHS England (Figure 1).

Context

NHS England has special status among designated bodies in that it may appoint more than one responsible officer. Arrangements for the NHS England responsible officer hierarchy were originally set out in the NHS England document Prescribed Connections to NHS England. This contains an algorithm to indicate which NHS England responsible officer a doctor will connect to. The recent and potential future arrival of doctors has triggered a review to ensure that doctors are connected to the most appropriate responsible officer. This document presents the rules resulting from this review and a revised algorithm to sit as an addendum to the guidance.

Principles

The following principles apply:

• NHS England should have the minimum number of responsible officers needed.
• Changes to the existing structure should be avoided, given logistical complexities such as creating supporting teams and amending IT infrastructure.
• Each NHS England responsible officer needs enough prescribed connections to ensure proficiency and efficiency (for the national responsible officer, this objective is currently assisted by delegating the operational activity to a regional responsible officer and their team).
• A doctor’s line manager does not need to be their responsible officer.
• The national professional lead for a group of doctors does not need to be their responsible officer. (They can, however, provide valuable assistance to the responsible officer, e.g., with appraisal and governance matters.)
• The national medical director’s (Level 3 responsible officer) prescribed connections should be limited to only those senior leaders who require their skills and expertise.
• The regional medical director’s (Level 2 responsible officer) connections to doctors who are not themselves responsible officers should be minimised.
• The rules for allocation to an NHS England responsible officer should be generically expressed, to future-proof against further organisational changes.
• There is secondary value in dispersing some types of doctors across different professional standards teams, especially if their work is in a cross-cutting area, whereby developing interactions and links with as many colleagues as possible is beneficial to their work.

Figure 1: Algorithm for allocating prescribed connections within NHS England

This algorithm is a visual representation of the rules for allocating prescribed connections within NHS England. It indicates the three levels of the professional standard function within NHS England and which level particular groups or types of doctors will connect to.

This information sheet is relevant to all designated bodies in England.

Released July 2023.