Informal First – the value of informal resolution and how Advice can support you

I have had the privilege to work alongside the Practitioner Performance Advice Service (and its predecessor organisations) for over 20 years. When I first started as an adviser, most of my conversations with medical managers drew heavily on the formal processes set out in national guidance such as Maintaining High Professional Standards in the Modern NHS.

Today the emphasis is different. The recognition of the disproportionate use of formal procedures in certain cohorts of practitioners and the profound impact on practitioners that are subject to these procedures means that all national bodies with a leadership role in resolving performance concerns are advocating local informal resolution first.

But what does that mean? Let’s start with dispelling some of the myths about informal approaches. It does not mean a passing, unstructured conversation, only suitable for low level concerns, with some vague commitments that are not recorded and cannot be referred to later and is unlikely to lead to sustainable change.

How does informal case management happen in practice?

It begins with a planned thoughtful invitation to the practitioner to share your concerns and to explore their perspective. It is characterised by collaboration with the practitioner and provides an opportunity for them to reflect and to agree with you a plan to address the concerns. The locus of control remains with the practitioner. A record of the conversation provides a framework for you as the manager to monitor progress against the commitments made by both you and the practitioner. Conducting these conversations takes time and skill. You need to consider both the setting of the conversation and be aware of the biases that you might be bringing to the conversation. Our Compassionate conversations programme supports medical managers in developing these skills and exploring their role in creating an organisational culture which is resonant with this approach.

Of course, patient safety will be your priority and there will always be occasions when recourse to formal procedures is in the interests of all parties, for example where an investigation or a period of exclusion is required, but done well, with an engaged, reflective practitioner with a commitment to change even the most significant concerns can be resolved informally.

I predict that you are thinking that this is not a description of the characteristics of the practitioners that cause you concern but are you sure? The vast majority of professionals are motivated to do their best. Faced with the recognition that you have fallen short of this and, worse that it is apparent to others, responses of disappointment, frustration, confusion, and fear would not be unusual and are likely to impact on behaviours. Imagine if, layered on top of this, you were faced with a formal process over which you have little control. How easy would it be to be engaged and reflective? So surely it is in the interests of the practitioner, their colleagues and the service to genuinely try informal first?

How Practitioner Performance Advice can help

Practitioner Performance Advice can support you to review the concerns at an early stage, as there is no threshold for contacting us. We can support you in deciding whether to manage cases informally or formally, and we can guide you in how to clearly document the rationale behind your decision. We can help you to review your policies and procedures for managing concerns to ensure they encourage and support informal resolution whenever this is appropriate. Our impartial advice is available throughout the process and we can help you to ensure fairness in your case management process.

If you have any questions or require further information about formal or informal case management please email nhsr.Advice@nhs.net or call 020 7811 2600.