In Nirmal v Birmingham Women’s and Children’s Hospital NHS Foundation Trust (2026), the High Court confirmed how employers should approach concerns raised against doctors (or dentists) in recognised training grades under Maintaining High Professional Standards (MHPS). 

In this insight, we look at the reasons for this decision and key takeaways for employers. 

Background 

The Claimant, a trainee doctor, sought an injunction against Birmingham Women’s & Children’s Hospital NHS Foundation Trust (the Trust) in respect of an ongoing MHPS process.  

Upon receipt of concerns about the Claimant’s behaviour from two female employees, the Trust undertook an initial fact-finding process and met with the Claimant to discuss the concerns, which were denied. The Trust’s Practitioner Advisory Group (PAG) considered the fact finding and consulted with Health Education England (HEE) in respect of whether the concerns should be investigated by the Deanery or the Trust. HEE advised that the concerns were a ‘conduct issue’ and should be investigated by the Trust. As such, the Trust’s PAG concluded that the concerns should be formally investigated under the MHPS procedure and the investigation was commenced in April 2025.  

The investigation concluded in December 2025, and the Claimant was notified that the matter would proceed to a misconduct hearing on 4 March 2026.  

The Claimant subsequently issued an urgent application in the High Court on 2 March 2026 seeking an injunction to prevent the misconduct hearing from proceeding. One of the arguments advanced by the Claimant was that the Trust was required to treat the allegations against him as a ‘training issue’. He argued that this was in accordance with both the Gold Guide and the National MHPS Framework, with the latter stating:  

“Any allegation of misconduct against a doctor or dentist in recognised training grades should be considered initially as a training issue and dealt with via the educational supervisor and college or clinical tutor with close involvement of the postgraduate dean from the outset.” 

The Claimant’s application was heard by the Court ex parte, meaning that the Trust didn’t have the opportunity to make representations. It resulted in an injunction being granted on 3 March 2026, preventing the misconduct hearing from proceeding the following day. This was subject to the matter being relisted for a further hearing, during which both parties’ arguments would be considered. The Trust had been unaware of the application or the initial hearing until this point.   

The High Court’s decision 

Following a full trial, at which the Trust had the opportunity to present evidence and make representations, the High Court’s judgment was handed down on 25 March 2026. Mr Justice Ritchie discharged the injunction on the basis that there was no serious issue to be tried. The Trust was therefore permitted to continue with its misconduct process. 

Importantly for NHS employers, the High Court rejected the Claimant’s submissions that the allegations had to be treated as a training issue.  

The High Court held that “some types of gross misconduct allegations are likely to be inappropriate for the training route. They are more likely to be considered in the disciplinary route. This is so for many reasons… Finally, the national MHPS, which the Claimant relies upon, does not say “must,” it says, “should initially.” That phrase is slim pickings for the Claimant to hang his whole claim upon.”  

Conclusion 

NHS employers are not required by MHPS to treat all issues raised against a doctor or dentist in a recognised training grade as a training issue. However, whether it is appropriate to characterise the concerns as a training issue should be an initial consideration at the outset of the MHPS process, and it is advisable to record that such consideration has been given. 

Although there are no prescribed definitions of training and conduct issues in MHPS, decision makers may find helpful the High Court’s distinction between the two: “medical training and supervision is likely to be more focused on how to train the Claimant to be a good doctor, knowledgeable, capable and skilful, interacting well with patients and colleagues, and less about how to behave properly more widely (for instance not providing training about not committing crimes or how to drive carefully).” 

In this case, the Trust was able to evidence that the PAG had considered whether or not the concerns raised were training issues, and that it had consulted HEE about the correct route. Therefore, the Trust could evidence that it had initially considered whether the concerns should be dealt with as a training issue prior to making the decision to proceed under MHPS.  

Capsticks’ view 

If concerns are raised against a trainee doctor or dentist, employers should build into the initial stage of their process the formal consideration of whether the concerns could be characterised and dealt with as a training issue. Such considerations should be formally recorded, for example during a PAG or Decision-Making Group. If it is not appropriate to deal with the concerns as a training issue, the employer can then confidently move forward through a formal MHPS process. 

How Capsticks can help 

Capsticks has leading experts advising nationally on doctor cases and MHPS. We regularly conduct training on MHPS processes and help NHS organisations navigate the MHPS process without challenge. Where that cannot be avoided, we are leading experts in defending threatened injunctions successfully in the High Court.

 For further information on how we can support your organisation, or if you have any queries about what’s discussed in this article, please contact Partner Jonathan Lewis, Partner Andrew Rowland or Partner Laura Horovitz.