Suppose you are a doctor or dentist employed by an NHS body in England. If your employer raises a concern about your conduct, capability or health, the rules come from a national framework. That framework is Maintaining High Professional Standards in the Modern NHS, known as MHPS, and this guide explains how an MHPS investigation works. Your trust will have its own policy, but that policy must reflect the framework. When the local document is unclear, the national text is the place to look.
Where the framework comes from
The Department of Health issued the first two parts in December 2003 under cover of circular HSC 2003/012. Part I deals with action when a concern arises and Part II with restriction of practice and exclusion from work. The Department then agreed three further parts with the British Medical Association and the British Dental Association. Part III covers conduct hearings and disciplinary matters, Part IV capability and Part V concerns about a practitioner's health. The Directions on Disciplinary Procedures 2005 required every NHS body in England to build the framework into its local procedures by 1 June 2005, and foundation trusts received it as advice.
Two decades on, the framework is still in use. In May 2024, NHS Employers published a page on MHPS. It describes MHPS as the framework that addresses concerns about doctors and dentists in the NHS, and it traces MHPS to the 2003 document. NHS England's 2019 guide for responsible officers says that NHS Resolution must be engaged where a case is progressing through MHPS. GPs on the performers list fall under separate regulations.
The people in your case
The framework assigns roles, and knowing who holds each one tells you whom to write to. Every serious concern must go to the chief executive for registration, and the chief executive must then ensure the appointment of a case manager. The chair of the board designates a non-executive director to oversee the case and keep it moving. That person is the designated board member. The medical director acts as case manager for clinical directors and consultants and can delegate the role in other cases. In addition, the medical director appoints a case investigator.
The case investigator gathers the facts and reports on them. Part I is explicit that the investigator does not decide what action to take or whether you should be excluded. Nor may the investigator sit on any later disciplinary or appeal panel. Where a question of clinical judgement arises, the investigator must formally involve a senior member of the medical or dental staff. If no suitable colleague is employed locally, that person comes from another NHS body.
What you are entitled to at the start
Paragraph 13 of Part I sets out your entitlements. The case manager must tell you in writing that an investigation is to take place, and must do so as soon as the decision is made. The case manager must also give you the name of the case investigator and make you aware of the specific allegations or concerns. You must have the opportunity to see correspondence relating to the case. The same applies to a list of the people the investigator will interview. The framework also gives you the opportunity to put your view of events to the investigator.
You may bring a companion to any interview or hearing. The framework names another employee, an official or lay representative of the BMA, the BDA or a defence organisation, or a friend, partner or spouse. It adds that a companion may hold legal qualifications but will not act in a legal capacity. That point matters if you plan to bring a lawyer into the room, because the role there is support rather than advocacy.
The investigation also has a timetable. Paragraph 17 says the case investigator should complete the work within four weeks of appointment. The investigator should then submit the report within a further five days. NHS England's 2019 guide gives an estimated timescale of one to three months for a full investigation. So expect the four week target to slip. Each time it does, ask in writing for reasons and a revised date.
What the report can lead to
The report must give the case manager enough to choose among the outcomes that paragraph 17 lists:
- misconduct, for a conduct panel
- a health concern for occupational health
- further specialist assessment of a performance concern
- restrictions or exclusion from work
- a referral to the GMC or GDC
- a capability panel
- no further action.
Misconduct runs under the trust's ordinary disciplinary procedure, because the framework abolished the old distinction between personal and professional misconduct. Capability runs under Part IV, and Part V routes health issues through the occupational health service. If the outcome is a referral, our guide to what happens when the GMC receives a concern explains the next stage.
The 2005 text names the National Clinical Assessment Authority as the adviser. Today that advice comes from Practitioner Performance Advice at NHS Resolution. That service describes itself as an advisory body and says the employer keeps responsibility for every decision.
Why the detail matters
You can challenge a departure from the procedure in court. On 18 December 2013, the Supreme Court gave judgment in West London Mental Health NHS Trust v Chhabra [2013] UKSC 80, a case about a consultant psychiatrist. The court restrained the trust from treating confidentiality concerns about the psychiatrist as gross misconduct. An associate director of HR had undertaken not to take part in the investigation. Despite that undertaking, the director proposed extensive amendments to the case investigator's draft report, and those amendments sharpened its criticism. Lord Hodge held that the report had to be the product of the case investigator, and that it was not. The facts found did not, even at their highest, amount to gross misconduct.
The same judgment warns that the courts will not micro-manage minor irregularities. Your protection lies in a clear written record of each step. When a step goes wrong, it also lies in a prompt written objection to the case manager, copied to the designated board member.
Other healthcare professionals
MHPS applies to doctors and dentists employed by NHS bodies in England. Other professionals are investigated at work under the employer's own procedures, and the regulator that may follow is the NMC, the GPhC or the HCPC. See our pages for each profession.
Eloquia acts for doctors in MHPS investigations on our inquests and NHS disciplinary track, on a fixed fee for each stage, stated plus VAT and including a specialist barrister from the outset.
If you have received a letter telling you that your employer has appointed a case manager, read your trust's policy alongside the national framework. Check each entitlement above against what you have received. Then write to the case manager about anything missing before your first interview.
Sources
- Maintaining High Professional Standards in the Modern NHS, Department of Health framework, Parts I to V (copy hosted by East London NHS Foundation Trust)
- Department of Health, Maintaining High Professional Standards in the Modern NHS (UK Government Web Archive)
- NHS Employers, Maintaining high professional standards and appeal panels (1 May 2024)
- NHS England, A practical guide for responding to concerns about medical practice, v1.0 (March 2019)
- NHS Resolution, Practitioner Performance Advice: what we can do
- West London Mental Health NHS Trust v Chhabra [2013] UKSC 80 (The National Archives, Find Case Law)
