Principles and Framework for healthcare organisations managing performance concerns
NHS Resolution have collaborated with NHS England’s Professional Standards Team to develop a comprehensive framework for employers to identify the key considerations to promote fairness, proportionality and consistency in decision making when managing and resolving performance concerns for all practitioners.
This work includes the Principles and Framework for Fairness and Proportionality, a new Insight paper and fictional case studies, all of which have been reviewed for applicability to Wales and Northern Ireland.
This work supports the NHS People Plan’s ambition for more people to work in a compassionate and inclusive culture. We recognise the strategic importance of delivering fair resolution and where possible, keeping healthcare staff out of formal processes to minimise distress and cost.
This work also aligns with NHS England’s Being fair tool: supporting staff following a patient safety incident. If the relevant case relates to a patient safety incident, the Being fair tool should be completed in the first instance to support decision making on next steps.
The principles and framework
Download the principles and framework
The Framework addresses five key areas (“the Principles”) in case management which are equally applicable to cases managed in both primary and secondary care settings, irrespective of the grade, specialty or protected characteristics of the practitioner:
- Ensuring welfare and support
- Understanding the issues
- Ensuring the practitioner is heard
- Adherence to process
- Equity and proportionality
It is intended to be an integral part of documented local case management. The overall goal is to improve the handling of performance concerns locally by promoting fairness and proportionality in decision making, helping to ensure concerns are resolved efficiently and appropriately at the earliest possible stage.
It may be adapted for use by individual organisations and consideration should be given to how and when it is implemented, as well as how it works together with other local processes. However, we advise that the overall five Principles are not changed.
Case Studies
Alongside the Fairness and Proportionality Principles and Framework, we have developed four fictional case studies to demonstrate how using the checklist could positively influence case management. Please read each case study carefully and consider the different outcomes with and without the use of the Framework, including the impacts on the individual practitioner, their team and patient care. Alternatively, you may wish to discuss these in small groups within your organisation.
Download our Fairness and Proportionality case studies learning pack.
Insights in Practice publication
Our Insight publication provides more information on why and how the framework was developed, the anticipated benefits and future evaluation.
Please see our Insight in Practice webpage
The British Islamic Medical Association supports this framework which we believe will foster better fairness and proportionality of case management at a local level. This framework empowers local trusts to ensure a quick resolution of cases which we know cause great distress to our workforce. 50% of all doctors are from an ethnic minority background and a significant proportion are IMGs. We can not afford to continue to discriminate and disadvantage them and further decrease the morale of the NHS. This framework is a welcomed tool to start our journey towards a fair process for all.
British Islamic Medical Association
We welcome this framework as a way of ensuring local management of concerns about doctors are handled fairly and consistently. Eliminating areas of inequality will create more inclusive, supportive and fairer local environments, and inclusive environments lead to better patient outcomes and satisfaction. We have a target to eliminate the disproportionate pattern of fitness to practise complaints we receive from employers in relation to a doctor’s ethnicity and place of qualification by 2026 and we hope use of this framework will make a significant contribution to meeting that target.
Anna Rowland, Assistant Director, Policy and Business Transformation, GMC Fitness to Practise
Acknowledgements
Significant contributions were made to the development of the resources by the following individuals and organisations. We are extremely grateful to everyone who added their input to this work.
1. Development of the principles, framework and supporting materials
The creation of the framework would not have been possible without significant input from Clare Chapman (Practitioner Performance Advice) and from experienced Heads of Professional Standards, Iona Neeve (NHS England South West) and Rachel Kinghorn (NHS England North East and Yorkshire). We would also like to thank the following for their contributions:
- David Wilkinson, Adviser, NHS Resolution
- Paul Hutchings, Adviser, NHS Resolution
- Steve Evans, Adviser, NHS Resolution
- Eva Allen, Adviser, NHS Resolution
- Hanna Gillespie-Gallery, Evaluation and Research Lead, NHS Resolution
- Dan Wheat, Improvement and Evaluation Programme Manager, NHS Resolution
- Vicky Voller, Director of Advice and Appeals, NHS Resolution
2. Input into the resources and supporting materials
We would like to thank those individuals and teams who gave their time to help us consider the tone, language and content of the resources making sure they are relevant to those who will use them. This includes:
- British Islamic Medical Association (BIMA)
- British Medical Association (BMA)
- General Medical Council (GMC)
- Hospital Consultants and Specialists Association (HCSA)
- Independent Healthcare Provider Network (IHPN)
- NHS England
- Midlands Partnership NHS Foundation Trust
- Royal Orthopaedic NHS Foundation Trust
- Safety & Learning, NHS Resolution
- The Medical and Dental Defence Union of Scotland (MDDUS)
- The Medical Defence Union (MDU)
3. Support for resources and materials
- Megan Clarke, Evaluation, Research and Insight Officer, Practitioner Performance Advice
- Daniel Knight, Communication and Engagement Lead
- Simon Edmunds, Digital Content and Channels Manager, NHS Resolution
- Martha Evans, Policy and Communications Officer, NHS Resolution
- Sandra Middlehurst, Personal Assistant, Practitioner Performance Advice
- Claire Murray, Digital Content and Channels Executive, NHS Resolution
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