Final Report > Chapter 25: Competent Healthcare Professionals > The systems for assuring competence > Disciplinary action

Disciplinary action

71 We now come to the final element in the process of the regulation of healthcare professionals. If it begins with regulating entry into the profession, it ends, for some, in disciplinary action because of poor performance or misconduct. Of course, as more effort is focused on supporting healthcare professionals to develop and maintain good performance, the incidence of poor performance may decline. But it will happen from time to time. Our concern is how it should be dealt with.

72 We have already made it clear (in Chapter 24, A Health Service which is Well Led) that it must be the employer first and foremost who should be able to deal with poor performance and misconduct. We have proposed that the professional Codes of Conduct be incorporated into the contract between the healthcare professional and the relevant NHS employer. If this approach is accepted, the employer will be able to act not only in the case of breaches of duty owed as an employee but also when the professional has failed to observe the profession's Code of Conduct. In both circumstances, there would be a breach of contract enabling the employer to take appropriate action. Moreover, by empowering the employer in this way, issues can be resolved promptly and fairly, taking proper account of local circumstances, rather than be left to drag on through some lengthy process as is so often the case now. [32]

73 Whatever the employer may do, there is also the question whether the healthcare professional should be entitled to continue to practise or whether a limit on the individual's practice, including removal of recognition or registration, is called for. This aspect of regulation of professionals historically has been the responsibility of various professional bodies: the GMC, the UKCC for Nursing, Midwifery and Health Visiting and the Council for the Professions Supplementary to Medicine. As has been said, no professional regulatory body currently exists in the case of managers but we urge that it should.

74 We are aware that there are continuing discussions about the disciplinary role of the GMC in particular. We wish to make the following observations. All professional bodies charged with responsibility for disciplining their members must constantly keep in mind that they do so on behalf of the wider public. The trust granted to them is that they act in the public interest to preserve and maintain the safety and quality of healthcare provided to patients. To acquire the public's confidence and trust, these professional regulatory bodies must let the public in, to a degree not hitherto contemplated. The old binary approach to discipline - serious or nothing; removal from the register or nothing - is beginning to be dismantled. But the pace of change is not fast enough and the public's patience is running out. The professional bodies must be more flexible in their approach to what constitutes misconduct and practice that warrants disciplinary action; they must deal with cases as far as possible at a local level and they must have available a range of actions to meet the problem before them which both serve the interests of the public and the needs of the professional.

Footnotes

[32] One approach worthy of consideration is that represented by the Code of Practice published by ACAS in 1997 and brought into force by the Employment Protection Code of Practice (Disciplinary Practices and Procedures) Order 1998, SI 1998/44