NHSE Performance Advisory Group (PAG) Law

Performance Advisory Group Law - Legal Advice

Performance Advisory Group (PAG) Legal Guidance – Legal Advice and Representation

What is a Performance Advisory Group (PAG)?

A Performance Advisory Group (PAG) of National Health Service England (NHSE) is a small, local panel of people who are tasked with carrying out or directing the scope of investigatory and advisory work relating to concerns about doctors on the Performers Lists. Their role is to support the NHS in meeting its responsibilities in managing the performance of doctors on the lists (known as primary care performers). Investigations will be directed by the PAG and they will on occasions agree undertakings with a doctor, to agree rules of conduct and competence that a doctor must meet, if concerns are not to escalate to a Perfomers List Decision making Panel (PLDP) level hearing.

The PAG framework is set out in the Framework for Managing Performer Concerns (NHSE 2017, revised May 2022).

See the: Framework for managing performer concerns (May 2022)

See the February 2022 PAG document: Practitioner Performance Advice: Professional Support and Remediation plans: guidance and resources for clinical supervisors – a guide to supporting doctors who need clinical or other support and assistance with remedial steps to be taken.

What does a PAG investigate?

Each case will turn on its own facts. Some doctors might be investigated in relation to their ill-health and their ability to perform (or not) their duties, as a consequence of cognitive or physical impairment – including the misuse of drugs or alcohol. Some doctors will be investigated due to behavioural concerns, such as irritability or anger or unusual behaviour that is at odds with the work ethics, and which is impacting on their ability to do their job. Doctors can be investigated due to alleged criminal activity, such as fraudulent use of prescriptions or claiming for monies that they are not entitled to, or failing to deliver services to the level expected, sometimes leading to the involvement of NHS Counter-Fraud. In other cases, doctors can be investigated for poor clinical performance or sub-optimal decision making that risks impacting on patient care or wider service delivery. This list is not exhaustive.

How does PAG handle Concerns about Doctors

PAG will usually meet without the doctor being present, examining the evidence and forulating a plan of action. Investigations behind the scenes, to gather evidence, will also take place. The PAG will usually arrange for their concerns to be put in writing and invite the doctor’s comments. A carefully written submission at this stage can often bring an investigation to an end. However, some investigations and monitoring may occur over a longer period of time. If a doctor satisfies the PAG that the concerns have been properly acknowledged and that steps have been taken to remediate any perceived sub-optimal practise or behaviour and demonstrate insight and lower the risk of repetition, the investigation may well come to an end. On occasions doctors face allegations that are unfounded but nevertheless it will be helpful to demonstrate, all the same, that they have worked on the area of concern in such a way as to reassure PAG that whether true or not the conduct of concern is unlikely to be repeated.

Agreeing and Withdrawing Undertakings with PAG

An undertaking is an agreement between the NHS and a doctor which governs the way  they should conduct themselves. PAG will look at all of the evidence available and consider a doctor’s replies. If they are of the view that the concerns can be managed by undertakings, they will draft a document and send it to the doctor for consideration. The doctor can suggest amendments before signing undertakings. Once a doctor signs an undertakings agreement, they must adhere to it. Any failure to work within the undertakings could lead to the case being escalated to a PLDP hearing. In most cases, undertakings will be in place for a number of months and then be withdrawn by mutual agreement. Undertakings can include agreeing to behave appropriately, or to not carry out certain work at all or without supervision. A doctor can apply to the PAG to have the undertakings withdrawn or amended as time passes. Many concerns about doctors are managed by undertakings, thereby avoiding more formal interventions.

What should a doctor say to PAG?

A doctor should be very careful in the way that they respond to concerns raised through the PAG process. Inconsistent statements should be avoided.

A careful analysis of the available evidence should be undertaken, and clarity sought where there is uncertainty or little evidence to support a concern. Further disclosure should be obtained where needed.

A doctor facing allegations will usually need to obtain evidence in support of what they are saying in reply (their defence or mitigation), or obtain evidence to undermine the concerns/allegations brought against them.

Submitting a written submission (letter) to PAG is also usually very helpful and can lead to the closure of concerns. Such a reply should be carefully crafted. We can advise on the content of such letters and the evidence that should be appended in support.

If you are a doctor seeking legal advice or representation in relation to a NHSE PAG investigation or meeting, contact us in strict confidence and without obligation on: 0800 10 88 739