NHS Capability Procedure Explained: Stages and Support

Being told your work is not up to standard is hard to hear, particularly in a profession built on dedication. A capability process can feel like an accusation. It is not meant to be a punishment: the intention is to define what the standard is, identify the gap and give you a fair, supported chance to close it. This guide explains how the process is meant to work, using the ACAS guidance and the NHS Terms and Conditions Handbook, and flags what depends on your trust's own policy.

Capability vs conduct

ACAS advises employers to decide first whether the problem is one of capability (ability to do the job) or conduct (behaviour), because that decides what the right response is.

The line can blur. ACAS notes that sometimes an apparent conduct issue stems from a disability, and an employer must consider whether a reasonable adjustment is needed before taking disciplinary action. Our guide to the NHS disciplinary and misconduct process covers the conduct route. If you believe a concern about your capability is really about something else, such as a health problem or a recent complaint you made, say so in writing early.

The usual stages

Every trust has its own policy, with its own stage names (for example "informal", "stage 1", "stage 2", "final stage"), and timescales vary, so we describe the common shape rather than any one trust's detail.

Support you should expect

ACAS says employers must provide adequate resources for an employee to do their job, and that for capability issues coaching, mentoring and training should be offered. In practice, ask what is being offered and when:

• • Regular one-to-one supervision with dated notes.
• • Training or a shadowing or supernumerary period where a skills gap is the issue.
• • A named buddy, mentor or clinical supervisor.
• • Adjustments to workload, shifts or the environment if relevant.
• • Occupational health input if a health factor is involved.
• • Access to a wellbeing or employee assistance service.
• • Written confirmation of each element of support, with dates.

If support is promised but not delivered, record it: the date, who promised it and what happened. It matters to whether you were given a fair opportunity to improve.

Reading an improvement plan

The test for a good plan is whether you could tell, on any given day, whether you are meeting it. Use this as a checklist when you receive yours:

A hypothetical illustration. A band 5 nurse is told: "Complete medication rounds safely." That is a standard, not a measurable objective. A more workable version might be: "Complete medication administration for a six-patient allocation with an observed assessment every two weeks over eight weeks, against the trust's medicines competency framework, with supervised practice sessions weekly." The example is invented to show the layout, and your own plan will reflect your role and your trust's standards.

Keep a dated log of support offered and support actually delivered alongside the plan. It is the most useful single record if a review meeting becomes contested.

Capability and health

Health and capability are closely connected, and mixing them up is one of the commonest problems. Points worth knowing:

• ACAS says employers must make reasonable adjustments for disabled employees to remove disadvantage, and should consider return-to-work support such as role changes or phased returns. See reasonable adjustments at work.
• If a health condition is affecting performance, ask for an occupational health referral and ask that the capability process reflects its advice.
• Where absence is the concern rather than performance, a separate sickness absence process normally applies. The Handbook says sickness absence arrangements are supplemented by Annex 26, and (England, paragraph 14.18) that after investigation, consultation and consideration of alternative posts, an employer may, where there is no reasonable prospect of return, end employment before contractual sick pay runs out. See NHS sick pay explained.
• Stress, neurodivergence, menopause and long-term conditions can all affect how performance shows up at work. See long-term sickness support and work-related stress.

Your rights in the process

• • To be told the concern and see the evidence. ACAS expects the employer to tell you about the concern and its possible consequences, with copies of written evidence, where a formal meeting could result in action.
• • To be accompanied. The statutory right applies to hearings that could result in a formal warning or other action (ACAS Code paragraph 13). Many trust capability policies allow accompaniment at every formal stage.
• • To a reasonable time and resources to meet the standard, with support actually delivered.
• • To respond. You can set out your case, ask questions, present evidence and call witnesses at a formal hearing (ACAS Code paragraph 12).
• • To reasonable adjustments if you are disabled.
• • To appeal a formal outcome (ACAS Code paragraph 26).

Our guide to NHS staff representation explains who can formally support you. If you are also facing allegations about your behaviour, the NHS Disciplinary Hearing Pack helps you prepare a statement and a request for records.

Regulators and registration

A capability concern is an employment matter, but for registered professionals it can overlap with the regulator's role. The NMC's guidance for employers says that concerns about clinical competence that could be put right with reflection, insight and strengthened practice should usually be investigated locally before being referred, while serious harm, dishonesty or abuse concerns should be referred as soon as evidence emerges. See our guide to NMC referral by an employer and fitness to practise. Evidence of reflection and strengthened practice, such as training completed and supervision records, matters in both processes.

How outcomes work

• Standard met. The plan ends and the concern is closed. Ask for this in writing and whether anything stays on your record and for how long.
• More time or changed support. A plan is extended or revised, with new dates.
• Formal warning. Typically with a set period and conditions. Ask for the wording, the live period and the appeal route.
• Redeployment or a role change. Sometimes suitable where the standard cannot be met in the current role. See our guide on redeployment and pay protection.
• Dismissal. A last resort after a fair process. See the NHS dismissal letter and how to appeal. The tribunal time limit is 6 months minus 1 day for most claims arising on or after 1 October 2026, per ACAS, and the unfair dismissal qualifying period falls to six months for dismissals from 1 January 2027. See our Employment Rights Act 2025 guide.

Related guides

This page is general information about NHS capability procedures, drawn from ACAS guidance, the ACAS Code of Practice, the NHS Terms and Conditions of Service Handbook and published regulator guidance, correct to the best of our knowledge as of October 2026. It is not legal, HR or employment advice and does not replace your own trust's capability policy, your union's advice or specific legal advice. FrontlinePay is an independent site and is not affiliated with, or endorsed by, ACAS, any NHS trust, NHS England, a regulator or any trade union.