NHS Trusts urged to improve disciplinary processes as doctors report ‘devastating’ impact on mental health

NHS Trusts across England have been urged to ensure doctors are treated fairly and compassionately during disciplinary proceedings, as a new report reveals guidelines are often not adhered to, resulting in long investigations and exclusions which can have a devastating impact on doctors’ mental health and careers.

The report by the Medical Protection Society (MPS) also says the prosect of a protracted and unfair disciplinary is perpetuating a culture of fear in the NHS.

MPS - the world’s leading protection organisation supporting over 300,000 healthcare professionals, engaged with a group of 61 doctors who have faced an NHS Trust disciplinary, as part of its report. Eight in 10 (80%) said the disciplinary had a detrimental impact on their mental health, and over two in five (44%) experienced suicidal thoughts during the process.

75% of the doctors who took part said the length of the disciplinary affected their mental health most, with many lasting years. During this time some were excluded from duties and lost their clinical skills. Others were impacted by the severe tone in Trust communications, the lack of compassion and support from the Trust, and the unwillingness to consider an informal approach before initiating a formal disciplinary.

An MPS Freedom of Information request to NHS Trusts in England, to which 86 Trusts responded, also revealed that over a third (35%) do not mandate training for staff handling disciplinaries, and nearly a quarter (23%) do not regularly submit data on disciplinaries to Trust Boards for scrutiny.

MPS said Trusts could help to avoid potentially devastating consequences for doctors facing disciplinaries, by adhering to the Maintaining High Professional Standards (MHPS) framework established to guide Trusts through the process. It also called for better training for staff, and more transparency around the way Trusts use and conduct disciplinaries.

Dr Rob Hendry, Medical Director at MPS, said:

“All NHS Trusts in England have access to a framework designed specifically to help them conduct disciplinaries in a way that is fair, compassionate, swift and proportionate. Sadly, through our experience in supporting around 450 doctors facing a disciplinary each year, it is clear that many Trusts are not following the guidelines and for some doctors the consequences can be devastating – personally and professionally.

“Failure to conduct disciplinaries swiftly and fairly can also perpetuate a culture of fear amongst doctors in the NHS which works against improving patient safety. Openness and learning rely on doctors having confidence in senior management and their commitment to due process.

“Trust disciplinaries must be conducted fairly - right from the outset. This means, for example, considering whether a matter could be dealt with in a less formal way, and taking steps to ensure discrimination is not a factor initiating a disciplinary.

“If a disciplinary is the appropriate route, doctors must be notified of the allegations against them straight away, and a decision to remove a doctor from duties should be proportionate to the nature of the allegation. This will avoid doctors becoming deskilled, which can damage hard won careers and affect patient care.

“Crucially, all Trust staff running disciplinaries must have specialised training. This would ensure they have an adequate understanding of employment law, the MHPS framework, and patient safety. But it would also give them the tools to interact with doctors in a compassionate way, and recognise when steps must be taken to safeguard their health and wellbeing. Dedicated time should be ring-fenced for these staff members so they can adhere to timeframes – it is unacceptable for a disciplinary to last years.

“There has been limited transparency or scrutiny into how NHS Trusts initiate and conduct disciplinaries against doctors, particularly in contrast to the attention on the GMC investigation process. This must change. All Trust Boards should have oversight of Trust processes, and NHS England should require all Trusts to provide standardised data on use of disciplinaries. This should be published and scrutinised to identify trends and outliers.”

President of HCSA - the hospital doctors' union, Dr Naru Narayanan, said:

“HCSA has supported countless doctors through disciplinaries which are time-consuming, traumatic and open to abuse by employers. The process routinely takes many months or even years. It can have a huge impact on doctors’ mental and physical health, and destroy careers.

“They are also all too often used to silence or exert control. The fact that over half of doctors polled believed that their raising patient safety concerns was a factor in their investigation should shock but it sadly comes as no surprise. We need urgent reform to ensure efficient, independent and properly scrutinised disciplinary processes, free of bias and discrimination. NHS staff deserve no less.”

Doctors who took part in the MPS research, commented anonymously:

“I had anxiety and depression. The process was brutal.”

“It had a devastating impact on all aspects of my life even though I am at the tail end of my career. The initial steps taken by the trust were disproportionate.”

“The process was tedious and humiliating.”

“The investigation was done very poorly and I was not interviewed at all. A repeat investigation done at my request exonerated me. In the meantime I was not allowed to do major operations. There was a major toll on my confidence and mental health.”

“Prolonged period of restricted practice for an investigation which took over a year to complete. I am currently awaiting a period of retraining.”

“I was informed of the allegations only when I faced a panel of Trust management personnel, having just finished operating. There was no warning, a secretary called my mobile and asked me to attend the Medical Director's office with no further explanation. Nobody should be treated like this.”

“I was stopped from going to work for 48 hours while the issue was investigated. This caused me great distress and anxiety, as during the investigation I was instructed not to contact anybody at work, and I wasn’t even aware of what the concerns were.”

“It took so long I needed reskilling. How can you show your skills when you haven’t been on ward for 16 months.”

“A four-week investigation with a report in 5 working days, said the letter from the medical director. It took 16 months.”

“Trust made accusations without checking facts, jumping straight into formal procedures, failing to communicate.”

“Horrible, treated like a criminal, my office space given to someone else, my belongings confiscated.”

“The arrangement was based on the assumption of guilt until being proven innocent. There is absolutely no interest in treating doctors with dignity and supporting them.”

“The process was extremely harsh, the local protocol for dealing with such allegations was not followed, there was no attempt at mediation and it all felt like a witch hunt.”

“There is no independent oversight so Trusts can do as they please.”

View the MPS report: Improving NHS disciplinary processes: Efficient, fair and compassionate

For further information contact [email protected]

MPS engaged with a group of 61 doctors who have previously faced an NHS Trust disciplinary as part of its report. Key findings:

• 80% said the disciplinary had a detrimental impact on their mental health.
• 81% said feeling 'guilty until proven innocent' impacted their mental health most.
• 75% said the length of the investigation impacted their mental health most.
• 65% said the published timeframes for the investigation were not adhered to.
• 14% said their disciplinary took 3-6 months to resolve, 31% said it took 6 months – 1 year, 31% it took 1- 2 years, 8% said it took 2-3 years, 14% said it took 3+ years.
• 58% said lack of communication from the Trust during the process affected their mental health most
• 50% said being excluded from practice during the investigation affected their mental health most. Of those, 79% felt the decision to exclude them was disproportionate to the allegation and 67% were concerned about losing their skills during this time.
• 44% said they experienced suicidal thoughts during the disciplinary process.
• 60% said they were not informed of the allegations in good time before the process began.
• 52% said knowing an informal approach was considered before a disciplinary commenced would’ve made the process less stressful overall.
• After the investigation concluded, 51% they were fearful about raising patient safety concerns in the future, 48% had lost confidence in their clinical skills, 88% felt angry and frustrated about how they were treated.
• 91% said a dedicated person to support those facing a disciplinary could help improve the process.
• 67% said help to maintain clinical skills during exclusion/restrictions would help
• 70% said Trust boards should be required to share data on disciplinary outcomes.

About MPS

The Medical Protection Society Limited (“MPS”) is the world’s leading protection organisation for doctors, dentists and healthcare professionals. We protect and support the professional interests of more than 300,000 members around the world. Membership provides access to expert advice and support and can also provide, depending on the type of membership required, the right to request indemnity for any complaints or claims arising from professional practice.

Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.

Our philosophy is to support safe practice in medicine and dentistry by helping to avert problems in the first place. We do this by promoting risk management through our workshops, E-learning, clinical risk assessments, publications, conferences, lectures and presentations.

MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.