Making recommendations: non-engagement where the doctor has raised public interest concerns

This scenario looks at:

  • The doctor has raised public interest concerns, which have been investigated and closed.
  • The issue of an actual or perceived conflict of interest between you and the doctor, where the doctor has raised public interest concerns. And how the higher level or second tier RO can be a source of advice for you.
  • Whether the doctor raising public interest concerns has had an effect on the doctor’s ability to engage in revalidation.
  • What we consider when making a decision on licence withdrawal in the circumstances where a doctor has raised public interest concerns.

Scenario: Making a non-engagement recommendation where the doctor has raised public interest concerns

Dr Nathwani raised a public interest concern about night time staffing levels on the acute admissions ward in November 2017. The concern was fully investigated and the designated body decided no further action was needed. Dr Nathwani was frustrated with the outcome and believes the concerns were not properly investigated and therefore was not engaging in revalidation.

Dr Nathwani’s revalidation date was in July 2018, however she did not complete all of her annual appraisals, or manage to collect and reflect on all of the required supporting information by her revalidation date.

Key points: Making a non-engagement recommendation where the doctor has raised public interest concerns

Key issues are:

  • doctors must be given sufficient opportunity and support to engage
  • you should check whether a doctor has made efforts to engage, even if this has not been successful
  • you should consider whether there are reasonable circumstances that explain the doctor’s non-engagement
  • you may want to check whether the doctor has raised public interest concerns and specifically has this prevented the doctor from engaging in revalidation, e.g. are they on sick leave?
  • in all cases of non-engagement where the doctor has raised public interest concerns you should discuss the situation with your Communitybaptistpa Employer Liaison Adviser (ELA).

Your ELA will discuss the following with you:

  • the reason for the doctor’s lack of engagement including whether the doctor raising public interest concerns has had an impact on their ability to engage in revalidation
  • ask you to keep a record of any discussions between the doctor, you or your team regarding the doctor raising public interest concerns and the revalidation process
  • how the doctor’s public interest concerns were investigated and how or if you were involved in the investigation
  • suggest if there appears to be an actual or perceived conflict of interest that you seek advice from your higher-level or second tier RO.

In more detail: Making a non-engagement recommendation where the doctor has raised public interest concerns

You can discuss the situation with your higher level RO (HLRO) or second tier RO and consider whether a non-engagement recommendation is appropriate and whether there is a perceived or actual conflict of interest between you and the doctor.

In this case, the HLRO/second tier RO noted that the RO had not been made aware of the doctor’s concerns until after they had been investigated and closed. He had not been involved in the investigation directly; this was handled by a local case manager. There was therefore, no conflict of interest and it was appropriate for the RO to make a non-engagement recommendation to us.

If you have been directly involved in the investigation of the doctor’s concerns, there may be a conflict of interest or a perception of one. It would, therefore, be appropriate for an alternative RO to be offered to complete the recommendation.

After considering all the information, you can make a non-engagement recommendation to us but you should always inform the doctor and your reason for it.

Following the recommendation we will provide the doctor with the opportunity to make any representations as part of the normal licence withdrawal process; including having the option to provide us with a reasonable excuse as to why they had not fulfilled the requirements and whether having raised public interest concerns has affected their ability to engage in revalidation.

In this case the doctor responded by telling us that she felt the non-engagement recommendation was made because she had raised public interest concerns.

We asked for clarification about why the doctor felt this was the case and if they had any information/documents that indicated this.

After consideration of all the information, our decision maker noted that:

  • the doctor had raised concerns which had been investigated locally and closed four months before the doctor’s revalidation date
  • the non-engagement recommendation was not a consequence of her having raised concerns
  • the doctor had been given sufficient opportunity to meet the requirements and had not been prevented from doing so
  • the doctor's engagement in the process following the investigation and closing of the public interest concerns had been poor
  • the doctor did not provide us with any evidence to demonstrate they had met all the requirements for appraisal and other supporting information and they did not provide an explanation as to why they had been prevented from meeting them
  • the information showed that the RO appropriately separated themselves from the process of investigating the doctor’s concerns. The RO was, therefore, able to make a recommendation to us without any bias or perception of bias.

Our decision maker decided to withdraw the doctor’s licence to practise.

Additional resources:

See more information about the requirements for making a recommendation when the doctor has raised public interest concerns.

Further information about managing conflicts of interest and bias during the revalidation process can be found at:

  • For England, Scotland and Wales, the , see page 30
  • , paragraphs 109-113.