Judgment was handed down on 31 July 2025 in the High Court in the case of MN v NHS Foundation Trust L (‘the Trust’). The case makes an important finding about who should act as Case Manager in cases involving NHS consultants under the national framework for dealing with serious concerns about doctors, Maintaining High Professional Standards (‘MHPS’).   

We acted on behalf of NHS Resolution’s Practitioner Performance Advice Service, which gave factual and statistical evidence as to the number of cases it is involved in where the Medical Director delegates the Case Manager role and the difficulties that it may cause for the Medical Director to be the Case Manager in all consultant cases under MHPS. 

Facts  

Dr MN is a Consultant in Diabetes and General Paediatrics employed by the Trust. He brought a claim for declaratory relief against the Trust in relation to an alleged breach of his contract of employment. This related to an MHPS investigation and the steps flowing from its conclusion. The key issue in the claim related to who should be appointed as Case Manager in cases involving consultants and whether the role could be delegated by the Medical Director.   

MHPS 

The national MHPS framework states: “The Medical Director will act as the case manager in cases involving clinical directors and consultants and may delegate this role to a senior manager to oversee the case on his or her behalf in other cases”.  This wording was reflected in local policy in the NM case. However, the role of Case Manager was undertaken by the Director of Corporate Affairs. 

Judgment  

The High Court found that the Medical Director must act as Case Manager in cases involving consultants under MHPS.  It did, however, indicate that there is nothing to prevent the Medical Director from receiving the assistance and advice of other personnel in carrying out the role, provided the Medical Director makes the decisions and carries out the specific actions required of the Case Manager.  

Implications for NHS organisations 

In light of this Judgment, and subject to any appeal against it, unless a Trust’s local policy provides more flexibility around who carries out the role of Case Manager, the Case Manager should usually be the Medical Director for cases involving consultants (and it will be a breach of contract if this is not the case). There will be some limited exceptions to this, such as when there is a conflict of interest or the Medical Director is on long-term sick.  Conflicts of interest could include situations where the Medical Director has personal or direct knowledge of the key subject matter of the investigation, or because they are the partner, or a close relative of the consultant involved.   

Where a local policy, agreed via the local negotiating committee, provides more flexibility regarding who can act as Case Manager for consultants, the NHS organisation should be able to rely on that flexibility in appointing to the role.  A consultant may, of course, also agree in specific cases to someone other than the Medical Director acting as Case Manager. 

For existing cases where there is no such flexibility, consultants may not object to an individual other than the Medical Director acting as Case Manager in any event.  However, if they do, there is an argument that any alleged breach of contract has been affirmed (i.e. accepted by the consultant), particularly if the process has been underway for some time.  Alternatively, the Trust could agree to appoint the Medical Director as Case Manager to avoid any legal challenge. 

We recommend that NHS organisations seek to agree (via the local negotiating committee) flexibility in local policies implementing MHPS, specifically in relation to who can carry out the role of Case Manager in consultant cases.  

Other findings 

The Judgment suggests that MHPS does not need to be followed where there are issues which fall outside its scope (consistent with earlier cases). These could potentially include reputational issues and breakdowns of working relationships (often referred to as “some other substantial reasons” for potential dismissal), provided no reliance is placed on concerns relating to conduct, capability or ill health (which fall within MHPS). 

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 help them to defend threatened injunctions successfully in the High Court.  

Please contact Andrew Rowland or Laura Horovitz if you would like to discuss the MN case, or any other doctor-related issues that you have, in more detail.