NHSE Professional Standards Group (PSG) (formerly (PAG)) Law
Performance Advisory Group (PAG) Legal Guidance – Legal Advice and Representation – Now the Professional Standards Group (PSG)
What is a Professional Standards Group (PSG) formely the Performance Advisory Group (PAG)?
A Professional Standards Group (PSG, fomerly the 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 clinical governance role is to support the NHS in meeting its responsibilities in managing the performance of doctors on the lists (known as primary care performers – such as GPs). Investigations will be directed by the PSG and they will on occasions agree undertakings (known as Agreement Terms) with a doctor, so as to agree rules/standards of conduct and competence that a doctor must meet, if the concerns are not to escalate to a Performers List Decision-making Panel (PLDP) level hearing.
The PSG holds private meetings; the public is not permitted to attend. A Local Representative Committee (LRC) member may be invited to attend but enjoys no voting rights.
Remit of the PSG
The Professional Standards Group (PSG) has the following remit:
NHS England has established a Professional Standards Group (PSG) to support the assessment and management of concerns relating to performers. The remit of the PSG is to consider information relating to applicants wishing to join the NHS England Performers Lists and performers already on the NHS England Performers Lists, and to make well-reasoned and robust decisions in relation to the information presented so that patients and the public are protected, and performers only work in primary care when they are safe to do so.
(see: Policy on managing the NHS Performers Lists (England), para 10)
The obligations of the PSG are as follows (at para 10.2 of the above-linked document):
- patient safety is of paramount importance
- concerns are managed in a consistent, fair, open and non-discriminatory way
- performers whose performance, conduct or health has given cause for concern are supported to return to a satisfactory standard wherever possible
- the resolution of concerns is through appropriate local action and support to remedy issues wherever possible
- where health concerns are indicated that appropriate advice is sought from occupational health or other specialist services to help inform appropriate resolution
- concerns are resolved and managed with input from the performer
- where it is deemed to be necessary, information is shared with, or referrals are made to, other health regulators to protect patients, the performer and the public purse
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Checklist for Doctors Facing PSG
DDS has produced a checklist for doctors facing PSG investigations, based on the criteria the group is to apply when considering concerns about a doctor. It may assist doctors to provide the relevant evidence needed to reassure the PSG: The PSG Checklist (compiled by DDS)
What should Doctors Submit to the PSG?
A doctor might consider including the following information when submitting their bundle to the PSG: List of Evidence for Doctors to Supply to the PSG
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This web page is under review and is not yet fully updated as of 29/3/26
The previous 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 (PSG) 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 (PSG) 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 (PSG)
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 (PSG)?
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 (PSG) 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 (PSG) investigation or meeting, contact us in strict confidence and without obligation on: 0800 10 88 739