This information guide is
intended for a psychiatrist who faces
exclusion from work. The information should be used as a
guide only and is not a substitute for professional advice. If you
need further advice and support, please contact the Psychiatrists’
Support Service or one of the organisations listed at the end of
this information guide.
Being excluded from work can be a distressing and unpleasant
time for any doctor. Exclusion from work is used as an interim
measure while action is being considered to resolve a problem at
It is essential to seek advice immediately the
moment that you are, or consider yourself likely to be, subject to
exclusion or restriction of practice. It is important to be aware
of the medico-legal and personal conduct representation available
to you in the National Health Service (NHS), from professional
bodies and from medical defence organisations.
This leaflet provides guidance and information
on best practice as defined in
Maintaining High Professional Standards in the Modern
NHS (Department of Health, 2005). It will act as
guidance on what to expect from your employer throughout the
process. However, it is not a substitute for obtaining professional
and legal advice.
The process of exclusion from work
Key NHS trust officers and the
trust board have overall responsibility for ensuring the
exclusion process is carried out quickly and fairly, is kept under
review and that the total period of the exclusion is not unduly
- The chief executive of the employing organisation has overall
responsibility for ensuring the exclusion process is properly
- The medical director is usually the case manager but this role
may be delegated to a senior manager to oversee the case.
- The investigating officer/case
investigator will provide factual information to assist the
case manager in reviewing the need for exclusion and will provide
progress reports to the chief executive and the trust board.
An immediate time-limited exclusion may be
necessary for the following:
- a critical incident when serious allegations have been
- a breakdown in relationships between a colleague and the rest
of the team
- the presence of the practitioner is likely to hinder the
making the exclusion must explain why the exclusion is being made
in broad terms (there may be no formal allegation at this stage)
and agree a date, up to a maximum of 2 weeks away, at which the
practitioner should return to the workplace for a further meeting.
The case manager must advise the practitioner of their rights,
including their rights of representation.
Formal exclusion may only
take place after the case manager has first considered whether
there is a case to answer and after a case conference has been held
to consider if there is reasonable and proper cause to exclude. If
a case investigator has been appointed, a preliminary report must
be prepared as soon as possible for a case conference. This report
will enable the case manager to decide on the next steps and should
contain sufficient information for a decision to be made as to
- the allegation appears unfounded, or
- there is a misconduct issue, or
- there is a concern about the practitioner’s capability, or
- the complexity of the case warrants further detailed
investigation before advice can be given on the way forward.
Formal exclusion will only be used where:
- there is a need to protect the interests of patients or staff,
pending the outcome of a full investigation of:
- allegations of misconduct,
- concerns about serious dysfunctions in the operation of a
- concerns about the lack of capability or poor performance of
sufficient seriousness to warrant protecting patients, or
- the presence of the practitioner in the workplace is
likely to hinder the investigation.
Review procedures for exclusion
The case manager must
review the exclusion before the end of each 4-week period and
report the outcome to the chief executive and the trust board. This
report is advisory and the case manager will decide on the next
steps. The NHS body must take review action before the end of each
4-week period. After three periods of exclusion, the National
Clinical Assessment Service (NCAS) must be called in.
First and second reviews (and reviews after the third review)
Before the end of each
exclusion period, the case manager should review the position and
will decide on the next steps as deemed appropriate. Further
renewal may be up to 4 weeks at a time.
The role of the Strategic Health Authority (SHA)
The SHA will inform NCAS
about the exclusion, after it has been notified. When an exclusion
period has been extended twice, the chief executive of the
employing organisation must inform the SHA of any actions which are
proposed to resolve the situation. Where re-training or other
rehabilitation action is proposed, the reason for continued
exclusion must be given.
The role of the Trust board and designated members
The trust board has
overall responsibility for ensuring the correct procedures are
established and followed. Board members may be required to sit as
members of a disciplinary or appeal panel. Information given to the
board must be sufficient for the board to satisfy itself that the
correct procedures are being followed.
The board will designate one of its
non-executive members as a ‘designated board member’ under these
procedures. This individual will oversee the case manager and the
investigating manager during the investigation process and ensure
that the momentum of the case is maintained.
Return to work
If it has been decided
that the period of exclusion should end, formal arrangements must
be made for the practitioner’s return to work. It must be clear
whether clinical and other responsibilities are to remain unchanged
or what duties and restrictions are to be imposed or if any
monitoring arrangements are needed.
Rights of an employee during
the exclusion process
- If you wish, you can be represented by colleagues, and/or union
officials and you may call witnesses.
- A solicitor can accompany you, but he or she should not act in
a legal capacity.
- Those excluded from work should be informed of their right to
- If you are dismissed or have exhausted local procedures, you
have the right to take your case to an employment tribunal.
Rights of an employer during the exclusion process
Your employer has a right to expect:
- compliance with the contract of employment
- requisite standards of performance
- concerns to be investigated
- practitioners to cooperate with the process
- information to be shared with other organisations, if there are
concerns about patient/staff safety
- the practitioner to be dismissed as necessary.
Checklist for psychiatrists excluded
What to consider
- Have you read a copy of Maintaining High
Professional Standards in the Modern NHS?
- How does this document apply to you?
- Is your treatment consistent with Maintaining High Professional Standards in the Modern
- Is there a local policy within your organisation setting out
how practitioners undergoing performance or other investigations
will be supported?
- Is your treatment consistent with this document?
- Have the issues for which you are
being excluded been raised with you previously?
- Have you been offered a reasonable opportunity for
- Has the trust sent you a copy of their disciplinary rules and
other relevant procedures?
About your case
- Have you been informed in writing about the nature of the
complaint or allegation?
- Have you received copies of all relevant documentation about
- Does the letter confirming your exclusion contain:
- effective date and time of exclusion
- duration (up to 4 weeks) of exclusion
- content of the allegations
- terms of the exclusion, such as not returning to the premises,
avoiding contact with colleagues and the need to remain available
- that an investigation or other action will follow?
- Have you been given the opportunity
to state your case and propose alternatives to
Management and investigation of
Do you know?
- Who is managing the case?
- Who is leading the investigation?
- Who will be called as witnesses?
- Have any of the parties involved in the
investigation/disciplinary process been involved in making the
complaint or allegation?
- If so, do you think this could this affect their ability to
deal with this matter?
Other information and
Have you been informed?
- That your case should be reviewed every 4 weeks?
- Of your right to receive pay throughout the exclusion
- That you must be available for meetings during your normal
contracted hours, within 24 hours of being asked to attend?
- That you cannot be put on ‘trial’ for the same issue twice, but
account can be taken of previous concerns about your conduct or performance if you are
already receiving support or monitoring of these issues?
- You should still be able to have access to occupational
- That the Trust should outline arrangements for your continuing
professional development, if it is expected that your exclusion
will last for some time?
Frequently asked questions
Q: I am on an ‘old’ employment
contract, does this procedure apply to me?
A: Yes, Maintaining High Professional Standards in the Modern
NHS applies to everyone in England. At the time of printing,
Northern Ireland have agreed a similar version but with some
crucial differences. Scotland is using its own version of
Health Circular HC(90)9, as is Wales
which is also in the process of agreeing something close to
Maintaining High Professional Standards in the
Q: Do I still have the right to
appeal to the Secretary of State?
A: The new policy
(Maintaining High Professional Standards in
the Modern NHS) supersedes the right of appeal to the
Secretary of State. There may be some exceptional circumstances to
this, which can only be assessed by your legal advisers.
Q: What do I do if I have been
excluded from work as a result of malicious or vexatious
A: Speak to your
professional advisers about following the disciplinary or grievance
procedures in your organisation to seek redress.
Q: I am
likely to be excluded from work; is it lawful to be excluded
without a face-to-face meeting?
A: The chief
executive/medical director must call a meeting with the person
threatened with exclusion to discuss the situation first before a
decision is made about excluding the doctor from work. It is not unlawful to exclude without a
face-to-face meeting. You do not have to attend the meeting where
it is decided to exclude, but where possible you should be informed
about the decision face to face.
Q: What happens if
my employer fails to follow the MHPS procedure?
A: You and your
professional representative will be able to make formal
representation to the non-executive director of the board charged
with ensuring the procedures for exclusion from work have been
Q: What happens if
I do not follow the procedure as specified in Maintaining High
Professional Standards in the Modern NHS?
A: You are required to
comply with the obligations imposed on you. If you do not, this
could render you subject to further disciplinary action.
Q: Is there a
distinction between professional conduct and personal
A: The principles of Maintaining High Professional
Standards in the Modern NHS apply to both categories of
Q: What sources
are available for further help and support?
A: The human resources
department should be involved in the exclusion process to ensure
fairness. Have you been reminded or informed about occupational
health services and counselling services available to
Q: Should I seek
support from others?
A: Look for someone who
is not involved in the investigation who can be ‘a friendly set of
ears’ to listen to your concerns, provide advice and support you
through your difficulties, for example a mentor. Look after your
physical and mental well-being by paying attention to your health,
your diet and take exercise that you enjoy.
Sources of further help and
BMA House, Tavistock Square
London WC1H 9JP
Tel: 020 7387 4499, Fax: 020 7387 4499
Society of Clinical
The Suspended Doctors Group
Honorary Secretary Dr Peter J Tomlin
Tel: 01725 513367
Hospital Consultants and
1 Kingsclere Road,
Hants RG25 3JA
Tel: 01256 771777, Fax: 01256 770999
MDU Services Limited, 230 Blackfriars
London SE1 8PJ
Tel: 020 7202 1500
Medical Defence and
Dental Union of Scotland
Mackintosh House, 120
Glasgow G2 4EA
Tel: 0141 221 5858
33 Cavendish Square, London
Tel: 020 7399 1300, Fax: 020 7399 1301
1st Floor, Market Towers, 1
Nine Elms Lane
London SW8 5NQ
Tel: England and Northern Ireland 020 7062 1655,
Wales 029 2044 7540, Scotland 0131 220 8060; 24-hour emergency
contact 020 7062 1655
Royal College of
21 Prescot Street,
London E1 8BB
Tel: 020 7245 0412
Department of Health (2005) Maintaining High
Professional Standards in the Modern NHS. Department of
the Psychiatrists’ Support Service in partnership with Stephen
Campion, Chief Executive of the Hospital Consultants and
Specialists Association, and Karen Wadman, Senior Human Resources
Adviser at the National Clinical Assessment Service.
© Royal College of Psychiatrists
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