MHPS – A difficult task at the best of times

Kieran Seale Verita Consultancy Ltd

Kieran Seale

Published 4 November 2021 More about Kieran

If you’re responsible for managing doctors, how do you deal with their performance problems? This can be one of the most difficult issues that healthcare managers face.

Inhibitions about the special status of doctors, the lack of familiarity managers have with clinical skills and performance standards, and the reluctance to challenge poor practise mean that managing doctors’ performance can be a real challenge.

Is the NHS guidance enough?

Covid has added another layer of complication to this, of course. It is welcome that NHS Resolution has produced specific guidance on using Maintaining High Professional Standards (MHPS) during the pandemic, but the complexities of handling cases in the current circumstances can be seen from this extract from the guidance:

“Our advice is that NHS organisations will have to carefully consider what, if any, action on managing concerns can be undertaken during these difficult times and how ongoing investigations should be handled, always considering patient safety and public protection first. Robust and tailored support is essential for practitioners at this time, especially if restrictions or exclusion are in place or processes are prolonged.”

These are unprecedented times for everyone, but the advice to “carefully consider” what action to take, “always considering” patient safety first is bland to the point of being useless. As if trusts didn’t carefully consider how they use MHPS normally!

MHPS needs prompt action

In our experience healthcare managers undertake MHPS processes only as a last resort because they know how long and complicated the process can be. Much can be done to avoid starting down the MHPS road. Prompt action should be taken by managers to identify and address performance problems early with a doctor. The key is to spot the issue, and to address it with the practitioner directly as soon as it happens. Ignoring the problem, and putting off this discussion almost always leads to the issues persisting.

Sometimes the performance issue will be limited to one individual but, more often, the performance of the doctor’s team will also be affected. To make the problem clear to the doctor, it is essential for managers to be specific about the issue, to explain where the performance falls short of the standards expected, and to describe the effects of their performance failures on the team and, most importantly, the patient. And it is also important to help the doctor understand what’s expected and to help them with the practical steps they need to take to correct their performance.

In many cases, simply raising the issue promptly in a constructive way will be enough for those involved to see what needs to be done better. However, we know that some issues are more difficult to address and, in some cases, action under MHPS may be needed. That can be a big step to take, especially as the stakes for those involved are so high.

Avoid unnecessary time and costs involved

The big concern that most managers have about MHPS is about the time it might take. This case involving a consultant radiologist ended up in the Employment Tribunal. The report casually mentions that the MHPS process began in 2014 and didn’t conclude until mid-2017. The tribunal hearing didn’t happen until March 2020. And that all was pre-Covid! The cost to the NHS of this process – let alone the distress caused to all those involved – must have been massive. And such timescales are not uncommon in MHPS cases.

MHPS investigations and support

Conducting an MHPS case will put serious demands on managers to conduct fair and thorough investigations. At Verita, we have carried out the investigation in a number of cases where the MHPS process has been used. In our experience, complex cases like this one do indeed need to be handled carefully. We also know that MHPS cases are often assigned to inexperienced managers or to fellow doctors, who might never have had to investigate colleagues before.

As specialists in investigations we are always happy to support or advise those carrying out investigations of this sort, or take on the investigation ourselves. We would much rather do that, than be called in to carry out an investigation after an internal one has gone wrong! MHPS investigations are never easy – but there is so much to be gained from carrying them out to a high standard and to a reasonable timetable.

If you would like to know more about how Verita can help you with MHPS investigations, do get in touch. We are always happy to talk through the issues around MHPS. Give us a call on 020 7494 5670 or email [email protected].

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