Recommendation BRIS-104: Professional bodies must adopt flexible, local disciplinary actions for misconduct
From Bristol Heart Inquiry — Final Report, published 18 July 2001.
Recommendation
In the exercise of their disciplinary function the professional regulatory bodies must adopt a more flexible approach towards what constitutes misconduct. They must deal with cases, as far as possible, at a local level and must have available a range of actions which both serve the interests of the public and the needs of the professional.
Government response
No government response to this recommendation is on the record yet.
Delivery
DHSC and NHS England say in progress (27 February 2026)
Please see Recommendation 46/70 (Professional standards); 71 (Professional Standards Authority).
The General Medical Council, Nursing and Midwifery Council and Health and Care Professionals Council publish their approach to investigations. This includes the role of local advisors (GMC and NMC) who provide advice on how to handle concerns and whether thresholds for referral to the professional regulator are met.
Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Implemented – Ongoing”. Table row: section 6.2 No. 104, PDF page 117-118.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (27 February 2026)
The Government agreed with this recommendation.
In its January 2002 response, the Department of Health said that disciplinary matters were best dealt with a local level, for which it would provide guidance. The Department referred to the establishment of the National Clinical Assessment Authority to provide support and advice to trusts and health authorities in dealing with doctors whose performance gives rise to concerns, with it being able to make an assessment of the doctor and to recommend an appropriate course of action where local action fails to resolve the problem.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 6.2 No. 104, PDF page 117-118.
Earlier findings (1)
Thirlwall Inquiry legal team (15 May 2024)
The Government agreed with this recommendation.
In its January 2002 response, the Department of Health said that disciplinary matters were best dealt with at local level, for which it would provide guidance. The Department referred to the establishment of the National Clinical Assessment Authority to provide support and advice to trusts and health authorities in dealing with doctors whose performance gives rise to concerns, with it being able to make an assessment of the doctor and to recommend an appropriate course of action where local action fails to resolve the problem.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 6.2 No. 104, PDF page 106.
Themes and tags
Who has spoken
- DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding