Conducting fair disciplinary procedures in healthcare practices

In busy healthcare environments such as GP practices, dental surgeries, veterinary clinics, and primary care settings, managing staff disciplinary issues effectively is crucial for maintaining quality patient care and a positive workplace culture. But how should healthcare practice managers conduct disciplinary procedures to ensure they are fair and compliant? Here’s a comprehensive guide to following fair disciplinary procedures in healthcare HR management.

What is a disciplinary procedure?

A disciplinary procedure is a structured process enabling healthcare employers to address misconduct issues that might arise during an employee’s tenure. It establishes a framework that ensures consistency of treatment across your practice, while also allowing for individual circumstances and mitigating factors to be properly considered.

Remember the ACAS code!

The ACAS code of practice outlines the minimum best practice processes employers should follow when taking disciplinary action. While not following the ACAS code isn’t unlawful, compliance will be scrutinised in any unfair dismissal case. Compensation awards are often adjusted in the employee’s favour if the employer hasn’t adhered to the ACAS guidelines.

Disciplinary procedures in healthcare settings

Most healthcare organisations have procedures that allow for both informal and formal approaches.

Informal process

This typically involves a private meeting with the staff member where concerns are raised and discussed. The outcome may include issuing a ‘letter of concern’ that documents the discussion and outlines required improvements.

Using an informal process can often address issues before they impact patient care. Misconduct that remains unchecked can escalate to a point where the practice manager or clinician in charge becomes frustrated and wishes to terminate employment. In most cases, this would be considered unfair if no previous attempt has been made to alert the employee about their concerning behaviour. It’s vital that issues are addressed promptly to avoid any negative effects on patient care or practice operations.

The formal disciplinary process

A formal disciplinary process typically involves several stages:

1. Investigation (including consideration of suspension)

When misconduct is alleged, an investigation usually follows. The investigation must be fair and balanced – not solely focused on proving the employee’s guilt. The objective is to determine, on the balance of probabilities, whether there is a case to answer. Consider appointing an impartial investigator, perhaps from another department within your healthcare organisation.

In some cases, suspension (with full pay) may be appropriate while investigating, particularly if patient safety could be compromised. However, this decision shouldn’t be reactive – suspension is appropriate only if there’s a threat to the practice, patients, or other staff, or if the employee might interfere with the investigation. Suspension is not punitive nor an indication of guilt, so it should always be with pay.

2. Invitation to disciplinary hearing

Ensure the allegation is correctly formulated; consider including a more generic allegation (e.g., a breakdown in trust and confidence within the team), as specific allegations may not have sufficient evidence but the employee’s behaviour may have undermined essential trust relationships.

The invitation should specify potential outcomes of the meeting. If the issue constitutes potential gross misconduct (e.g., patient data breaches, medication errors, abuse of patients or colleagues), state that summary dismissal could result.

Provide adequate notice for the hearing so the healthcare employee can prepare their case. Include all relevant documentation and information to be used at the hearing. Explain the right to be accompanied and request confirmation of attendance.

3. The disciplinary hearing

Structure the hearing clearly and explain attendees’ roles. Outline how the hearing will be conducted (including representation rights) and whether notes will be taken. For virtual hearings (via Zoom or similar platforms), recording is an option if all parties consent.

Check for any additional or mitigating circumstances, such as understaffing, lack of training, or personal health issues. Always adjourn to consider the final decision.

4. The disciplinary outcome

Determine whether disciplinary action is justified. Refer to the hearing invitation when deciding, as you shouldn’t impose a sanction more severe than outlined in the invitation.

Potential outcomes include:

• No action (but could include alternatives such as clinical training, supervision, or professional counselling)
• Verbal warning
• First written warning
• Final written warning
• Dismissal with notice
• Summary dismissal (appropriate for gross misconduct affecting patient safety or care)

Confirm the outcome in writing, stating how long any warning will remain active. Clearly outline expected standards of future behaviour and conduct, potential consequences if no improvement occurs, and whether there will be reviews before the warning expires. Include information about the right to appeal.

5. The appeal process

Encourage the employee to provide written reasons for their appeal. Upon receipt, arrange a timely appeal hearing with an impartial Chair who hasn’t been involved in the previous disciplinary stages.

Potential outcomes include overturning the previous decision or dismissing the appeal and confirming the original decision. The appeal outcome concludes the internal process.

Healthcare-specific considerations

When managing disciplinary procedures in healthcare:

• Consider patient safety implications at every stage
• Maintain appropriate confidentiality regarding patient information
• Be aware of professional registration requirements (GMC, GDC, RCVS, NMC) that may be affected
• Document thoroughly with healthcare-specific contexts in mind
• Consider whether incidents require reporting to regulatory bodies

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Conclusion

Fair and effective disciplinary procedures are essential in healthcare settings where professional standards directly impact patient outcomes. By following these guidelines, practice managers in primary care, dental practices, veterinary clinics, and other healthcare settings can address misconduct constructively while protecting both patients and the organisation.