Will the Practitioner Performance Advice(formerly NCAS) do more to deter referring employers’ untruths about medical whistleblowers? Perhaps.

By Dr Minh Alexander retired consultant psychiatrist 20 May 2022

Summary: The Practitioner Performance Advice Service (formerly the National Clinical Assessment Service or NCAS) has a history of enabling NHS employers’ victimisation of medical whistleblowers by rubber stamping unjust suspensions and disciplinary action. PPA issues advice based on what it is told by employers, which is sometimes false. Employers manipulate the process to obtain the advice that they want from PPA, in order to seriously mistreat staff who may be blameless. This poses serious health risks to the mistreated staff and represents a gross waste of precious medical personnel. NHS Resolution has now agreed to consider safeguards against being fed false information by employers, such as requiring a statement of truth from employers.

PPA, formerly NCAS, is an NHS oddity which supervises the operation of the much criticised Maintaining High Professional Standards process in the NHS – a disciplinary process for senior doctors. In recent years NCAS (PPA) has come under the control of NHS Resolution.

Maintaining High Professional Standards (MHPS) 2005

MHPS was seen as an own goal by the BMA which accepted this provision in place of much more rigorous and fair processes for disciplining senior doctors.

The well-known case of Wendy Savage obstetrician, who was successfully defended under the old procedure, would most likely have turned out quite differently if she had been at the mercy of MHPS.

Consultants used to have rights of appeal to the Secretary of State. Nowadays, whistleblowers’ letters just pile up on the floor of the Minister’s office, assuming they are even allowed to get that far. Part of the game is to block contact, to preserve plausible deniability.

A critique of MHPS was provided by John Hendy QC:

HC(90)9 v MHPS: managers win after doctors’ own goal! 2008

Employers’ Discipline of Doctors in the NHS

For the little that it is worth, this is a link to official NHS guidance for employers on the competencies required of case investigators and case managers:

NHS England/ Improvement page on MHPS guidance

PPA has no powers, it is merely a consultative service with which employers must liaise in order to trigger suspensions and disciplinary action on grounds of incapability or misconduct.

In the experience of practitioners at the receiving end of this service, employers easily manipulate this arrangement by feeding whatever information is necessary to NCAS to get a desired outcome and a rubber stamp for their actions.

Those who are entirely blameless can be easily suspended and disciplined by abusing the MHPS/PPA mechanism.

And so many NHS whistleblowers have been roughed up by this route.

The unnecessary suspension of doctors is both traumatic for the individuals, constituting serious threat to health, and also a great waste of precious personnel resource for the NHS.

Surgeons in particular are easily de-skilled and it is very wrong that precious, expensively trained medical resource can be so easily flushed down the drain by corrupt managers covering up and protecting their own interests.

After continuing examples of baseless whistleblower exclusions such as those of Mr Tristan Reuser and, Dr Jasna Macanovic, I pressed NHS Resolution, to ensure that PPA implements safeguards against employers’ lies about whistleblowers.

This is a letter of 27 March 2022 to NHS Resolution’s CEO Helen Vernon about the issue:

Letter to Helen Vernon about introducing NCAS safeguards

Today, NHS Resolution has responded in a letter about various matters, with the relevant extract as follows:

“Turning to the first and the query about declarations from managers (including medical managers) who request advice and interventions (including assessments) from Practitioner Performance Advice. You will be aware that we already ask at the point of an initial contact with Advice whether the practitioner is a whistleblower or has made public interest disclosures and are able to offer advice within the context of that. We would anticipate this would be considered routinely throughout the lifetime of a case.

We are currently reviewing our approach to cases which go to the Assessment Consideration Group which determines whether or not a case is suitable for a behavioural or clinical performance assessment or professional support and remediation plan (and is being extended to consider team reviews and assisted mediations). This is equivalent to the type of decision making forum where the GMC have implemented Hooper’s recommendations as part of the fitness to practice referrals. We will be considering with stakeholders (including practitioners) how we can incorporate a statement of truth regarding their referral and whether we need to do something in addition to our current practice to consider whether or not the practitioner has made public interest disclosures. In our referral documentation the practitioner has space to write about the referral from their perspective and this currently provides an opportunity for practitioners to record if they consider themselves to be a whistleblower.” [my emphasis]

So we may in due course see a requirement for medical managers to make a statement of truth when referring doctors to PPA and when seeking PPA’s agreement for exclusions and disciplinary action under MHPS.

This would not stop victimisation but it would add a small safeguard that can be levered if necessary. As was a similar GMC safeguard in the case of Mr Reuser, when a false GMC referral ended in a GMC warning against his former medical director.

I have asked NHS Resolution to:

Advise of the timescale for the above work and to feed back the outcome of its deliberations.
Ask referring medical managers to make a formal declaration about whether the referred doctors are whistleblowers. It is not enough just to ask referred doctors to self-declare. The whole point is that referring organisations must be made to take responsibility and be held accountable for how they treat whistleblowers, in full awareness of a person’s status as a whistleblower.

I have emphasised that insufficient protective action, by not deterring employers’ abuse of process, would mean that NHS Resolution risks contributing to the serious personal injury of blameless whistleblowers. Which would be rich for the agency that oversees the NHS’ compensation of staff for work-related injuries.

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