Responding to concerns

In a minority of cases, responsible officers may become aware of concerns or difficulties in relation to a doctor’s practice. These concerns may come to light through appraisal or clinical governance processes and may relate to one or more issues around conduct, performance or health. For a small number of individuals who may struggle to meet the professional standards described in Good Medical Practice (GMC, 2013), it will be important for responsible officers to have appropriate and effective routes for support in place.

The approach to responding to concerns and supporting doctors who find themselves in difficulty through the revalidation process is important, so that doctors throughout England can expect consistent standards of support, retraining and supervision.

NHS England aims to promote consistency and effectiveness in responding to concerns and ensure all designated bodies can deliver on their responsibilities in this area. In order to do this we have published a practical guide for responsible officers on responding to concerns (2019). This is the output of a year-long process of gathering views and inputs from a wide range of people, not least the responsible officer community itself. The aim is to help all responsible officers to follow a methodical process when addressing concerns, to engage doctors in addressing concerns professionally and to deliver constructive and timely outcomes within local processes, avoiding unnecessary recourse to regulatory and legal actions.

The practical guide builds on the previous guidance document Supporting Doctors to Provide Safer Healthcare (RST, 2013), and the concerns categorisation framework, it describes.

Doctors on the performer list

The scope of the framework for managing performer concerns framework reflects NHS England’s powers as set out in the National Health Service (Performers Lists) (England) Regulations 2013 for all performers; medical, dental and ophthalmic. The powers enable NHS England to ensure that performers are fit for purpose. This means they are suitable to undertake NHS primary care services and to protect patients from any performers who are not suitable, or whose ability to perform those services may be impaired.

This framework encompasses:

  1. the process for considering applications and decision making for inclusion, inclusion with conditions and refusals to be made by the area team;
  2. the process by which area teams identify, manage and support primary care performers where concerns arise; and
  3. the application of NHS England’s powers to manage suspension, imposition of conditions and removal from the performers lists.

Supportive documents such as the standard operating procedures and national performers lists applications forms, are available to view and download.

Employed doctors: NHS England’s policy for the identification, management and support of employed medical practitioners whose performance gives cause for concern. This policy is only available through NHS England’s Intranet pages.

Framework for managing concerns about Responsible Officers who have a prescribed connection to a higher level Responsible Officer of NHS England: This guidance document is for use by higher level Responsible Officers (HLRO) of NHS England, providing a framework for the management of concerns about responsible officers (ROs) who have a prescribed connection to the HLRO in the four regions of NHS England (North, South, Midlands & East, and London). This framework guides the processes in relation to identifying concerns, storage of records and managing concerns brought to the attention of the HLRO and the oversight of investigation into ROs for relevant concerns. This framework does not cover the processes for pre-employment checks and routine management of appraisal and revalidation recommendations for ROs by the HLRO.