Contract Wales

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Upholding professional standards in Wales

This procedure sets out the approach for addressing concerns about capability, performance and conduct for all doctors and dentists (referred to below as “practitioners” in the rest of the document) employed by Local Health Boards or other NHS organisations in Wales.

It replaces all existing procedures in operation within the Local Health Boards and NHS Trusts in NHS Wales or successor bodies with effect from 1 September 2015, “the effective date”.

The new procedure replaces all previous disciplinary procedures enshrined in WHC(90)22 and DGM(95)44, as implemented by any NHS organisation or LHB policy document. The procedure also replaces the provisions in WHC (82)17 for Special Professional Panels (the “Three Wise Men”) as implemented by NHS Wales organisations. The right of appeal to the Secretary of State, held by certain practitioners under paragraph 190 of their terms and conditions of service, is also abolished from the effective date of this procedure.

The procedure applies to all practitioners, which covers all practitioners employed in LHB’s or NHS organisations in Wales including those in training and on temporary, locum or honorary contracts and comprises of five parts:

(I) Action when a concern arises;
(II) Restriction of practice and exclusion from work;
(III) Handling concerns about a practitioner’s health;
(IV) The Standard Procedure;
(V) Extended Procedure.

All NHS organisations, in their response to performance concerns, will ensure that due account is taken of the potential relevance of the practitioner’s health, system failure and the working environment. The application of this procedure will be considered in conjunction with the relevant organisation’s incident reporting or investigation systems.

Where possible, NHS organisations will seek to address capability and/or performance concerns through training or other local remedial action. It will continue to support practitioners in their professional development in particular, through appraisal, GMC/GDC guidance and other relevant local or Welsh Government processes.

The role of the Welsh Government (WG) in monitoring the effective implementation of this procedure will be coordinated through the Workforce and OD Division and any others as appropriate. Detailed arrangements for practical operation of this procedure will be notified to employers in NHS Wales directly by the Workforce and OD Division.

The NHS organisation will ensure that this procedure is operated in a way that does not discriminate on the grounds of any protected characteristic as defined in the Equality Act 2010.

 

Action where a concern arises

Initially, concerns regarding the capability or conduct or performance of a practitioner should be addressed through local mechanisms e.g. appraisal and one to one meetings with the practitioner’s consultant/lead clinician. In the majority of cases matters can be dealt with locally and without the recourse to formal procedures.

Where concerns are such that they suggest that an individual may not be complying with the GMC “Good Medical Practice” or the GDC “Standards for the Dental Team” these should be registered with the Medical Director to consider whether a GMC / GDC referral is appropriate.

 

Restriction of practice and exclusion from work

Principles

This part of the procedure replaces any previous local policy dealing with exclusion of medical or dental practitioners.

Throughout the procedure, the phrase "exclusion" has been used which should not be confused with action taken by the GMC or GDC to exclude the practitioner from the register pending a hearing of their case or as an outcome of a fitness to practice hearing.

No practitioner will be excluded from work other than through this procedure. The organisation will not use "gardening leave" or other informal arrangements as a means of resolving a problem covered by this procedure.

The organisation’s Medical Director has overall responsibility for managing exclusion procedures. The decision to exclude a practitioner must be taken only by persons nominated under paragraph 2.11.

The case will be discussed fully with the Medical Director, the Workforce & OD Director or nominated deputy, NCAS (where appropriate) and other relevant interested parties prior to any decision to exclude a practitioner.

Where there are serious allegations which are of a potentially criminal nature, the Director of Workforce & OD must provide advice in respect of the parallel management of the matter with any criminal proceedings.

The authority to exclude a practitioner is set out in LHB/NHS Trust Schemes of Delegation.

The Case Manager will provide factual information to assist the Medical Director in reviewing the need for exclusion and making progress reports to a Designated Board Member.

The organisation will ensure that:

  • Ordinarily exclusions will be confirmed in writing by the Medical Director or nominated deputy within 24 hours of the exclusion being actioned and in any event at the end of the next working weekday;
  • Exclusion from work is used only as an interim measure whilst action to resolve a problem is being considered;
  • Where a practitioner is excluded, it is for the minimum necessary period of time: this must be reviewed at four week intervals and the outcome of such reviews, including the justification for any extension, communicated to the practitioner;
  • A progress report should be provided by the Case Manager to the Designated Board Member (see Designated Board Member responsibilities under “Roles within the Procedure”), on a 4 weekly basis. The Designated Board Member will be responsible for monitoring the situation, advised by the Medical Director, until the exclusion has been lifted.
  • The Board is kept informed at three month intervals of any ongoing exclusion, and the status of the case. Information given to the Board will be sufficient to enable the Board to satisfy itself that the procedures are being followed and that regular reviews are taking place as appropriate;
  • The Designated Board Member will monitor whether the investigation and any subsequent action is proceeding in conformity with this procedure and report to the Board accordingly.
  • A progress report should be provided by the Case Manager to the Designated Board Member (see Designated Board Member responsibilities under “Roles within the Procedure”), on a 4 weekly basis. The Designated Board Member will be responsible for monitoring the situation, advised by the Medical Director, until the exclusion has been lifted.
  • The Board is kept informed at three month intervals of any ongoing exclusion, and the status of the case. Information given to the Board will be sufficient to enable the Board to satisfy itself that the procedures are being followed and that regular reviews are taking place as appropriate;
  • The Designated Board Member will monitor whether the investigation and any subsequent action is proceeding in conformity with this procedure and report to the Board accordingly.

 

Handling concerns about a practitioner’s health

The key principle for addressing practitioners with health problems is that, wherever possible and consistent with the need for reasonable public protection, such individuals should be allowed time for treatment, rehabilitation or re-training as appropriate (for example if they cannot undertake exposure prone procedures) and kept in employment, rather than be lost from the NHS.

 

The standard procedure

The UPSW Standard Procedure deals with the vast majority of alleged disciplinary issues where medical and dental staff are concerned ie those allegations which (even if proved) would not amount to a finding of gross misconduct and potential dismissal.

Accordingly, the maximum possible penalty under the UPSW Standard Procedure is a final written warning on the practitioner’s employment record.

 

Extended Procedure

The extended procedure will be used when handling more serious issues, where the outcome of disciplinary action could potentially lead to the dismissal of the medical or dental practitioner (‘the practitioner’) concerned or the issuing of a final written warning.

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