Handling Concerns

There will be circumstances where concerns arise in relation to colleagues-in-training who are placed within Host Organisations. If concerns are raised in relation to a Lead Employer colleague, we will support your organisation to handle these in line with the appropriate Lead Employer policy.

Concerns raised may include matters relating to:

• The colleague-in-training's conduct, health or capability
• The disclosure of a health condition
• A colleague-in-training raising concerns about a colleague employed by their host organisation
• Matters regarding education and training
• Safeguarding matters
• General Medical Council Fitness to Practice Investigations
• Serious untoward incidents (SUI) and Never Events
• Concerns raised by patients in relation to care received by a Lead Employer colleague-in-training
• Colleagues involved in Police matters

In all of the above circumstances, it is vital to notify the Lead Employer at the earliest opportunity to enable prompt resolution of any concerns raised and appropriate support is offered to the colleague. 

Below we have delved into each matter to support with handling each concern.

• Health, Conduct or Capability

  In circumstances where matters arise relating to a colleague-in-training's conduct, health or capability may need to be investigated under the Lead Employer Handling Concerns Policy in line with the Maintaining High Professional Standards Framework (MHPS) and prompt advice must be sought from the Lead Employer HR Case Management Team in the first instance. Such concerns will be managed by the Lead Employer in conjunction with the Host Placement Provider and the appropriate NHS England region as the Educational Provider. 

  We understand that serious concerns may also arise which require immediate intervention including a period of exclusion from the workplace or restrictions to practise. In these circumstances a review of the facts available and risk assessments must be undertaken by senior stakeholders including the Lead Employer Medical Director, Post Graduate Dean, Associate Deans, Head of School, Training Programme Directors and Educational Supervisors, in conjunction with the Host Placement Provider HR and Medical Director. The decision to exclude or place restrictions on a colleague-in-training's practice must not be taken in isolation by the Host Placement Provider. 

  Host Organisations can familiarise themselves with the definition of close supervision and direct supervision.

  NB Where an immediate exclusion is required outside of normal office hours; this must be immediately reported to the Lead Employer Case Management Team the following working day to ensure a full review of the case can be undertaken with the Lead Employer Medical Director and NHSE senior stakeholders including the colleague-in-training's PGD and responsible officer. Where required the Lead Employer may also seek advice from external sources e.g., Safeguarding Teams, Practitioner Performance Advisory Service.

  In circumstances where a formal investigation under the Handling Concerns Policy is required, this decision will be communicated to the Host Organisation and the colleague-in-training. The Host Organisation will be asked to appoint an appropriately trained case investigator to undertake the investigation. Once appointed, the case investigator will be provided with full details of the concerns to be investigated including any supporting information.

  Guidance in conducting an investigation under the Lead Employer Handling Concerns Policy in line with the Maintaining High Professional Standards Framework (MHPS) is available here.

• Disclosure of a health condition

  The Lead Employer champions an equal, diverse, and inclusive workforce, as such, there will be occasions when colleagues-in-training require adjustments because of a health condition. In most cases, the need for adjustments is addressed during the recruitment process. Such adjustments are communicated with Host Organisations via the Lead Employer Management Information process. It is imperative that reasonable adjustments are implemented where recommended to ensure that the colleague has all appropriate support in place. 

  There are occasions when a colleagues-in-training is newly diagnosed with a health condition. In such circumstances, the Trainee or Host Organisation must share this information with the Lead Employer. This will enable the Lead Employer to offer the appropriate support and explore what (if any) reasonable adjustments may be needed to support the colleague through their speciality training. 

  In addition to this, should a host organisation recognise that a colleague-in-training would benefit from a referral to the Lead Employer Health, Work and Well-Being Team, a well-being referral form can be submitted here

• Raising concerns about a colleague employed by their Host Organisation

  We understand that there may be circumstances where a colleague-in-training wishes to raise concerns about another colleague employed by their Host Organisation. In these circumstances, the Lead Employer will always encourage informal resolution of these concerns in line with the Lead Employer Respect and Dignity at Work Policy. In circumstances where informal resolution is not deemed possible, full details of the concerns raised by the Lead Employer trainee will be shared with the Host Organisation to undertake a formal investigation. This investigation must be carried out by an appropriately trained colleague from the Host Organisation. For Guidance in conducting an investigation under the Lead Employer Respect and Dignity at Work Policy can be found here

  All such concerns must be discussed with the Lead Employer immediately to enable the Host Organisation to be supported to resolve the concerns raised in a timely manner and enable the Lead Employer to offer appropriate support to the colleague-in-training raising the concerns.

• A colleague-in-training's education

  Any concerns relating to a colleagues-in-training's prior education must be raised with the relevant NHSE Programme in the first instance. Any colleagues requiring additional support because of an educational concern being raised must be communicated to the Lead Employer to enable the offer of support to be given to the colleagues-in-training.

• Safeguarding

  Where safeguarding concerns are raised involving a colleague-in-training, these must be immediately notified to the Lead Employer. In these circumstances the Lead Employer team will liaise directly with Mersey and West Lancashire Teaching Hospitals NHS Trust Safeguarding Lead, and external parties to ensure the relevant stakeholders are involved i.e. LADO, Police, and Social Services etc. The Lead Employer will liaise directly with the Host Placement Provider to ensure that appropriate updates are shared.

• General Medical Council Fitness to Practice Investigations

  The General Medical Council are required to investigate any concerns about a Doctor’s ability to practise safely or threaten public confidence in the profession. We are aware that such investigations can be difficult and stressful for the trainee who is under investigation.

  As the colleague-in-training's employer, the Lead Employer receive notification of any such investigation from the GMC which results in support being offered to the colleague by the Lead Employer.

  Host Organisations will be notified of any colleague-in-training who is subject to a GMC Fitness to Practice investigation. The purpose of sharing this information is to enable the colleague to be supported by their Host Organisation throughout the duration of the GMC FtP investigation. 

• Serious Untoward incidents (SUI) and Never Events

  During a period of training, a colleague-in-training may be involved in an SUI or Never Event, which then the Host Placement Provider will be required to undertake their own internal investigation/Root Cause Analysis. In these circumstances, the Host Placement Provider must formally notify the Lead Employer HR Team, NHSE Senior Educational stakeholders including Postgraduate Dean and Associate Deans. 

  In these circumstances, there is also a requirement for the Lead Employer Medical Director to be notified so relevant risk assessments can be undertaken in conjunction with NHSE Regional Office, and the Host Placement Provider to provide appropriate assurances that patient safety is not impacted. In these situations, it may also be necessary for interim restrictions to practice being implemented with approval from the key stakeholders as outlined above. 

  N.B. Restrictions to practice should be discussed with the Lead Employer Medical Director in conjunction with the NHSE Regional Office before they are put in place.

• Concerns raised by patients in relation to care received by a Lead Employer colleague

  We are aware that Patient complaints can be distressing for our colleagues-in-training. Whilst we appreciate that often, such complaints can be dealt with locally. It is vital to ensure that a colleague subject to a patient complaint is offered the appropriate support. It is therefore important that we are notified of any patient complaint received in relation to Lead Employer colleagues-in-training.

  This will enable the Lead Employer to provide timely support to the individual and assess if any intervention is needed from the Lead Employer. 

• Colleagues involved in Police matters

  There may be situations when colleagues-in-training are involved in Police matters, which can range from being a victim of crime, be an alleged perpetrator of a crime or being subject to a patient complaint that has been escalated to the Police. It is vital that the Lead Employer are aware of any such situations as soon as a Host organisations becomes aware of any Police involvement relating to a Lead Employer Trainee.

  The Lead Employer will liaise closely with Host Organisations to determine the most appropriate action to be taken dependent upon the circumstances of the situation.