Keeping doctors and patients safe in the NHS – project extension to further explore remediation

“We’ve heard many times that this has been a year like no other, and this isn’t about trying to find areas or people that aren’t working effectively. It’s about exploring how we can optimise existing remediation programmes through the use of evidence-based recommendations."

The next stage of a programme of research to help ‘underperforming’ doctors improve their practice is taking place at the University of Plymouth.

RESTORE 2 will look at how the NHS can optimise remediation – the range of interventions aimed at improving doctors’ performance if they slip below expected standards. While serious cases of underperformance will see doctors struck off, remediation can range from a ‘quiet word in the ear’ to more formalised training programmes, helping to retain talent, save money and ensure patient safety.

The RESTORE 1 project, which ran from 2017-2020, reviewed existing studies on what works, where and for whom in remediation, and highlighted that remediation programmes are effective when a doctor's insight and motivation are developed and behaviour change reinforced. Doctors were motivated to improve by being involved in remediation planning, working towards set goals, and having the remediation process destigmatised. See the full report.


But the project also uncovered several gaps in the existing literature, as few of the studies focused on a UK NHS setting. Now RESTORE 2, which is funded by the research partner of the NHS, public health and social care, the National Institute for Health Research (NIHR), will work with five NHS sites across the UK to develop NHS-specific recommendations to improve remediation programmes.

The first step will involve working with each site to help them develop an action plan to optimise their remediation programmes using the RESTORE 1 recommendations; step two will evaluate the action plan; and step three will use focus groups to develop an ‘implementation toolkit’ that captures what we have learnt to help other NHS organisations not involved in this research project.


Dr Nicola Brennan, Senior Research Fellow in Medical Education, is leading the research with a team from the Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA) at the University of Plymouth, along with the University of Oxford and Lee Kong Chian School of Medicine, Singapore.

She said: 

“Estimates suggest that 6% of doctors in the hospital workforce could be below standards at any time and, as training a doctor costs around £500,000 to the UK taxpayer, ensuring the process is effective in all settings could help to retain talent, save money for the NHS and ensure patient safety.
“We’ve heard many times that this has been a year like no other, and this isn’t about trying to find areas or people that aren’t working effectively. It’s about exploring how we can optimise existing remediation programmes through the use of evidence-based recommendations. We’ve all seen how important our NHS is, so we want to equip it with the tools to help and retain talent as far as possible. It’s a really important project and we’re looking forward to learning what comes out of it.”  

This study is funded by the National Institute for Health Research (NIHR) HS&DR 130922. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA)

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