What is MHPS?
MHPS stands for ‘maintaining high performance standards’ which is a framework produced by the Department of Health to assess the performance of doctors and dentists. When dealing with performance concerns, NHS managers will utilise this national framework along with local processes and external support as part of an MHPS investigation.
There are several aims of the MHPS framework including improving patient care, encouraging collaboration, promoting continuous improvement and increasing efficiency. MHPS is therefore an important approach because it feeds into the primary objective of the NHS which is to continuously improve patient care.
MHPS in healthcare
Maintaining high performance standards in the healthcare sector is a challenging endeavour. 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.
It is especially difficult due to inhibitions about the special status of doctors, the lack of knowledge managers have with clinical skills and performance standards, and the reluctance to raise concerns over poor practise.
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 investigations 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 carry out MHPS processes only as a last resort due to concerns about how long and complicated the process can be. To avoid going down the route of MHPS, identifying performance issues as they arise is key. Addressing those issues rather than ignoring them will help to prevent them persisting.
Understanding how to manage performance issues is important to ensure the doctor 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.
Raising the issue promptly and constructively may be enough in itself to drive change but sometimes an MHPS case is needed.
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.
At Verita, we have supported the MHPS process of many cases by carrying out the investigation. In our experience, complex cases like this one do indeed need to be handled carefully.