Maintaining High Professional Standards as an Independent Healthcare Provider: Why External Investigators Matter


Maintaining high professional standards (MHPS) of doctors and dentists within the NHS is vital for patient confidence and improved outcomes, maintaining high quality care provision and increased service efficiency through enhanced communication and regulation compliance.

Maintaining these high professional standards not only applies to those within the NHS but also independent healthcare providers (such as contractors or those providing complementary or specialist services).

In order to ensure a high quality of service exists, the Department for Health created the Maintaining High Professional Standards Framework to assess and deal with performance concerns of doctors and dentists within the NHS. NHS managers can utilise this national framework alongside local processes and external support.

MHPS defines clear roles and responsibilities for individuals investigating and managing the outcomes of concern. MHPS investigations can be triggered by a variety of concerns including capability and performance, mismanagement, behaviour and conduct, fitness to practise or concerns around their own health.


Why do independent healthcare providers need to follow the MHPS process?

The MHPS process isn’t restricted to the NHS. It must also be followed by independent healthcare providers when carrying out an investigation into professional standards. Any independent healthcare provider looking to initiate an investigation into a doctor or dentist needs to do so within the MHPS Framework.

Any investigation can be difficult, particularly if the person carrying it out hasn’t done an investigation for some time. But MHPS investigations are likely to have features which make them particularly challenging compared with investigations into serious incidents. That is because as well as being technically complex, they are sensitive for the clinician.

Working with an experienced external investigation company such as Verita can help by acting as case investigator, carrying out MHPS investigations quickly and impartially.  If you need help in this area please get in touch or book a free consultation. so we can discuss your requirements.

It’s important to note that MHPS investigations are usually a last resort. Ideally, any performance issues would be addressed informally by managers before a formal investigation is necessary.

Maintaining high professional standards examples

If a regulatory body has concerns about a doctor or dentist’s fitness to practise, they might refer the case for investigation under MHPS. This could be due to an increased number of complaints or disciplinary actions against a doctor or dentist.

If there are questions about a practitioner’s competence or performance in meeting the expected standards of care an investigation might be launched. In some cases the cause might be related to operational aspects of healthcare, such as a lack of resources or a shortage of staff.

In our experience of acting as case investigator, a common theme is poor record keeping.

This could come about for a variety of reasons, one possibility being that it is not uncommon for specialist doctors to work independently for a variety of healthcare organisations. Being employed in this ‘freelance’ nature means not being subject to the same processes or procedures as those employed by the NHS (for example, personal development plans or being managed closely on a day-to-day basis). The absence of a defined structure of management could lead to a failure to carry out certain administrative tasks.

Concerns about a doctor or dentist’s behaviour or conduct surrounding things like rudeness towards patients or colleagues, bullying and harassment of staff and patients could lead to investigation. This might have been triggered by a patient or their family raising a complaint about the care they received.

Colleagues and patients might raise concerns over the health of a doctor or dentist, such as burn out, leading to a failure to carry out administrative or safeguarding tasks.


Who carries out the MHPS process?

The two key roles in the MHPS process are case manager and case investigator. The investigator role can be outsourced, and this can bring improved objectivity and impartiality to the process which can be reassuring to the subject. It is unusual, and not advisable, to outsource the case manager role who will make the final decision on any action that needs to be taken. We recommend that this role is always undertaken by someone in the organisation.

It is essential that the subject of the investigation understands who, ultimately, will make decisions after the investigation is concluded. It is also crucial to ensure that the case investigator and case manager are appointed early, and that their respective roles are clear.

If carrying out the investigation internally, it would usually need to be carried out by senior staff. There are then questions around whether that is a good use of their time, what is the opportunity cost, and whether their seniority makes it harder for them to be objective about the organisation’s failings.

Specialist technical input is always likely to needed on clinical aspects of an investigation of this sort. Many investigations would also benefit from specialist investigation skills. Verita acts as case investigator working alongside a case manager, and this collaborative approach enables the case manager to be fully supported to make their final decisions.


Challenges of maintaining high professional standards

Managing dentists’ and doctors’ performance is difficult due to the their special status, the lack of knowledge managers may have with clinical skills and performance standards, and the reluctance to raise concerns over poor practice.

Clinicians are likely to be well supported by a colleague, defence organisation or lawyer, so it is important to use experts who are qualified, credible, and perceived to be impartial (whether sourced by a commissioner or by Verita).

A further challenge is that the clinician may well feel attacked and stressed by the process, especially if they are suspended or under restriction. This could generate a response of clinicians of passing the blame back to the employer – “this happened because of a lack of resources, shortage of staff or lack of time – so it is your fault rather than mine”.

In a world where most organisations are short of resources there is always likely to be something in this argument. It is difficult for the employer to be objective in response. There is a natural tendency to be defensive of the organisation. It is therefore hard for the investigator to strike the right balance between fairness to the clinician and to the organisation.

What are the possible outcomes?

The purpose of an MHPS investigation isn’t about exclusion of a practitioner or imposing sanctions, but about helping them in certain areas where they are underperforming. This ensures practitioners can develop and continue their career path and improve the quality and level of service to the patients in their care.

Patient care and safety always remains the priority and is at the heart of any decision making. Even during the investigation careful considerations are given to alternatives for exclusion. For example addressing the immediate problem through training or mentorship as well as taking into account the current pressures facing healthcare providers.

Redeployment of the practitioner to a less pressured environment might also be suggested. If this is the case adequate retraining and re-skilling will be undertaken before the practitioner would be allowed to provide front line services.


Reasonable timeframes

Addressing performance concerns as they arise is key to managing out any issues before they escalate into a full investigation. Understanding how to manage performance issues is important to ensure the practitioner is clearly aware of the problem, the required standards, and how it might affect their team members and patients. Explaining the steps involved to better their performance is necessary for standards to improve.

The case investigator and case manager are responsible for ensuring the investigation and decisions are made in timely fashion. The MHPS Framework sets out that any investigation should be completed within four weeks. In more complex cases this guidance may not be achievable.

It is not within the best interest of the doctor or dentist under investigation for cases to linger on for months or even years. The wellbeing of those under investigation must be considered and open and honest communication around any delays in the timescales and reasons for those delays. It is also important to offer support to the practitioner during this time.

The benefits of an external investigator

Raising the issue promptly and constructively may be enough in itself to drive change but sometimes an MHPS case is needed. If so, an external investigator such as Verita can make the investigation process easier and more efficient for a number of reasons, including:

Impartial view

A clear advantage of an external investigator is that they are impartial and act fairly and objectively without bias, which minimises the potential for an employee to allege bias over the process.

Fresh perspective

Investigators possess the specialised clinical skills and experience of performance standards meaning they can delve into complexities of a case and offer a fresh take on the investigation.

Provides new insights

Verita has experience of handling some of the most sensitive investigations in the healthcare sector, and have helped a number of NHS trusts with investigations under the MHPS. Their wealth of experience, independence and discretion is useful when handling difficult cases.

Prompt action

External investigators can hit the ground running as they have the system and processes in place to deal with MHPS framework investigations efficiently. By utilising a specialist company like Verita organisations are free to continue business as normal and focus on patient care.


In summary

Investigations into maintaining high professional standards can be daunting due to uncertain timescales, lack of managerial clinical knowledge and performance standards, and the difficulties associated with challenging poor practice. An external investigator can help make the investigation process smoother and more efficient while maintaining impartiality to offer a fresh perspective, leading to improved professional standards among practitioners within independent healthcare providers.

By utilising our impartial, external support we can manage these concerns to protect the wellbeing of those involved, and so that any problems can be addressed efficiently, saving time and money.

If you would like to know more about how Verita can help your organisation carry out investigations into maintaining high professional standards, please book a free consultation, or if you prefer, use our contact form, or contact Ed Marsden on 020 7494 5670 or [email protected]. We are always happy to talk through the issues around MHPS.


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