New framework for discipline and suspension - Joint statement of agreed principles
September 2003
1. The BMA’s Central Consultants and Specialists Committee and Department of Health are developing a framework for trusts in England to use in drawing up their own detailed procedures for responding to concerns about the practice of doctors and dentists. The framework is intended to address the ‘suspension culture’ in the NHS by introducing new arrangements for restrictions on practice and exclusions from work. The focus of the framework is to help doctors and dentists. Exclusion will be regarded as a last resort and no practitioner should be excluded from work other than through these new arrangements.
2. The framework will replace existing guidance on discipline, suspensions and the ‘3 wise men’ procedures (HC(90)9, HC(82)13, HM(61)112 and HSG(94)49). It will also replace the ‘paragraph 190’ appeal. Trusts will be required to ensure that their procedures accord with the framework. Many trusts’ existing procedures will already accord with much of the framework.
3. The new framework recognises the continuing development of the National Clinical Assessment Authority and emphasises the central role of the NCAA in helping trusts to deal with issues of conduct and capability.
4. The emphasis will be on regarding exclusion very much as a last resort. There will be short time limits on exclusions. Any exclusion will be for four weeks and will have to be actively and formally reviewed and renewed (otherwise it will lapse). There will also be a requirement to notify and seek advice from the NCAA throughout the process and before repeated renewal of exclusion. We would only expect exclusion to be prolonged for over six months in cases involving criminal investigations.
5. The focus is on helping doctors and dentists to keep up to date and to practice safely, not to punish them for any problems with clinical performance.
6. The framework will focus on matters of clinical performance and capability. All issues of conduct will be dealt with under local trust procedures.
7. The trust is required to develop a co-ordinated approach to handling concerns. Whatever the source, of information, the response must be the same – to quickly establish the facts, ascertain the extent of any risk or validity of any concern and take immediate appropriate action.
8. Investigation into concerns about a doctor’s or dentist’s practice will be handled by appropriately trained individuals locally. The advice of the NCAA will always be sought on options to resolve the matter. The outcome of any investigation will be discussed with the doctor concerned. A range of options such as no case to answer, re-education, supervision, mentoring, a change in the employer’s working systems or referral to occupational health should be explored. If a workable solution cannot be found, agreement should be sought with the doctor for a referral to the NCAA. The practitioner him or herself can also refer to the NCAA.
9. If there is no agreement on a plan to resolve any identified problems or on referral to the NCAA, then the trust may have to consider disciplinary action. Disciplinary procedures should be regarded as a last resort. The majority of problems will be addressed as they arise.
10. If there is a capability hearing, the trust will convene a panel involving its executive and non-executive directors. The panel will be required to have clinical and human resources input. The practitioner will be able to respond to any investigation report, appear before the panel, question any witnesses and be accompanied by a companion. The companion can be legally qualified but will not be acting in a legal capacity.
11. There will be a right to a local appeal panel chaired by an independent individual from an approved pool trained in legal aspects of appeals.