Ruth Clement is Head of Kent Children’s Therapies at Kent Community Health NHS Foundation Trust.
A concern was raised about a HCPC-registered therapist that Ruth line-managed. Here she gives her perspective on the events and shares tips for employers or managers in similar situations.
I manage the Children’s Therapies team in our NHS Community Trust. In March 2022 a therapist in the team was notified by the HCPC about a fitness to practise (FTP) concern that had been raisedThis was the first time the therapist or I had had any involvement in a fitness to practise case.
In addition to supporting my employee, I was required to contribute to the process in my capacity as their line manager. This contribution was intended to identify if there were any concerns over the individual’s ability to practise. I suspect this part of the process was simpler for me than it might have been if, for example, there had been concerns about the individual’s clinical competence, or if any previous complaints had been upheld.
Ultimately, the panel considering the concern found there was no case to answer. But having been through this experience, and with the benefit of reflection, I can share my insights for other employers and line managers who may find themselves in the same position.
1Seek support from within your organisation
Throughout the fitness to practise process, the HCPC required detailed information from the clinician relating to their role with the complainant. This included copies of clinical records and would often be requested with tight deadlines. If the registrant had been involved with the complaint for a long time, then pulling this together would be no small task.
We engaged the support of our organisation’s legal team to assist with the disclosure of information and the formatting of responses. I cannot stress how much of a difference their involvement made in the management of the whole process. What is for most clinicians a daunting and unfamiliar task is the legal team’s everyday business.
The team gave us clarity and structure that enabled us to navigate the process. Most notably, this included the confidence with which they pushed back to the HCPC to renegotiate timescales: these didn’t always seem reasonable to achieve for a practising clinician with a full caseload. Had it been left to myself and the clinician I’m not sure we would have had the courage to challenge the deadlines. Of course, not everyone will be able to take advantage of a support service like this, but if it is available for you, my recommendation would be to use it.
2Be aware of the impact on the registrant
To date, research into the impact of fitness to practice investigations on clinicians’ health and wellbeing has mostly focused on doctors and nurses, but there is little doubt that this process can have a profoundly negative effect on any person under investigation.
While the HCPC, in its communications to the clinician, did acknowledge that this was a stressful process, I felt that the onus was on the clinician to identify that stress and seek support, or for me as the line manager to discuss that need with them. I would expect that, in many cases, access to counselling would be beneficial. This is something that the manager would need to explore or suggest.
In this case, the clinician remained remarkably resilient and pragmatic throughout. I suspect their response was exceptional. They were able to reflect on the learning opportunities presented by the requirement to scrutinise and unpick their clinical decision-making. At the end of the experience, they explained that this was attributable to a number of factors.
These included the support available from their organisation and line manager, which allowed them to step away from clinical work when they needed to focus on providing information for the investigation.
Another factor was the knowledge that the concern being raised had previously been investigated by myself and our organisation’s complaints team; an investigation which had concluded that appropriate care had been delivered. This gave the clinician some level of confidence in further examining their clinical decisions and reasoning.
The clinician reflected that, if they had simultaneously been dealing with bereavement or relationship issues, for example, they may not have had the same level of resilience. The absence of other significant life events or pressures at that time played its part in helping them cope with the situation. (Of course, we have no way of predicting or managing when a fitness to practise case could land and no control on the other factors at play in a clinician’s life.)
3Offer practical support to the employee
A key practical way I was able to offer support to my clinician was to enable them to clear their diary at the points where they needed to collate information and provide the clinical perspective to the HCPC.
Another way was reviewing responses to the HCPC together, and alongside the legal team. I believe that taking the role of critical friend within that context enabled an objective examination of the content.
Finally, as I have indicated, the need for pastoral support for this individual was minimal, but counselling was certainly at the forefront of my mind in our conversations. If there had been any doubt over this, I would have suggested seeking professional support swiftly.
4Don’t be afraid to feed your experience back, positive or negative
During the ten-month process I was aware that the clinician was struggling to make sense of the communications sent to them and to unpick the HCPC’s expectations, and there was a lack of responsiveness to the clinician’s approaches throughout the process.
At the time, I felt my ability to intervene with this was limited. I had no knowledge of what was normal for the process, and feared influencing the outcome.
However, once the outcome had been decided and the investigation had ceased, the clinician and I shared our thoughts and experiences with the HCPC. We fed back the difference that could have been made by unambiguous communication, clear timescales and the importance of quick contact with case workers.
The clinician and I were pleased to be met with a positive response that took the feedback seriously. There is now active work being done in the organisation as a result of our engagement, and active work that has already taken place in these areas.
If they have the chance, I would absolutely encourage other employers, managers or registrants involved in the process to feed back on their experiences to the HCPC.
Following research commissioned by the HCPC into the impact of fitness to practise on its registrants, the HCPC has developed and has been delivering its Registrant Health and Wellbeing Strategy 2021-24. This has included:
- Developing and embedding a new tone of voice
- Developing new organisational values, and delivering a programme of work to embed its new 'compassionate' value
- Publishing new information to support registrants, including new Health and Character Guidance and a reflective practice toolkit
- Dedicated information pages in the HCPC Employer Hub with support for managing concerns locally
- The development of, and work undertaken by, the Professional Liaison Service: to support registrants and employers with knowledge about the fitness to practise process and other aspects relevant to registration
Registrants who are involved in a fitness to practise case are always encouraged to obtain support and advice from their professional body, trade union and/or employer.
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