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NHS England Investigations

Aug 19, 2025

Background

Dr B is an experienced GP, who was working sessions for a private, and exclusively remote, GP organisation. He had been working there successfully for some time, when he was allocated a new supervisor. Dr B found the relationship with his new supervisor more challenging and less collaborative than the positive relationship he had enjoyed with his previous supervisor.

At one of Dr B’s routine meetings with his new supervisor, his supervisor informed him that he had reviewed a number of Dr B’s patient consultations (telephone recordings and written records) and had some concerns about the way in which those consultations were managed. The concerns related to various areas of clinical practice. Dr B’s supervisor asked him to undertake an online GP skills and knowledge assessment.  His supervisor then suggested they meet again to discuss his concerns, and Dr B’s online assessment results, so he could reassure himself that Dr B was practising to the appropriate standard.

Dr B was upset by the approach his supervisor had taken regarding what he believed to be relatively minor concerns, and felt that he had been over critical and unreasonable in asking him to undertake a formal online assessment. Dr B therefore decided to resign from his position, before taking the assessment or having any further meetings with his supervisor.

NHS England involvement

In light of Dr B’s resignation, his supervisor referred his unaddressed concerns to NHS England, as Dr B was of course on NHS England’s Performers List.

NHS England has a statutory responsibility to respond to concerns raised about a GP, dentist or ophthalmic performer on the National Performers List. NHS England is responsible for ensuring those on its performers list are safe and able to work independently in the relevant setting. When NHS England is notified of a concern, it undertakes a risk assessment to establish the potential risk to patient safety. It will then undertake a preliminary enquiry. This involves, amongst other things, informing the performer about the concern; inviting them to reflect on the information received; and giving the performer an opportunity to provide a written response to the concerns, along with any information which the performer considers relevant. NHS England may also gather information from third parties and / or conduct a formal investigation. The information which NHS England gathers must then be considered by a Professional Standards Group (“PSG”) Panel or a Performers List Disciplinary Panel to decide what, if any, further action is required. Performers List regulatory actions include suspension from a list, imposition of conditions, or removal from a list.

In this case, NHS England contacted Dr B to inform him of the referral, and invited him to reflect and to provide a response to the concerns raised, along with any other documents that might assist NHS England with its decision making. At this point, Dr B contacted the Medical Defense Society for assistance, and we were instructed to act on his behalf.

Assisting Dr B

As soon as we were instructed to assist Dr B, we contacted him to offer reassurance that we would be able to help him in dealing with the NHS England process. We invited him to provide us with all of the relevant documents, which we reviewed, before arranging to meet Dr B. In addition to Dr B being invited to provide a written response to NHS England, he was also invited to attend a meeting to discuss the concerns.

When we met with Dr B, we explained the NHS England process for dealing with concerns, where he was within that process, and what would happen next. Having reviewed Dr B’s draft response to the concerns (which Dr B had already prepared when we met), we explored the concerns in more detail, and were able to offer advice on possible changes to the response for Dr B to consider. As Dr B had felt upset by his supervisor’s criticisms, which he felt were unnecessarily harsh, he found it difficult to accept that there might be justification for any of the concerns. We were able to assist Dr B in viewing the concerns in a more objective manner, and in gaining a better understanding of where some areas of concern might be valid. We were also able to offer advice on how Dr B could reassure NHS England that any concerns were not serious enough as to require any regulatory action. With our help, Dr B was able to view the concerns more objectively, and revise his draft response, acknowledging where he could have improved on some areas of his practice noted in the audited consultations. Dr B was able to explain how he had taken this opportunity to reflect, and undertake relevant CPD, to ensure he was practising at a high standard.

We arranged to attend the NHS England meeting with Dr B, and met with him beforehand to explain the type of questions that he might be asked, and offer suggestions on how to participate in the most helpful way. We assisted Dr B in finalising his response to the concerns before the meeting, and advised him to use that document as a reference point during the meeting. In our experience, this is helpful, since it is common to become anxious during meetings and either say unintended things, or omit to say important things. We were able to reassure Dr B that we were there to intervene if the correct process was not followed by NHS England, or if he needed prompting to refer to his written response.

The meeting with NHS England went smoothly, and afterwards we assisted Dr B in finalising his written response and gathering further supportive information. As Dr B had since taken up a new position, we suggested sending NHS England copies of recent audits undertaken by his new employer, to reassure NHS England that there were no concerns in Dr B’s current position. We also assisted in obtaining character evidence, and suggesting relevant CPD activities for Dr B to complete. Finally, we encouraged Dr B to undertake the online assessment that his previous supervisor had recommended, so we were able to inform NHS England this had been done. At all times in assisting Dr B, we had in mind that the matter could, potentially, come to the attention of the GMC. Therefore, it was important to have in mind the view the GMC might take of any information or documents which Dr B provided to NHS England.

Outcome

Once NHS England had gathered all of the relevant information, the case was referred to a PSG for a decision. Fortunately, having considered all of the material provided to it, the PSG decided to close Dr B’s case with no further action, which allowed him to put this matter behind him, and focus on his future in his new role.

Learning Points

  • It is important for practitioners to seek help from their defence organisation at an early stage in any investigation.
  • It is important to engage fully with investigatory processes at every stage. This matter could potentially have been resolved without NHS England if Dr D had agreed to undertake the GP skills and knowledge assessment originally requested by his supervisor.
  • Try and approach all concerns as opportunities to learn and, potentially, to improve practice.
  • Be well prepared for any investigatory meetings. Have a plan of the points you wish to make, and try to stick to the plan.
  • Bear in mind that anything said or documented within any investigatory procedure could at some point end up being considered by the GMC, so speak and write accordingly.
  • It is important to look after your wellbeing during investigations, so do seek appropriate support. Some excellent and free resources include:

 

Author: Leigh Taylor – Consultant Solicitor, Keystone Law