Insight report resource
Emergency medicine and Health Care Professional Alert Notice (HPAN) case study: behavioural and clinical concerns
This is a composite case study with some facts altered to protect confidentiality.
Features of the case
A locum doctor was appointed as a consultant in emergency medicine. This was their first consultant role but they had previously worked in emergency medicine at an associate specialist grade and had provided positive references from this post.
As part of the doctor’s induction into this new role they were paired with a senior consultant to provide mentor support. After working with the doctor for a few weeks the senior consultant was concerned that the doctor’s clinical competence appeared to be noticeably lower than that expected of a consultant. The senior consultant discussed this with the Clinical Director and it was considered that the doctor was taking time to adjust to the step-up in role and support would be enhanced to help them further.
After several more weeks passed the doctor showed little sign that they were adapting to the consultant role and in addition to the ongoing concerns of the senior consultant, multiple complaints had been made about the doctor from various colleagues. These related to their clinical decision-making, communication and behaviour towards colleagues, and an incident where their misdiagnosis resulted in a patient being discharged who later had to be readmitted.
Given the widespread concerns, the Clinical Director considered the doctor might have to be excluded to protect patient safety.
How did Advice respond?
The Case Adviser explored potential alternatives to exclusion with the Clinical Director, including restricting the doctor from clinical work or moving them to another site. The Clinical Director did not consider any other measures to be viable given the nature of the work required and the lack of capacity to manage the doctor in a non-clinical setting. The Clinical Director was also concerned that, having discussed matters with the doctor, they did not accept there was an issue with their level of clinical competence nor did they demonstrate any insight into the concerns reported.
The Case Adviser signposted the Clinical Director to the Advice service’s exclusion resources and highlighted that if a decision was made to exclude this should be managed in accordance with part II of MHPS. The Clinical Director was advised that concerns should also be reported to the doctor’s locum agency and the Case Adviser also highlighted the trust’s obligations under MHPS should the doctor leave their employment with unresolved concerns.
The trust was also advised to consider whether the performance concerns warranted a referral to the GMC to consider the doctor’s fitness to practise.
What action did the trust take?
The trust made the decision to exclude the practitioner but the subsequent investigation could not be concluded before the end of the doctor’s locum contract. The trust made a referral to the GMC to consider if further action was required but there was a worry the doctor may seek employment elsewhere while the concerns about their practice remained unresolved.
Following further discussion with the Advice service, the trust requested a Healthcare Professional Alert Notice (HPAN) as the doctor had left their employment with unresolved performance concerns. The basis for requesting a HPAN is that the concerns relate to a registered healthcare practitioner who poses a significant risk of harm to patients and/or staff, and who may continue to work or seek work elsewhere.
What was the outcome?
The request was agreed by Advice and the HPAN issued. Three months later, as part of the regular review of active HPANs, the Advice service became aware that the GMC had imposed interim conditions on the doctor’s registration. As the regulator had now taken action to safeguard patients and the public, the HPAN was no longer required and was revoked by the Advice service.
