Dealing with disciplinary investigations

• Facing a disciplinary investigation as a doctor can be daunting, but we can help.
• Contact us first. The sooner we're involved, the sooner we can support you.
• Don't rush into a response without getting advice.

An investigation by an employer is potentially one of the most emotionally demanding professional experiences a doctor can face.

It generally involves people you're close to and work with, so it's not unusual for there to be a complex interplay of system and human factors in the background and a long history of problems within a department.

Thankfully, we have a specialist disciplinary team that has helped hundreds of our members through these complex investigations. Because of this, we're expertly placed to answer the sorts of questions that come up at the beginning of an investigation.

Here are some of the most common.

Finding out - and first steps

I've just been told I'm facing a disciplinary investigation into my clinical care of patients. What should I do now?

First things first - contact us. We like to be involved as early as possible, and ideally before you respond to the allegations.

It's important to wait for as much information as possible before giving your account of events. You can ask for the allegations that have been made, and you can ask to see the relevant clinical records, but this may take a little while to collate.

Don't access clinical records without permission, and don't ask who has raised the concerns at this point.

Can the MDU help?

Yes we can. If you're told about an investigation about your care of patients, contact our advice line on 0800 716 646 or email us at advisory@themdu.com.

Your case will be allocated to an adviser with experience of assisting members with complex disciplinary and GMC investigations. All our advisers are doctors themselves, and they'll be able to guide you through the process and what to do next.

We also have a peer support network of members who have first-hand experience of being investigated (you can read more about that in our digital journal).

If you're facing allegations about your personal conduct as well as care of patients, we will likely advise you to contact the BMA or HCSA for support with those aspects.

What information do I need to send to the MDU?

It's helpful for us to see everything you're sent about the investigation, especially the allegations in the terms of reference and the policy being followed by your employer.

It's essential we have the facts of your response - again, ideally before you give any account to the investigation yourself.

What happens in the investigation

Can you look at my statement?

Your MDU adviser will be able to help you draft and revise your statement. This is an opportunity to get your thoughts in order, set out the chronology and collate the facts. It shouldn't contain any patient identifiable information, such as names and addresses.

Your adviser will tell you how and when to send your draft statement through - but don't send it to the employer until we've had a chance to advise you further.

Can you come to a meeting with me?

Investigatory meetings and hearings are largely held remotely, but we're usually still able to be involved and represent you nevertheless. Most employers allow dual representation if you also need BMA support for conduct allegations.

If you're called to a meeting urgently by your medical director, it's more likely that you'll be given some information, rather than being asked for a response. Write down what you're told.

If there's a simple answer - for example, they have the wrong doctor - you can say that. For any matters recorded in a document, whether an email or a clinical note, we'd suggest deferring a response until you've had time to check the documents and take advice.

Who else do I need to tell about an investigation?

There can be obligations to notify other agencies, but this depends on your circumstances.

• If any restrictions at all are placed on your practice, you must notify all other employers, workplaces, and any patients you see independently.
• If the investigation is ongoing while you have an appraisal, you'd need to mention this in your appraisal and ensure it's noted in the outcome form, together with any restrictions.
• If you are a GP on a Performer's List and become the subject of an investigation, you must inform NHS England or the relevant health board in Wales, Scotland or Northern Ireland.
• If you have practising privileges or a contractual relationship with a private provider, it's possible the terms of your agreement include that you will inform them of investigations by an employer.
• If the same events give rise to criticism by a public inquiry/ inquest or a criminal charge, you must inform the GMC.

What might happen next

Will I be referred to the GMC?

In general, the GMC waits for the local process to conclude, as many cases resolve without any need for their involvement. Do not self-refer to the GMC without discussing the situation with the MDU.

Your responsible officer should be aware of the investigation and will have regular meetings with a GMC employment liaison adviser, where they will discuss doctors at risk of referral to the GMC.

I've had restrictions placed on me. Is that reasonable?

The employer's policy will set out the threshold for restricting a doctor's practice. This is typically that the medical director considers the restriction necessary to maintain patient safety, or to prevent interference in the investigation.

Restrictions are also often imposed to protect a doctor from the risk of further allegations being made - for example, when a doctor is vulnerable because serious allegations have been made.

It's possible to suggest alternative restrictions. If you're restricted from clinical work for a prolonged period of time, it may be appropriate to request a placement elsewhere so you can maintain your clinical skills.

What might the outcomes be?

Most cases end with a remediation plan of some kind. Other options include no action, mediation, a referral to practitioner performance advice and/or an employer panel hearing to consider a warning or (rarely) a dismissal.

The outcome depends on the evidence of what happened and the view your employer takes of it - and how much you agree. Where an employer and a doctor don't agree about what happened or what safe care would look like in future, the employer is more likely to dismiss a doctor.

Clinical matters that are near misses or that caused harm are potentially very serious, but the insight a doctor has after the incident usually has more of an impact on the outcome of an investigation.

Should I call the complainant and apologise?

Immediately after an incident, you can speak to your colleagues, and should consider your duty of candour to patients. This includes during routine clinical governance processes like morbidity and mortality meetings.

An apology is not an admission of liability, and may prevent an escalation in the concern and open the door to positive communication in future.

Once you've been told of an investigation, do not contact any witnesses to discuss the situation. That includes the complainant, as this can be perceived as interfering in the process or even attempting to intimidate a witness.

If you have an outstanding need to comply with the ethical duty of candour, it's possible to pass on a written apology via the case manager.

Are there limits to the MDU's support?

Our member guide outlines the type of things we usually assist with, as well as the sorts of situations where we're unlikely to assist.

Even if we're not assisting you with an investigation by your employer (for example, if the allegations are about personal conduct rather than your care of patients), please do let us know if the investigation progresses. And we encourage members to seek our assistance with GMC investigations, regardless of whether or not they are to do with clinical care.

If you're ever in doubt about whether or not we might assist you, you're always welcome to contact us to find out.

This page was correct at publication on 23/08/2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.