If you're facing a review, investigation or
inquiry, make sure you're:
- Clear – Do
you know what process you're facing?
- Prepared –
Are you ready for the process?
- Supported -
Have you spoken to a professional body for advice and to
family/friends for support?
isn't a sign of weakness or accepting blame. Showing regret and
willingness to learn lessons is an appropriate professional
reaction to an adverse event. If you're defensive, it could be
usually done locally by an investigator who is employed by the same
organisation as the psychiatrist, team or service being
investigated. As it is an internal process, timescales are
If there is a conduct or
behaviour problem that could lead to a disciplinary process, then
the issue will typically be investigated by a single investigator
or panel. A panel is sometimes more appropriate when the adverse
event is of clinical concern.
The Chair of the panel is
usually a non-executive member of the trust board in the NHS. In
independent sectors, there might be a non-clinician Chair. If the
concern is about the clinical practice of a psychiatrist there
should be a psychiatrist on the panel.
A review is conducted by
a panel, which has at least one member from a professional body
outside of the trust. There will also be a psychiatrist on the
panel who should be an experienced senior clinician with
appropriate speciality knowledge.
The process is longer
than a review investigation because there are external
professionals involved and the focus is on a service rather than an
Formal inquiries are a
response to serious events, such as an individual in contact with
mental health services committing murder or negative publicity
following an incident. Often chaired by a lawyer or judge, the
panel membership is wider - including a psychiatrist, a nurse, a
social worker and a lay representative(s).
More formal than a review
or investigation, the process is long and detailed. Witnesses give
evidence and their testimony could be recorded and transcribed.
Usually, the employer sets up an investigation or review before the
external inquiry from a primary care trust in the NHS.
Things to consider
If an adverse event has
occurred, anticipate that a process of review/investigation/inquiry
may take place. If you're told there will be a review,
investigation or inquiry, respond by letter to your clinical or
medical director. Seek advice from your medical defence
organisation, and the British Medical Association if you’re a
If you’re contacted in advance,
- Is this a review, investigation or
- What are the terms of reference?
- Will I have to give oral or written
- If I have to give oral evidence, can a
colleague or professional adviser accompany me?
- Will the process focus on learning lessons
and improving services or will I be criticised?
- How will the final report be produced?
Whether you're facing an
investigation, review or inquiry, make sure you provide a
transcript of what you said and what will be used to prepare the
report. Ask whether you’ll get to see either the whole report or
part of it without conclusions so there’s an opportunity for you to
- If there has been an adverse event, seek
professional advice and think about whether an investigation,
review or formal inquiry is most likely to follow
- If you give oral evidence, bring a
professional supporter/adviser with you
- You can always take a break from the
interview process if needed
and inquiries can be extremely stressful and impact both your
professional and personal life. Secure a professional support
network - a colleague you can trust or a mentor. Psychiatrists can
get mentors through local contacts, the local deanery or College
Take care of yourself. If
your mental or physical health is being affected, seek support.
For further help and
support, see our
resources page on contacting the British Medical Association
and Medical Defence organisations.
This document focuses primarily on the
consultant psychiatrist. It may be helpful for trainees or
non-training grade psychiatrists if brought into a review,
investigation or inquiry, but for them the first line of support
and advice should be from their consultant. The information should
be used as a guide only and is not a substitute for professional
© Royal College of Psychiatrists 2016
If you require advice and support about a particular issue then please contact the
Psychiatrists' Support Service at the Royal College of Psychiatrists on 0207 245
0412 or email
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