Department of Health

Website of the Department of Health

Please note that this website has a UK government access keys system.

Suspension of doctors

  • Last modified date:
    13 March 2007

More than 100,000 doctors practise in the National Health Service (NHS). The overwhelming majority of them work hard to provide excellent care. Standards of education and training are high, as are standards of care. As with any large workforce, however, a small minority will get into difficulty.

Throughout its history, the NHS has found it enormously challenging to address this small group of important cases. The dilemma has focused on the need to give prompt and effective priority to protecting patients, while at the same time recognising that disciplinary solutions may not be the fairest or the most appropriate way of dealing with doctors in real difficulty.

The Chief Medical Officer called for urgent action to replace the guidance on suspension of doctors and dentists in his Annual Report 2002.

A series of steps have been taken over the last few years to achieve this, including introduction of a framework on the exclusion of doctors and dentists employed by the NHS, published in December 2003, which modernises the management of what had previously been termed 'suspension'.

In the latest move, the Department of Health has completed this framework by publishing 'Maintaining High Professional Standards in the Modern NHS' on 17 February 2005. The framework comes into force on 1 June 2005 and covers issues of capability and health as well as conduct.

Like the exclusions framework issued in 2003, which is included in the new version, the new procedures will be implemented through the 'Restriction of Practice and Exclusion from Work Directions 2003', and the 'Directions on Disciplinary Procedures 2005'.

The new framework is part of a three-pronged approach to patient safety arising from the practice of medical and dental staff.

  • Where a concern arises about the practice of a doctor which may place patient safety in doubt, the 'Restriction of Practice and Exclusion from Work Directions 2003' provides for an immediate, temporary period of exclusion which may be needed to enable rapid investigation of the concern and creation of a plan to address it
  • The new procedures provide a clear framework to deal with such concerns in a way that addresses the problems directly
  • In the situation where there is a continuing unresolved concern, for example where an NHS employer considers that a member of its health care staff may pose a threat to patients and may be working or seeking work elsewhere in a health or social care setting, an alert letter may be issued. The arrangements for alert letters are currently undergoing reform.

The new procedures, supported by the British Medical Association (BMA) and British Dental Association (BDA), end the distinction between personal and professional misconduct which has shaped the NHS approach to dealing with poor clinical performance since its inception, and add procedures on capability and health. As a consequence, NHS doctors and dentists will be managed under the same disciplinary procedures as any other NHS staff member. Consultants who are dismissed lose the right of appeal to the Secretary of State for Health.

A central aim of the new framework is to make resolution of disciplinary cases much quicker than has been possible to date. The guideline in the past for handling cases has been 32 weeks to a final decision, but it was not possible to conclude many cases within this time. There will be close monitoring of the new framework to make sure it is - and remains - fit for purpose.

In the past, the traditional emphasis on disciplinary solutions meant that many concerns were managed through discipline, where other methods such as performance assessment and a re-entry and retraining programme would be more appropriate.

The new procedures, along with the exclusions framework, require NHS trusts to seek help and advice from the National Clinical Assessment Authority (NCAA):

  • To help plan the management of a case
  • Where needed, to carry out targeted specialist assessment
  • To support the development and delivery of an action plan

The NCAA was set up in 2001 with the core purpose of helping the NHS deal effectively with concerns about poor performance through expert advice and by seeking to open up new avenues for exploring concerns about individual performance.

In the last four years the NCAA, used by more than 85% of the NHS since its inception, has helped deal with more than 1700 cases of performance concerns. It has found alternatives to exclusion in 85% of possible cases and has worked with the NHS to reduce the number of long-term suspension cases by almost half. It has intervened earlier and dealt with cases more quickly, closing 25% every quarter.

Access keys