NHS Resolution and the Practitioner Performance Advice Service: How Public Funds Are Used to Blame Whistleblowers

Part 1: The Role of the Practitioner Performance Advice (PPA) Service

For years, NHS whistleblowers have found themselves blamed for so-called "behavioural issues" or "relationship breakdowns" rather than having their concerns properly investigated. This is a familiar pattern in many Employment Tribunal (ET) claims, where trust executives and NHS legal teams reframe the narrative—turning those who expose wrongdoing into the problem themselves.

The NHS Resolution (NHSR) Practitioner Performance Advice (PPA) service plays a role in this process. While it may provide valuable support in some cases—with known behaviour issues or workplace struggles—it also has a mechanism that can be and has been exploited against whistleblowers. The concern is not that the service exists, but that it operates without transparency and lacks safeguards to prevent its misuse.

The Tribunal Deception: Behaviour Blame Without Clinical Expertise

Employment Tribunal panels frequently lack clinical expertise, yet they are sometimes led to believe that whistleblowers are problematic employees who deserve disciplinary action, suspension, or dismissal. How does this happen?

The answer lies in the PPA’s advisory function, which provides guidance on practitioner performance. However, this advice is often based solely on a manager’s narrative—without the involvement or even awareness of the practitioner in question. Many practitioners do not even know that a behavioural concern has been raised against them, that advice has been sought about them, or that such a unilateral mechanism even exists.

Through this mechanism, NHS Resolution enables employers to create an official paper trail and a narrative that can be referenced through formal or informal meetings, framing whistleblowers as difficult or disruptive, undermining their credibility before they even set foot in a tribunal hearing.

PPA Replaces the Old NCAS

The Practitioner Performance Advice service replaced the National Clinical Assessment Service (NCAS), yet its flaws remain—if not exacerbated.

• Managers can raise concerns without evidence?– There is no mandatory requirement to record complaints formally, declare conflicts of interest, or verify allegations.
• PPA advisors do not contact the practitioner?– The accused individual is left in the dark, unable to challenge what is being said about them.
• There are no mandatory complete records of these conversations?– NHS managers can call the PPA service informally, narrate their own views, and obtain advice that frames the practitioner negatively, with no evidence required.
• No clinical input is required?– The PPA advisors do not require medical expertise, yet they opine on whether a doctor’s behaviour is "problematic," especially so in a clinical context.
• Advice is separate from formal assessment?– A manager can seek advisory input, which sets off a disciplinary plan in which the practitioner is asked to undergo assessment. Only then may the practitioner get an opportunity to write their side of the story before any formal assessment takes place. This can take weeks to months.
• Advice given is not subject to regulatory oversight?– There is no governing body ensuring that PPA decisions are fair, accurate, or free from abuse and that serious safety issues have not been suppressed.
• No requirement on the manager to disclose whistleblowing activity by the affected practitioner.
• No requirement for NHS managers to inform the practitioner.

Conflict of Interest: NHS Resolution's Role in Defending Trusts

NHS Resolution (NHSR) is the very organisation that funds litigation against NHS whistleblowers. At the same time, it runs the PPA service, which provides "independent" advice that can be used to justify disciplinary action against those same individuals. This presents a clear conflict of interest.

By ensuring that whistleblowers are branded as problematic, NHSR helps NHS Trusts defend against whistleblowing claims while preserving their own financial position. If a claim is undermined by behavioural allegations, NHSR saves money by reducing compensation payouts.

The incentives are clear: discredit the whistleblower, protect the NHS, and avoid accountability.

Part 2: Risks and What Should HappenSilencing Whistleblowers Through "Behavioural" Allegations

The implications of this system are serious:

• Whistleblowers are ambushed with unfounded allegations?– They are often unaware that the PPA service has been used against them until they face a formal process, by which time a damaging narrative has already been established.
• Subjective opinion-based advice can be used to suspend a practitioner.
• Employment Tribunals accept these findings without scrutiny?– ET panels can take PPA advice at face value, despite the lack of transparency and procedural fairness.
• The evidence remains on file indefinitely?– Even if a doctor moves to another role, the behavioural concerns raised via the PPA service may follow them, impacting their future employment prospects.
• Serious patient safety concerns are buried?– If a whistleblower is discredited, the underlying issues they raised are often ignored.

Additionally, employment unions often advise whistleblowers to offer an apology. This is problematic because failure to apologise can be framed as "a lack of insight"—even when the individual is raising legitimate safety concerns.

The Bias and Unaccountability of PPA Advisors

NHSR claims that PPA advisors provide "expert, neutral, and independent" advice. However:

• There is no requirement to verify managers’ claims.
• Advisors do not ensure that whistleblowers’ concerns are addressed before behaviour allegations are considered.
• The process is not designed for fairness, as the whistleblower is given no opportunity to respond before their reputation is tainted.

Even more concerning, NHSR research does not analyse whether PPA advisors exhibit biases in their recommendations. This is a glaring omission given the potential impact on practitioners' careers and the known disproportionate representation of BAME practitioners in disciplinary actions.

Systemic Failures That Must Be Addressed

• Has NHSR ever formally challenged organisations that provide untrue or exaggerated claims?
• Has NHSR conducted an audit of NHS managers' practices in informing practitioners of their engagement with PPA?
• On what grounds does the PPA assume an NHS manager is trustworthy?
• Has NHSR contacted affected practitioners in the past five years to disclose what is held about them?
• How long is practitioner data retained, and under what authority?

The NHSR states:

"We use national frameworks, guidance, and standards to underpin and inform our work."

Yet, no healthcare standards support unilateral decision-making without engaging the affected practitioner. This alone raises serious concerns about the PPA service.

What Needs to Change

1. All PPA interactions must be recorded and made available to the practitioner concerned.
2. Details of concerns being discussed must be provided before any consultation.
3. The service must be conditional on mandatory transparency and information from both parties.
4. All practitioners must have access to all information held on them by the PPA service and NHSR.
5. Independent oversight is required to audit the use of the PPA service in whistleblower cases.
6. Employment Tribunals must scrutinise PPA advice and not accept it as objective or valid evidence of behaviour.
7. Time limits for whistleblower detriment claims must be revised to account for these covert mechanisms.

Until these changes are made, NHS whistleblowers will continue to face serious risks, and the system remains open to exploitation.

We invite NHSR to publicly clarify whether practitioners can report unsafe healthcare managerial behaviour directly to the PPA. If not, why does the service exist in its current form?

This issue must be escalated to DHSC, BMA, MDU, MPS, MDS, NHS England, and NHSR?to demand true accountability and reform.

Disclaimer:

This article is intended for informational purposes only and does not constitute legal advice. While every effort has been made to ensure accuracy, readers should seek independent legal counsel regarding their specific circumstances. The views expressed are those of the author and do not necessarily reflect the position of any organisation or regulatory body. The article critiques systemic practices within NHS Resolution and the Practitioner Performance Advice (PPA) service based on publicly available information, case studies, and expert analysis.