Court of Appeal confirms the Medical Director must act as Case Manager in a MHPS process involving consultants and clinical directors

This article is written by Sarah Wimsett, Joanna Burrows, Andrew Uttley, and Alex Horan.

Introduction

The Court of Appeal has handed down judgment in the case of NHS Foundation Trust L v Dr MN [2026] EWCA Civ 71, delivering an important steer as to whether contractual effect should be given to provisions contained in workplace disciplinary policies.

On 31 July 2025, the High Court found that the provision at Part I, para 4 of Maintaining High Professional Standards (MHPS), which 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” is binding where it is incorporated into doctors’ contracts. 

The High Court went on to find that the provisions of the NHS Foundation Trust’s local policy implementing MHPS were incorporated into a consultant doctor’s employment contract. The Trust’s local policy did not allow for the Medical Director to delegate the function of Case Manager in cases involving consultants and, consequently, the court found that the Trust had acted in breach by appointing its director of corporate affairs as Case Manager. 

Our previous article in respect of the High Court decision can be found here.

The Court of Appeal has since dismissed the Trust’s appeal. 

The Appeal

On appeal, the Trust submitted that:

• The High Court misinterpreted the basis of the contractual wording, suggesting that the references to MHPS were descriptive rather than incorporative. 
• The High Court erred in law by finding that the reference that the Medical Director “will act as case manager” created a mandatory obligation that did not permit the Medical Director to delegate his role to a senior manager.
• The reference to Case Manager denotes a number of steps that are to be taken by various actors in the institution and does not confer rights on individuals and are instead a “suite of initial procedural requirements” that seek to identify roles for corporate officers within the Trust and regulate the initial reaction of the Trust when there is an MHPS concern.
• Insufficient weight had been given to the nature of the functions of the Case Manager submitting that, properly analysed, it did not require the Medical Director to act as Case Manager.

The Decision

The Appeal Hearing took place on 17 December 2025 and the Judgment was published on 12 February 2026.

The Court of Appeal upheld the High Court’s decision that paragraph 1.6 of the Trust’s local MHPS Policy was incorporated into the doctor’s contract of employment and that it was a mandatory requirement for the Medical Director to act as the Case Manager in respect of consultants. The Trust were not permitted to delegate that role and, therefore, were in breach of contract. 

It was, however, accepted that the Medical Director may delegate his function as Case Manager to another person in circumstances such as unavoidable conflict of interest or illness, and delegation in such circumstances would not undermine the obligatory nature of the term.

The Court of Appeal dismissed the Trust’s appeal and commented as follows:

• That the wording of the clause “will act” in this context has the same meaning as “must act”, therefore imposing a contractual requirement, that the Medical Director acts as Case Manager in cases involving divisional directors and consultants. 
• That the language used was suitable for a contractual obligation and to confer rights on the relevant members of staff and imposes obligations on the Trust rather than merely being addressed to various persons in the Trust as an institution
• That it would not be unworkable for the Medical Director to act as Case Manager in cases involving divisional directors and consultants.
• That the relevant provision did not mention the delegation of the Medical Director’s function in cases involving divisional directors and consultants. 

 Legal Analysis

It is important to note that this case relates to the interpretation of a particular NHS Foundation Trust’s local MHPS policy. More generally. whether an NHS employer can delegate the role of Case Manager in cases involving consultants or clinical directors to someone other than the Medical Director, will depend on and require an analysis of the organisation’s local policy and their consultant contracts. 

The Court of Appeal also accepted in this case that the Medical Director may delegate his function as Case Manager to another person in exceptional circumstances, such as unavoidable conflict of interest, ill health or other long-term absence, and delegation in such circumstances would not undermine the obligatory nature of the term.

As we set out in our previous article, tthis judgment is likely to have different implications for NHS Foundation Trusts than it does for NHS Trusts. For NHS Trusts, this decision is more problematic. We would recommend that Trusts review their local MHPS policies and consultant contracts in light of this judgment and give consideration to both current and future MHPS cases. 

If you would like to discuss this topic in more detail, please contact Andy Uttley, Legal Director or Joanna Burrows, Partner. 

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