Disciplinary Procedures for Doctors and Dentists

Disciplinary issues arise when problems of conduct are identified by the employer. All employers should have a disciplinary procedure for dealing with such issues.

Issues of straightforward misconduct or gross misconduct by doctors or dentists, should be dealt with through the local NHS employer's internal disciplinary procedures.

All such disciplinary procedures should be based firmly on the principles of fairness and designed to both protect patients and practitioners themselves. Where the penalty imposed is dismissal, the employee has a right, as with all employees, not to be unfairly dismissed. An otherwise fair dismissal may be found to be unfair if there is procedural unfairness.

Dismissal will also need to be justifiable as a reasonable response and employers need to be aware of the risk of the unfairly disciplined employee resigning and claiming constructive dismissal.

These disciplinary procedures should be augmented by additional disciplinary procedures for dealing specifically with doctors and dentists' professional conduct or capability issues.

An NHS organisation is required to develop a co-ordinated approach to handling disciplinary concerns about doctors and dentists. Whatever the source of information, the response must be the same – to quickly establish the facts, ascertain the extent of any risk or validity of any concern and take immediate appropriate action.

• Issues of straightforward misconduct or gross misconduct by doctors or dentists should be dealt with under the local NHS employer's internal disciplinary procedures.

• In addition to standard disciplinary procedures, NHS organisations are required to have additional procedures in place for handling concerns about the conduct, performance and health of medical and dental employees where standard disciplinary procedures are not considered appropriate.

• A disciplinary framework, High Professional Standards in the Modern NHS, has been developed at a national level by the Department of Health, the NHS Confederation, the British Medical Association and the British Dental Association and applies to the NHS in England.

• The new framework covers:

  • initial action, to be taken when a concern about a doctor or dentist first arises

  • procedures for considering whether it is appropriate to place restrictions on a doctor or dentist's practice or if suspension is necessary

  • guidance on conduct hearings, including Conduct Panels, Capability Hearings and Appeals Panels

  • procedures for dealing with issues of capability

  • arrangements for handling concerns about a practitioner's health.

• Investigations into concerns about a doctor’s or dentist’s practice should be handled by appropriately trained individuals, locally wherever possible.

• Advice from the National Clinical Assessment Authority (NCAA) should be sought wherever necessary.

• The outcome of any investigation should be discussed with the doctor concerned.

• A range of outcome options should be explored, such as 'no case to answer', re-education, supervision, mentoring, a change in the employer’s working systems or referral to occupational health.

• If a workable local solution cannot be found, agreement should be sought with the doctor for a referral to the NCAA. The practitioner him or herself can also self refer to the NCAA.

• Dismissal should be considered only as a last resort.