People Performance Management Toolkit: Make time to talk about all aspects of performance

Practical support to help you develop the skills needed to deal with key management situations confidently and consistently.

13 March 2024

Part 1


About this toolkit

The People Performance Management (PPM) Toolkit encourages NHS managers to make time to talk about all aspects of performance with staff.

Whether you are a new or experienced people manager, the toolkit provides practical support and aims to help you develop the skills needed to deal with key management situations confidently and consistently, such as:

  • How do you review performance on an ongoing basis?
  • What to do if a member of your team is underperforming?
  • How do you give constructive feedback?
  • How can you support staff who are high achieving?

PPM matters, and how well we do it has a huge impact on the quality of care that people who use our services receive.

Who should use the toolkit

This toolkit for line managers in health and social care aims to encourage and enable good PPM in practice. Scroll through the toolkit to complete the seven main sections sequentially, or go straight to the section you need using the table of contents.

The principles of PPM in any care setting are the same, but the context may differ. This resource is intended for your organisation regardless of whether it is small or large, and whether it is commercial, voluntary sector, local authority or NHS.

The information contained in the toolkit is for general guidance purposes only. It should not be relied upon as a substitute for advice on specific facts or matters and we recommend that you contact your usual HR contact or employment law adviser for detailed advice on the facts of the case. Where organisational policies and procedures conflict with the content of the toolkit, the organisational policies and procedures take precedence. We assume no responsibility for the contents of linked websites and we have no control over the availability of the linked pages.

How to use this toolkit

Use the +chapters navigation menu at the bottom of your window or click on a chapter on the right-hand side of the page to explore the different elements of PPM. 

Partnership behind the toolkit

This toolkit has been co-developed by NHS Employers and Skills for Care.

It has been updated in line with the NHS Long Term Workforce Plan, the NHS People Plan, the People Promise, and the post-COVID-19 labour market.

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Part 2

What is good people performance management?


How you lead and manage your employees from the moment they join your team can make a big difference to them and to the people they are providing with care and support.

PPM is important and how well we do it has a big impact on the quality of care that people who use our services receive.

As a line manager you are responsible for leading and managing an individual or team of people and the quality of the service they deliver. The way you recruit, supervise and develop your employees will make a difference to how they feel about their job and their ability to work to the right standard.

Your leadership will also set the tone and help to create conditions for a positive workplace culture that is focused on delivering high-quality care. Good leaders create a positive environment for employees so that they feel engaged and are focused on caring for others.

Prof Michael West at Lancaster University Management School has undertaken research into the factors that determine the effectiveness of individuals, teams and organisations at work. His blog Cultures of Engagement explores the creation of high-quality cultures of care.

Get it right from the start

Every time you discuss work with your employee you are managing their performance, so PPM is really just one long conversation that starts on day one of employment and continues until the employee leaves your team.

People work best in an environment that encourages openness and honesty in a positive, constructive and professional way. They also work well when communications are two-way, involving a balance of feedback and active listening from both manager and employee.

The performance management conversation begins when you decide on the duties and responsibilities of a job and then continues through each step in an employee’s journey.

The employee performance management journey

The importance of people performance management

Investing your time in managing the performance of your employees is essential to ensure that your team, service and organisation are all delivering excellent services.

As a manager you are responsible for knowing if your team members are performing well. That means that they are conducting themselves in a way that is guided by the values important to your organisation and to the health and social care sector - promoting the health, wellbeing and independence of people they support with compassion, respect and dignity.

Research from Skills for Care suggests that the benefits of a valued, supported, and engaged workforce leads to job satisfaction and higher quality of care. The Workforce Productivity and Quality Model can also be useful for quality improvement and supporting health and wellbeing in social care teams.

PPM brings positive benefits to you as a manager, to your employees, and your organisation. People using your service also gain through the safe, high-quality of care they receive as a result of good performance and the open and honest environment that good PPM creates.

See our checklist in part 8: Considering the benefits of people performance management

Doing people performance management well

PPM is a term used to describe all the processes and techniques that ensure employees are working to the best of their ability and putting the values of your organisation into practice. It may seem daunting when described this way, but as a manager you do it every day.

Managing performance is a continuous process which involves making sure that the performance of employees contributes to the goals of their teams and the organisation.

When it is done well, performance management is not an administrative burden, but an essential tool that helps employees deliver care well to standards set by their employers for the benefit of patients and service users.

Professional Standards Authority for Health and Social Care

Excellent performance management helps everyone in the organisation to know:

  • What the service is trying to achieve

  • Their role in helping the service achieve its goals

  • The skills and competencies they need to fulfil their role

  • The standards of performance required

  • How they can develop their performance and contribute to development of the organisation

  • How they are doing

  • When there are performance problems and what to do about them.

    Source: ACAS

Key aspects of effective people performance management

To begin with, it's crucial to establish clear expectations for each employee's role and also outline what the employee can anticipate from you as their manager. This clarity forms the foundation for the entire process. Regular and transparent two-way discussions about performance are paramount. This ongoing dialogue provides an opportunity to comprehensively evaluate employee performance in a consistent, equitable, and fair manner. Such discussions also facilitate the exchange of feedback, which should always be delivered constructively and respectfully.

Equally important is the provision of appropriate feedback to employees regarding their performance. This feedback serves as a tool for improvement and growth, contributing to the overall development of the individual. It's also essential to engage in discussions regarding employees' learning and development needs. By supplying the necessary resources, such as training and support, employees are better equipped to effectively execute their roles and realise their full potential.

As a manager, it's imperative to lead by example, fostering a positive workplace culture. This entails modelling the right values and behaviours, which has a direct impact on the overall atmosphere of the workplace. Having well-communicated and effective performance management processes in place is a cornerstone of success. This includes not only the primary performance evaluation procedures, but also ancillary processes like induction, supervision, and appraisal.

A manager must also possess the appropriate mechanisms, training, knowledge, and confidence to address various types of performance-related situations. Being equipped to manage diverse scenarios contributes to a well-rounded performance management approach. Last but not least, employees should have a clear understanding of the purpose of their roles and should feel accountable for their performance. This sense of ownership enhances overall engagement and effectiveness within the organisation.

Indicators of how well your people performance management activities are going might be reflected in things like:

  • What people who use your service say about their experience

  • What your employees think about their workplace culture and whether they feel motivated, supported and responsible for their performance

  • Whether your employees stay or leave your team and the sickness absence levels

  • Feedback from your line manager on how well you and your team are meeting goals

Keeping conversations open and honest

Engaging in open and honest two-way conversations offers a range of benefits that contribute to a productive work environment:

These discussions play a pivotal role in maintaining employee well-being and motivation. They create a sense of being valued and empowered, enabling individuals to strive for their highest potential within the organisation. Such conversations provide a platform for employees to voice concerns that might be impacting their job performance. This open channel of communication encourages transparency and enables timely resolution of any work-related issues.

Furthermore, these dialogues encourage managers to actively seek feedback regarding their managerial approach and behaviour. This willingness to receive input enhances their ability to provide effective support to employees and teams. By addressing concerns through open conversations, managers can preemptively tackle potential challenges before they escalate into more significant problems. This proactive approach helps mitigate risks and ensures smoother operations.

Moreover, these discussions contribute to fostering an environment of confidentiality and safety. This safe space allows for the honest and constructive exchange of feedback without fear of repercussions. It's important to note that the effectiveness of such conversations hinges on their foundation in factual information rather than emotional reactions. Conducted sensitively and constructively, these discussions pave the way for mutual understanding and resolution.

PPM conversations involve observing and assessing how well your employee is reflecting the required standards of performance in their work. Your assessments of people performance will help identify and nurture exceptionally talented employees and highlight consistently good performance. They might equally involve taking action to ensure that an employee who is not performing well is made fully aware of where their performance is not meeting the required standard and given encouragement and support to improve. Should this not prove successful it could lead to the employee not continuing in the role. This may include dismissing employees in cases where your procedures have been followed and exhausted.

It takes courage and confidence to communicate openly and honestly; to take steps to hold conversations about someone’s performance and receive feedback about your own performance; to make improvements to existing ways of working; and to create and maintain the right culture of care. This is especially so when there is not yet an open and honest culture of performance management within your team, or helpful structures established within your organisation that can enable such conversations to take place.

Great leaders set the tone.

Simon Sinek, leadership expert

The key here is to draw on the values of good leadership and embed them in all you do, whether you have a formal leadership role or not. For example it may be important to:

  • Believe in your own values as a leader

  • Have courage to take the lead

  • Have integrity in making fair and consistent assessments of employees’ performance

  • Lead a positive workplace culture by role modelling the right values and behaviours

  • Seek support when you need it from your line manager or from other sources including informally through networking with peers

  • Take responsibility for your own development ensuring you are equipped to practice good PPM and to talk about performance with employees

Many people working in health and social care know in theory (or from their own experience) that good leadership is fundamental to good quality care, but find it difficult in practice to articulate what it means, either for themselves or their organisation.

The behaviours described within the Leadership Qualities Framework (LQF) for Adult Social Care represent the core leadership skills required by people at all levels within all organisations across the sector.

The LQF shares common links with the Healthcare Leadership Model, which is a tool to help those who work in health to become better leaders. Both are useful tools for developing yourself as a leader, whether you have formal leadership responsibilities or not.

Making time for people performance management

Line managers’ job descriptions may differ from role to role and from organisation to organisation, but a fundamental responsibility of any people manager is making time for PPM.

Your own line manager should help you to ensure you have the time to devote to PPM.

Taking time to recruit, induct, train, supervise, appraise and give feedback on performance as the need arises will help to ensure that your employees are equipped, motivated, engaged and know what is expected of them. Prioritising PPM also helps to reinforce people’s sense of its importance and that their contribution is valued.

Managing performance is not an add on to your other responsibilities – it is an essential part of your role.

Helpful hints

  • Show to your employees that you prioritise PPM, for instance do everything possible to keep appointments with employees and not be tempted to cancel or postpone

  • Regularly engage in conversation with employees as appropriate – to talk and to listen

  • Make sure you are approachable and that it is clear to staff that you are also happy to make time to listen outside of formal meetings should an urgent need arise ahead of the next scheduled appointment

  • Manage with fairness: do not discriminate against employees in the way, or how frequently, you manage their performance including because of their age, race, sex, gender reassignment, disability, religion or belief, sexual orientation, marriage and civil partnership or pregnancy and maternity

If you haven't been able to get it right from the start

Initiating open and honest conversations about performance with employees is a critical responsibility that should ideally begin early. As a manager, you play a central role in kickstarting and facilitating these essential discussions focused on performance.

Start by reflecting on your current approach to managing employee performance. This self-assessment will lay the groundwork for improvements. Seek out relevant training in PPM for both yourself and any employees you supervise.

Familiarise yourself with the organisation's PPM policies and procedures. Alternatively, consult reputable sources like ACAS for guidance. Envision the characteristics of effective PPM and plan for positive changes.

Engage employees in conversations about the significance of PPM and its impact on their work quality. Encourage them to share feedback, including concerns, which you can address in detail.

Embark on the PPM journey by collaborating with employees to introduce new work methodologies and strategies. Clarify their expectations from you in terms of support and any necessary adjustments.

Agree with employees to jointly enhance or maintain good performance standards. Follow through on your commitments to drive actual change.

Keep the conversation momentum going and maintain an ongoing dialogue. Strategically determine the best starting points for these discussions based on individual needs and circumstances, including any reasonable adjustments.

In essence, initiating open performance discussions involves self-assessment, training, policy understanding, envisioning improvements, engaging employees, addressing concerns, making positive changes, clarifying expectations, committing to actions, sustaining ongoing discourse, and strategically planning a successful beginning. Your active involvement in these steps fosters continuous improvement and effective communication.

Part 3

Where should I start?

As a manager, your initial actions hold significant weight in setting the stage for effective employee management. To begin, it's essential to establish a clear understanding of what your organization anticipates from your role as a manager overseeing employees. This foundational clarity ensures that your managerial efforts are aligned with organizational goals and expectations.

Furthermore, cultivating a practical perception of exemplary People Performance Management (PPM) is crucial. This involves translating theoretical concepts into tangible practices that contribute to enhanced employee performance, engagement, and overall organizational success.

In addition, take stock of the mechanisms and processes, if any, that already exist within your organization to facilitate performance management. Familiarizing yourself with these resources enables you to leverage established frameworks and potentially identify areas for refinement.

Begin by knowing why managing the performance of your team is important, how it works and what your role is.

Delving deeper, consider the prevailing culture within your team and the broader organization. Reflect on the values, norms, and communication styles that shape the working environment. This introspection equips you to tailor your managerial approach in a way that resonates with and supports the existing culture.

A transformative shift occurs when you view your employees not solely as workforces, but as individuals with multifaceted lives and needs. Recognizing and respecting their holistic identity fosters a more empathetic and effective management style.

Lastly, ensure you have a clear map of where to seek valuable information, support, and training. This proactive approach positions you to continually develop your managerial skills and stay abreast of industry trends and best practices.

You are best placed to set the tone and help to create conditions for a positive team culture by:

PPM roles and responsibilities

As a manager, you have a responsibility to recognise and encourage good employee performance, and identify and support improvement where needed. In fulfilling this responsibility you will be expected to:

Act as a role model

You can do this by demonstrating the kind of behaviour you are trying to promote. Think about what makes someone a positive role model. Assuming the role of a role model in leadership involves embodying positive traits, such as: fostering motivation, promoting open communication, valuing feedback, aligning with organisational values, contributing to solutions, nurturing relationships, team-building, honouring commitments, fairness, well-being advocacy, and resilience. By actively embodying these attributes, you set a powerful example for your team and contribute to a thriving organisational culture.

Employee health and wellbeing

Looking after employee health and wellbeing is not limited to the physical work environment (e.g. safety, equipment, access) but is also concerned with supporting the mental and emotional wellbeing of employees, managing sickness absence and occupational health. Evidence suggests that by prioritising employees’ health and wellbeing, their levels of engagement improve, as do their feelings about their job, their loyalty and their performance. Being a role model it's also important to be seen to be looking after your own health and wellbeing too.

NHS Employers’ mental wellbeing in the workplace infographic provides a range of up-to-date key statistics and facts about workforce mental wellbeing in the workplace.

Responsibility for health and wellbeing at work belongs to both employers and employees. According to ACAS, the key factors that can determine whether employees will have a positive or negative relationship with work are: the relationships between line managers and employees, whether employees are involved in organisational issues and decisions, job design, availability and acceptability of flexible working, and an awareness of occupational health issues.

Refer to your organisation’s policies and procedures on employee health and wellbeing. NHS Employers has a dedicated section on improving employee health and wellbeing as well as a Sickness Absence toolkit that outlines everything from what to do when an employee calls in sick to supporting their return to the workforce.

Employee learning and development

Support employee learning and development to ensure that training and support needs are identified and provided for your employees, so they are able to perform to the standard required and fulfil their potential. Don’t forget to look after your own learning and support needs too.

The Chartered Institute of Personnel and Development (CIPD) offers a number of free fact sheets on learning and development and related topics including:

When sourcing learning and development products, such as training or coaching sessions, it’s important to take steps to ensure that they: are of a high standard, reflect the policies and procedures of your organisation and the culture of your team, meet specified learning objectives and cover the skills your employee or employees are seeking to develop, and take account of the varying ways in which individuals learn e.g. a varied approach to delivery can help to ensure that everyone involved in a learning event benefits.

Providers of learning and development should be occupationally competent and appropriately qualified to deliver them. Skills for Care has published a guide Choosing workforce learning for purchasers of learning and development in adult social care. A checklist can also be found in ‘help in a hurry’.

Employees need to be clear about their responsibilities within the PPM process. For example, you might agree that their role in the performance management process will be to work towards achieving their objectives and take responsibility for their own professional and career development. This means being clear about how they want to grow professionally, knowing what knowledge, skills and experience they want and need to develop and seeking opportunities for professional and career development. Other things to consider are being open to feedback by accepting constructive feedback and taking the steps to improveseeking support as required from their manager or colleagues, asking for feedback and guidance and keeping a record of personal performance achievements, successes and challenges.

Getting started

As a starting point for people performance management (PPM), it may be helpful to ask yourself:

  • What are the PPM processes in my organisation?

  • Why is PPM important?

  • When should PPM happen?

  • Where should PPM take place?

  • Who am I managing and recruiting?

  • How will I go about introducing or making changes to the way I manage performance?

What are the people performance management processes in my organisation?

It will help if you familiarise yourself with your organisation’s policies and procedures on recruitment, induction, supervision, appraisal, capability (including reasonable adjustments) and discipline. Make sure that you follow these policies and procedures (if they exist) as they will give you knowledge and some structure to guide your open and honest conversations about performance with employees. Such policies have normally been developed in partnership with staff representatives.

If people performance management processes are not yet in place (or you are wanting to review or develop existing ones) what can you do?

As a starting point, explore this toolkit for information and examples on the general aspects of reviewing employee performance, managing different types of performance and how you can approach conversations about performance.

ACAS provides a helpful series of guides that can support you with the basics of performance management and help you to introduce a process to review and manage the performance of your employees.

Why is people performance management important?

You are responsible for ensuring that your team members are performing in ways that are guided by the values important to your organisation and to the health and social care sector.

Investing your time in managing the performance of your employees is essential to make sure your team, service and organisation are delivering safe and dignified care in a way that supports their health, wellbeing and fulfilment of their potential.

It is also important that you let your employees know why managing their performance is so important. When talking with your employees about the process, be sure to emphasise its benefits, and encourage them to take ownership of their own performance and development.

Managing performance well can have a positive effect on how employees feel about their job and their ability to work to the right standard, so it is important to have processes in place and that they are well communicated.

For more information, see the ‘what is good people performance management’ section.

When should people performance management happen?

It begins when you decide on the duties and responsibilities of a job and continues through each step in an employee’s journey. This includes during recruitment and induction, when expectations and objectives are first discussed.

Find out if your organisation already has set standards about how regularly you should carry out observation and assessment, supervisions or one-to-one meetings and if there is a dedicated time of year when appraisals are carried out.

Think about the day-to-day opportunities you have to maintain or improve the performance of your employees through regular two-way feedback and informal reviews of performance.

For more detail, see the ‘how can I review employee performance’ section.

When you need to act on underperformance by an employee, how will you decide when to speak to them about it? Straight away? In your next one-to-one? At appraisal?

If you need to have a conversation of this nature and need further support, see the checklist ‘how to approach a conversation about underperformance.’

See checklist in part 8: How to approach a conversation about underperformance

Helpful hints

  • Show your employees that you prioritise managing their performance: if they sense a lack of interest on your part, they’ll lose interest too

  • Regularly engage in conversation with employees as appropriate – to talk and listen

  • Help employees to take responsibility for their own performance at work; make sure they are clear about their responsibilities in the process

Where should people performance management take place?

Where you meet people is important. It tells the person that you think they and their work are important. This is especially true if you are discussing performance.

That is why you need to make sure you are meeting in a place where you won’t be disturbed or overheard.

Is there a quiet, confidential and discreet space - and time kept free in your diary - to have conversations with employees about performance?

Who am I recruiting and managing?

Getting this right means you will attract the right people and can select the person who has the skills needed to be successful and the personal attributes to fit in to your team culture.

Making sure you plan an effective recruitment process that clearly outlines the functions and expectations of the role, as well as the values and behaviours that you expect, is key in getting the right person for the job.

You need to be confident that the person you appoint has the right knowledge and skills. Crucial to the process will be the values they bring to their work and how those ‘fit’ with your organisation’s values. You need to be as sure as you can that not only will your preferred candidate be able to do the job, but that they will do it in the right way for you, and your organisation. Make sure however that this does not detract from attracting and developing a diverse workforce and that you do not discriminate against potential candidates on the grounds of race, or religion or belief, for example.

Effective recruitment and selection should help you to find an excellent candidate with the key skills and qualities to be successful in the role.

You should ensure that your recruitment process is as inclusive as possible. The NHS People Plan outlines that by October 2020, employers, in partnership with staff representatives, should overhaul recruitment and promotion practices to ensure the workforce reflects the diversity of communities, and regional and national labour markets.

Make sure you know who you are responsible for performance managing and that employees are also clear about who they are being managed by.

In some cases, people have more than one manager, which makes having clear roles and responsibilities around people performance management even more important.

An example might be in the case of student professionals, e.g. nurses, occupational therapists and social workers in training, or apprentices working as health care assistants or support workers as part of their training. Any of these might be responsible both to their employer and to their education provider.

Similarly, you might have employees seconded to you from another service or team or temporary workers from an agency or bank. Roles and responsibilities for line management and who will monitor and feedback on performance need to be clearly defined, agreed and communicated in these instances.

How will I go about introducing or making changes to the way I manage performance?

Once you have identified what, when, where, why and who, you should consider how you will go about introducing or making changes to the way you manage performance.

Remember to start by finding out if there are existing mechanisms and processes already in place in your organisation and be sure to follow these. In some instances you may be required to have discussions with trade unions and staff representatives about proposed new ways of working.

For information on the formal mechanisms and processes you can use to review the performance of your employees, such as induction, probation, supervision (one-to-one meetings) and formal review (appraisal) see the ‘how can I review employee’s performance’ section.

Start to consider what kinds of behaviours you will need to adopt and display, and what kind of culture you will need to promote within your team, for the changes to stick and be made effective.

Leading and managing change

Change is usually characterised by a desire to improve things whether it’s cash flow, products or processes. Change can be either planned or unplanned, and could affect individuals or the organisation. Major changes can mean mergers, redundancies, re-structuring or new working practices. Minor change can mean anything from introduction of new training courses or company policies to travel arrangements.

Although every situation is unique and every organisation is different there are common elements to managing most change:

  • Plan for change - although some change comes out of the blue it is better to have to review a plan than to have no plan at all
  • Provide leadership - this is particularly important during times of uncertainty when employees will need reassurance
  • Keep up-to-date with the law - legislation covering redundancies or transfer of undertakings (TUPE).”

    Source: ACAS

When you are leading a change, however small it may seem to you, have a plan for how you will lead the change and your employees through the process.

Change can affect performance: people react to change differently and as such a period of change can affect an individual’s performance and indeed a whole team’s performance. That is not a reason to avoid change; change is a necessary part of life and a necessary part of an organisation’s journey of continuous improvement.

As a manager, you have an essential role in making sure employees feel listened to, valued, involved and positive about the change.

When you are implementing a change, think about:

  • How do you feel about change?
  • How will you manage other people’s reactions to change?
  • How will you lead the team throughout the journey and beyond?

Second, think about the people in your team; listen and take time to understand their reactions so you know:

  • What are they concerned about?
  • How strongly do they feel about it?

Empathise and demonstrate you understand their feelings and acknowledge any concerns. Remember to seek support from your colleagues or manager.

Where changes such as restructuring, mergers and redundancies are being considered, it is essential that you consider your organisation’s change management policy, where one exists, and seek advice from HR or your organisation’s legal advisors to make sure you comply with the relevant legislation.

Why is culture important to performance management?

The culture in a team and organisation will often determine the quality of the service. A positive workplace culture focused on delivering care and support to people will thrive and be a rewarding environment in which to work.

In addition to improved quality, a positive workplace culture also brings a happier, more settled and skilled team with improved wellbeing, a team that is engaged in flexible and innovative ways of working, the ability to attract new, talented employees with the right values and behaviours (people make positive choices about where they want to work due to the culture of the workplace), and greater team resilience in times of change.

What does the right culture of care look like?

Helpful hints

Skills for Care has developed the Culture for care: your toolkit for all social care and support employers, regardless of size or services delivered. NHS Employers also has a Culture change tool, both resources can help you wherever you are on your culture change journey, with pointers and resources to provide advice.

Additional support tools

Make sure you know where to go when you need support.

  • Who are the key people?
  • What are the important resources?
  • Which are the trusted websites?

Do not leave finding them until you need them in a hurry.

The first place to look for information is your organisation’s policies and procedures. Line managers in larger organisations will have an HR department who will be on hand to offer support and advice. There are plenty of other resources available but make sure you look for properly accredited professional websites and organisations, such as:


Part 4

Reviewing employee performance

How can I review employee performance?

Managers are best placed to help employees understand the purpose of their role, what is expected of them and to review their performance.

The essentials

You will manage employee performance, often without thinking about it. It is essential that your employees:

  • Know what they are doing and why
  • Understand their employer’s expectations of them
  • Are confident in their skills and knowledge

This helps to ensure that their work is to the highest possible standard. Your role as a manager is to make sure you communicate the standards you expect and give advice and guidance where necessary to ensure these standards are maintained every day, and to take positive action to bring about a change or improvement in performance when required. You should also consider how to review performance through more formal mechanisms and processes such as induction, probation, one-to-ones, personal development plans and formal review (appraisal).

Designing a role

It’s important that you are clear about performance standards and expectations at the outset when designing new job roles. You can get support and advice about designing job roles from your HR department, your line manager or ACAS provides helpful resources and advice.

These are some useful things to think about:

  • How the job fits in with the existing team roles and what you want the post-holder to achieve
  • How this helps to achieve the overall objectives of your team and your service or organisation
  • Who else the post-holder will need to work with to achieve these objectives
  • What responsibility and/or authority the post-holder will have for making decisions
  • Who they can go to for support
  • What the key knowledge, skills and experience are to be successful in the job
  • What is expected of the post-holder in terms of values and behaviours

When you have done this you will have the information you need to write a job description and person specification. Being clear about standards and expectations at the point of recruitment provides a very good starting point for managing the performance of your employee when they are in post and for identifying how you will support them to be able to achieve and succeed.

When introducing people performance management processes to existing employees or teams, it is important to make sure that the roles have detailed job descriptions which have been clearly communicated and agreed with them. You should also check that they understand what is expected of them.

Helpful hint

You should be aware of the law regarding discrimination to make sure you do not unintentionally discriminate against certain groups through the use of particular phrases or by including specific requirements in the job description. For example, including health requirements can amount to direct discrimination against disabled people, or a requirement for continuous experience could indirectly discriminate against women who have taken maternity leave. If in doubt, seek advice from your HR department, ACAS or the Equality and Human Rights Commission.

Managing induction and probation

Managing induction

The selection process is only the beginning of the employment relationship. The future of that relationship depends to a significant extent on how your new employee settles into the job. Most employee turnover is amongst new starters, and work efficiency is reached only after a period of learning and adjusting to the new environment.

An effective induction can help employees to perform at their best from the start by integrating them into your organisation and setting out what is expected of everyone in a clear and consistent way. The ACAS website provides a helpful induction checklist.

Induction is the term used to describe the process of familiarisation with the work place and settling into the job.

An effective induction is the starting point for open and honest conversations with your new employee so allows you to:

  • Maintain their positive view of your organisation created through your recruitment process
  • Introduce them to key people who they will need to work with
  • Take them through key processes and important information they will need to understand to be able to do their job well
  • Set clear expectations about the values and standards of the organisation
  • Set clear expectations of the values of the sector (e.g. NHS Constitution and the People Promise)
  • Set clear expectations about the standards of the sector (e.g. CQC’s fundamental standards, the joint social care and health Care Certificate, or NHS England's Care Certificate.)
  • Make sure they are aware of organisational policies and procedures (e.g. whistleblowing (raising concerns) policy in the NHS and the whistleblowing in social care)
  • Cover any useful information about how the team works together

You may be able to seek further support in designing an effective induction plan from your organisation’s HR department or ACAS. It is also good practice to ask the employee if there is anything they would like to be included in their induction plan.

Managing probation

The probation period is for you and your new employee to see whether the decision to offer and accept a job was the right one. Part of the new employee’s induction should be to set time aside to discuss the probation period and set objectives which, if met, will lead to the employee successfully completing their probationary period.

You should discuss and agree a probation plan shortly after the individual has started in the job. This will set out clear objectives for the probation period and also allow you to pick up on any development needs noted at the recruitment stage or during the time they have been in the role. Objectives in probation will be about:

  • Becoming familiar with the organisation and its ways of working
  • Developing effective working relationships with fellow team members
  • Demonstrating competence in the role

Remember to consider the length of your probation period and set objectives accordingly. It’s often helpful to set aside some time in supervision (one-to-one) sessions to assess progress and provide additional support if it’s needed.

Being clear at induction about standards and expectations can also help to provide a benchmark for attitudes and behaviours. For healthcare support workers and adult social care workers, the Care Certificate can help to do this by supporting new health and care workers to understand their role, what is expected from them and how they will be supervised and assessed.

Meeting regularly during the probation period will give you the opportunity to provide feedback, recognise what has been achieved and address any issues that may have arisen.

If you have any concerns about performance within the role during the probationary period these should be raised with your employee as soon as possible. You can explore the underlying cause and take appropriate action to help them improve their performance. See the managing underperformance section for more information.

If there are no problems and the employee has achieved the agreed objectives, you can simply confirm that they have successfully completed their probation period.

Once probation is complete you can continue to manage their performance through other processes, including the formal review process (appraisal).

If an employee is not performing as required and has not met the agreed objectives, you may have the option of extending the probation period or terminating their contract in accordance with your organisation’s procedures. You will also need to be able to provide records that support your decision so keep careful notes, agree these with the employee, as you work through the probationary period.

Seek advice from your HR department (where this support exists). Guidance on handling dismissal fairly is also available from ACAS website.

Agreeing objectives

The key to people performance management (PPM) is having employees who know what they have to achieve and why. The main way to do this is to agree objectives or set goals. We use the term ‘objective’ in this resource but you should use the language of your organisation.

Every employee should have a clear understanding of the organisation’s and team’s objectives as well as an awareness of their own roles and responsibilities in achieving them.

Ideally, objectives should not be ‘set’ for an employee; they should be agreed between employee and manager. Employees should be part of the objective-setting process, it reinforces their ownership of the objectives and therefore can help to motivate employees to achieve success in their role.

You can agree objectives and how you will review progress together via a number of different processes, principally during induction, probation and at the performance review or appraisal.

Make sure that all objectives are‘SMART’, i.e. that they are Specific, Measurable,
Achievable, Relevant and Time-based. Remember that each objective should be linked
to the employee’s job role and should contribute in some way to the overall team or
organisational objectives.

Thinking about the questions below may help you in agreeing objectives:

  • What are your team, departmental or service objectives?
  • What do you and your team need to do to achieve these objectives?
  • How can you support your employee in fulfilling their potential – what else can you encourage them to do?

The agreed objectives will form the basis of your conversations about performance.

Helpful hints

  • Check your organisation’s policies. There may be existing tools and documentation available to help you agree ‘SMART’ objectives with your employees, otherwise consult ACAS

  • Utilise employees’ induction and probation periods to establish and reinforce expectations for performance, values and behaviours

  • Ideally, objective setting shouldn’t be a one- way street; be sure to give your employee the opportunity to share their views on what their priorities should be. Ask them what support they need from you and the organisation in order to be able to achieve their objectives and development goals

  • Objectives can be used to ‘stretch’ an employee. Consider setting objectives that require the individual to do a bit more than they might believe themselves capable of doing to encourage professional development. Stretch targets should be acknowledged as such when reviewing performance

Formal performance review (appraisal)

The annual appraisal is a process for agreeing objectives and work plans, discussing development needs and reviewing the performance and development of employees against these objectives and plans, i.e. personal development planning. It is also an opportunity to discuss individual career aspirations.

The terms used to describe the annual performance review include, formal performance assessments, performance reviews, or appraisal. They are terms which can be used interchangeably. We use the term appraisal in this toolkit, but you should use the language of your organisation.

The annual appraisal process is directly linked to the organisation’s annual setting of corporate objectives. These corporate objectives should be set prior to setting objectives and workplans for teams and then for individuals. In small organisations the organisational and team plans might simply be one overall plan for the service for the coming year, leading straight on to individuals’ objectives.

As with all people performance management, open and honest conversation is key. The paperwork should reflect the conversation accurately, but not dominate the process.

The formal annual appraisal process will typically include:

  • A review of ongoing supervision throughout the year between an employee and manager
  • Formal annual appraisal meeting between employee and manager
  • Interim appraisal review meeting during the year between employee and manager

In the first instance, check if your organisation has an appraisal process already in place and be sure to follow this.

What will the formal annual performance appraisal cover?

Past performance

Discussion and review of employee’s performance over the previous year against:

  • Agreed individual objectives and targets/workplans
  • The tasks section of the job description
  • The skills and knowledge requirements within the job description and person specification
  • Any learning undertaken during the year to support the achievement of work objectives
Future requirements

Discussion and agreement of the requirements of the employee for the coming year:

  • New objectives and targets/work plans linked to job requirements and business needs
  • Areas for skills and knowledge development linked to job requirements and business needs
  • Consideration of career and personal aspirations

The above should be considered in relation to the following documents:

  • The organisation’s vision and values
  • The organisation and team’s business plan, strategy and objectives
  • The job description and person specification for the job


Helpful hints

  • NHS managers can refer to NHS Staff Council guide ‘Simplified Knowledge and Skills Framework (KSF)’ for a simple appraisal process with tools, tips and templates

  • Are you responsible for managing nurses? See information on the Nursing and Midwifery Council (NMC) website about the process of revalidation used to ensure nurses practise safely and effectively

  • Are you responsible for managing doctors in the NHS? See information on the General Medical Council’s website about the process of revalidation and appraisal used to ensure licensed doctors are up to date and fit to practise

The four-stage process

A recommended four-stage process for a formal annual performance appraisal is set out below:

Regular discussion (supervision)

The most important aspect of the whole performance review process is regular, ongoing discussion, feedback and informal review of your employees’ performance. The day-to-day opportunities that you have to subtly maintain or improve the performance of your employees should not be ignored.

You will want to strive for a culture that encourages high performance and addresses underperformance at the earliest opportunity, using regular one-to- one discussions (also known as manager supervision) to:

  • Offer frequent feedback about performance
  • Encourage employees to raise concerns
  • Help address performance issues before they potentially become more serious
  • Identify any barriers to high performance, such as the quality of objectives, workload, training and skills needs or systems and processes etc.

Check your organisation’s performance management or employee supervision policy. Practices for one-to-one meetings (manager supervision) vary but it is common for them to take place every four to six weeks.

There may be occasions where employees are not meeting expectations. You have a key role to play in managing underperformance.

Video: see how effective manager supervision can enhance employees’development and improve care

Observing employees' performance

Observing employees’ performance should not be something that happens only as part of an induction programme or probationary period. You should use observation as an ongoing mechanism to assess and address performance. It can help you to build a good sense of awareness of an employee’s performance based on real examples and evidence.

Your observations will help to inform discussion in formal performance reviews and, more crucially, will provide you with an opportunity to offer early praise for a job well done and give constructive feedback.

When your observations need to take on a more formal nature it’s helpful to have a written record of your observations which can be discussed with your employee. This will assist you in coming to a rounded view of an employee’s ability and help you identify when an employee is performing well or not meeting expectations.

Part 5

Managing different types of performance

It’s easy to spend time, energy and effort dealing with employees who are underperforming and therefore see performance management as a negative thing. However, performance comes in many guises. Considering your team members, can you recognise those:

  • With leadership potential
  • With the dedication and commitment to simply get on with the job
  • Who are beginning to lack enthusiasm and motivation
  • Who are doing the absolute bare minimum

All types of performance require a different management approach from you. For tools and resources to assess employees’ performance, see the ‘how to review the performance of your employees’ section.

Be prepared to take steps

It is important to be aware that an employee’s motivation, performance, skill development and potential can change with time. Your role is to always have a sense of how your team is performing and to notice any changes in performance.

Managers are the people most able to influence employees’ performance.

You need to be equally prepared to give praise or take positive action to bring about a change or improvement in performance when required. Taking action is particularly important when there is a risk of a detrimental impact on the quality of health and social care.

Signs and symptoms of a change in performance

These are some common signs of an employee’s performance beginning to change:

  • Less engagement with you at one-to-one sessions or supervisions
  • Missing deadlines
  • Increased absence
  • Less engagement with the team
  • Poor timekeeping
  • Errors creeping into work where previously it was error free
  • Less interest in the organisation and what it is trying to achieve
  • Less willingness to do a little extra
  • People receiving care or support notice a difference in effort or attitude
  • Colleagues express concern

Ensure you are managing with fairness

The way you manage performance should be inclusive and fair to everyone. Decisions should be based on fact and evidence. You should be consistent with different employees on the same or similar issues. If your organisation has an equality policy, this should cover the way you deliver equality and value diversity. You should use these principles in the way you manage the performance of your employees.

If your organisation does not have a policy or you would like information on diversity and inclusion issues, see NHS Employers dedicated webpage.

How to manage underperforming employees

It is your responsibility to manage an employee who is underperforming. In health and social care there is always a real risk that underperformance could have catastrophic consequences for people using services and their family and friends.

Managers can worry about dealing with underperformance or poor performance. It can be challenging, but if problems arise it is crucial that you address them as soon as possible.

It is not fair to the employee, their colleagues or the people receiving care or support to let an issue become a more serious problem before action is taken.

See checklist in part 8: How to approach a conversation about underperformance

Underperformance – look out for any employee who:

  • Does not undertake the duties of the role as required

  • Does not complete the duties of the role to the standard required or within the timescale required

  • Does not understand the job requirements or directions

  • Does not comply with professional codes of practice (e.g. nurses, midwives, doctors, pharmacists, social workers)

  • Is unmotivated to do more than the bare minimum

  • Is regularly absent without cause

  • Shows poor timekeeping

  • Has poor working relationships

  • Is dismissive of the people receiving care or support and fails to engage with them meaningfully

  • Makes errors in work

Make sure you follow your organisation’s procedure for managing performance and seek advice from your human resources department or a senior manager if you need support. If these do not exist within your organisation, you can also contact ACAS for advice.

Underperformance is usually considered to be as a result of:

Day-to-day management of underperformance issues

Not all underperformance will need a formal approach.

In many cases an informal discussion is all that is needed to improve performance. You are encouraged to have early discussion through your normal management procedures, such as one-to-one (supervision) meetings. Remember to record such meetings in writing and to share records with the employee.

Use this informal meeting as an opportunity to talk to the employee about the need for improvement and to agree a plan of action to bring about improvement.

A four-step model for informally addressing performance problems

  • It is improtant to correctly and specifically identify the performance problem.

    You should ask yourself:

    • how serious is the problem?
    • how long has the problem existed?
    • how wide is the gap between what is expected of the role and what is being done by the employee?
    • are there any external factors causing the employee's underperformance? For example, systems and processes, financial constraints, etc.

    Helpful hint

    Sometimes there are multiple factors contributing to a concern about performance. It is important to assess the primary problem as this will inform your actions. 

    For issues of conduct that are of a minor nature, you may feel these are best dealt with informally through day-to-day management of the employee.

    Explain the nature of the concern and that the misconduct should not happen again. If you feel the matter is serious, or if minor issues persist, you may need to take more formal action.

  • Begin by having a discussion with your employee to explain:

    • what the problem is
    • why it is a problem
    • how it impacts colleagues, the workplace, and patients and/or people being supported
    • why there is concern. 

    There could be many reasons for underperformance (work and non-work related). It's important for you to determine what the reason is, so you can discuss practical solutions.

    You must give opportunity to hear and consider the employee's point of view. Check they:

    • are aware of what is required of them
    • have been shown what is required
    • understand the gap between what they are doing and what is required. 

    Helpful hint

    • Be prepared for the conversation: understand the issues, take advice, think about the potential reactions, practice what you are going to say.
    • Consider the environment: allow sufficient time and think about timing, choose a private and comfortable place away from distractions. 
    • Tackle the problem directly: be clear in communicating what the problem is, explain why it is important, provide specific examples and evidence if appropriate. 
    • Listen: give the employee opportunity to have their point of view be heard, be open minded and allow time for thinking and responses during your conversation. 
  • This might be in the form of a performance agreement or action plan to set out:

    • what is to be achieved and by when
    • what support will be in place
    • implications if performance continues to be poor.

    Consider whether a temporary change to the employee's duties is required while additional support is put in place.

    Set a date for another meeting with the employee to review progress and discuss performance against the agreed action plan. 

    The type and range of support which can be provided to the employee will vary depending on the nature of the issues identified and their role but could include:

    • training or coaching
    • the identification of a mentor
    • a review of the amount of supervision needed
    • referral to an occupational health advisor or counselling service.

    Helpful hint

    • Give a fair and reasonable opportunity for improvement: jointly agree the way forward and check for shared understanding.
    • Monitor progress: agree a timetable and scheduled discussions to review progress against a timetable.
    • Consider if any support is needed: this will depend on individual circumstances (where appropriate and feasible) but may include a referral to an occupational health service, a temporary change in duties, formal training or coaching.
    • Create a motivating environment: this means giving clear expectations and useful feedback, showing employees how their work contributes to the bigger picture and ensuring they have the resources to do their jobs well. 
    • Keep a written record: of all discussions related to underperformance in case further formal action is needed and share these notes with the employee. 
  • You should monitor the employee's performance against the plan of action and continue to take advantage of formal and informal methods to give feedback. 

    Action plans usually last for two to three months with regular progress meetings. Where disability or health conditions are a factor, you should allow for reasonable adjustments to be put in place and to take effect before reassessing the employee's performance. You may need to seek the advice of occupational health experts as necessary. Support is also available via ACAS.

    You may need to take more formal action if their performance does not improve, which could result in dismissal if they fail to make the necessary improvement. 

Taking steps (if there is no improvement)

There may be occasions where the four-step model does not improve the employee’s performance to the required standard and you need to take more formal action.

Always make sure that you follow any disciplinary, capability and health policies your organisation has and consider the welfare of the employee during what can be a stressful time for everyone concerned. What support can be provided to the employee? Perhaps access to an occupational health adviser, counselling service or a nominated person of support through the process might be appropriate. Be mindful that employees have the right to be accompanied at certain meetings by a fellow colleague or a trade union representative.

Advice and guidance on dealing with discipline is also contained in the ACAS booklet, ‘Discipline and grievances at work: the ACAS guide’.

The booklet contains sample procedures to guide you and template letters for all stages of a formal disciplinary procedure.

If the employee’s performance does not improve to an acceptable standard, termination of their employment may be an option.

You must make sure you act fairly and reasonably.

You should follow the advice set out in the ACAS Code of Practice on disciplinary and grievance procedures.

Learning lessons to improve our people practices

Getting disciplinary processes right is crucial to ensure that staff are treated fairly, consistently and supported with their health and wellbeing. You should be mindful to follow the ACAS guide on Discipline and grievances at work, taking informal action where possible, establishing facts and providing sufficient opportunity to appeal decisions.

The Amin Abdullah case is an example where these crucial principles were not followed, as outlined by the independent review into his death which is summarised in Dido Harding’s (chair at NHS Improvement) letter in May 2019 to all trust chairs.

The below key questions should be considered when starting a disciplinary procedure.

  • Is there sufficient understanding of the issues or concerns and their circumstances to justify formal action?
  • Considering the circumstances, in the eyes of your organisation and others external to it, would the application of a formal procedure be a fair and justifiable response? Have other potential responses and remedies been seriously considered before being discounted?
  • If formal action is being taken or has been, how will appropriate resources be allocated and maintained to ensure it is conducted fairly and efficiently; how are you ensuring that independence and objectivity is maintained at every stage of the process?
  • If formal action is being taken, how will appropriate resources be allocated and maintained to ensure processes are fair and efficient? How are you ensuring that independence and objectivity is maintained at every stage of the process?
  • What will be the likely impact on the health and wellbeing of the individual(s) concerned and on their respective teams and services, and what immediate and ongoing direct support will be provided to them?
  • How will you ensure the dignity of the individual(s) is respected at all times and in all communications, and that your duty of care is not compromised in any way, at any stage?

Referring information about a dismissal

If an employee’s performance has been investigated and as a result of the investigation and disciplinary hearing they have been removed from working with children or vulnerable adults, you must ensure appropriate action is taken to inform the relevant bodies:

  • Does the individual work in ‘regulated activity’ with children or vulnerable adults?

    You should make a referral to the Disclosure and Barring Service (DBS) where you have dismissed or removed a person from working with children or vulnerable adults (or would have done if the person had not resigned) because you have identified that they present a risk to children or vulnerable adults. Check when and if you need to refer information to the DBS.
  • Is the individual working in a role regulated by a professional regulatory body?

    If a concern about an individual’s conduct, capability or fitness to practise is identified you should make a referral to their regulatory body. Check with relevant health and care professional regulator.
  • If the individual has been dismissed, or resigned, as a result of serious concerns you may need to refer information for the Healthcare Professional Alert Notices (HPAN) system. Check with the NHS Resolution who are in charge of HPANs.
  • Is the Individual working as a trainee, locum, agency or bank employee?

    You may also have a responsibility to inform other appropriate bodies, for example, higher education institution or the agency.

Where you believe that information should be referred, seek advice from your human resources department (where this support is available) or a senior manager in the first instance.

How to manage consistently well performing employees

A key part of your role is to praise and nurture your consistently well performing employees.

Think about which employees get most of your time? Do you find that you spend very little of your management time on those people who get on with the job, consistently fulfil their basic duties, and consistently meet the expectations of their role?

Employees who are performing consistently well will bring many positives to the team, their dedication and hard work is the backbone to providing quality health or social care. It is crucial for managers to recognise and acknowledge the contribution of these employees to prevent them feeling undervalued.

Helpful hints

  • It is important not to focus your recognition only on big achievements, it is just as essential to recognise the day-to-day contributions of consistently well-performing employees

  • Think about the kinds of activities that could be used to help your employee in their learning and development; these should not be limited to formal training courses, but could be experiential, such as involvement in a work project

  • The way you manage performance should be inclusive and fair to everyone and decisions should be based on merit

Maintaining good performance

As a manager with an array of demands on your time it can be easy to overlook the consistent and well-performing employee. However, neglecting these employees could lead an individual to become demotivated or disengaged, which could lead to underperformance.

You can encourage employees to maintain good performance and help them to achieve their best by:

  • Having regular discussions about performance
  • Setting objectives that will challenge them and stretch their thinking
  • Working with individuals to identify learning and development needs through a formal performance review process
  • Offering training and development where available and appropriate (this could take the form of formal training, coaching, shadowing, mentoring, project work, etc.)
  • Acknowledging, encouraging and rewarding good performance: recognising the day-to-day contributions of consistently well-performing employees is just as essential as noting the big achievements.

Continuing learning and development

The development of your employees should be an ongoing process, supporting them to maintain good performance and encouraging excellence. Continuing professional development (CPD) can be achieved through a range of informal and formal learning that supports the employee to increase their range of skills, knowledge and experience.

Opportunities to support development could take the form of, for example: formal training, coaching, shadowing, mentoring and project work.

Helpful hints

Managers in the NHS – you can seek advice from your organisation’s learning and development department about the opportunities available and for information about training grants for employees.

Managers in social care – you can seek advice from your HR department if you have one.

Recognising and rewarding good performance

There are many ways to recognise and reward employees for good and excellent performance. Your organisation may already have a policy and procedures in place for the fair reward and recognition of employees, so check this first before taking steps to introduce your own recognition initiatives.

If you are a manager in a private or voluntary sector organisation you may have flexibility to offer financial and career development rewards.

Examples of how you can show appreciation to your employees:

  • Simply saying “thank you” and appreciating effort and contribution from your employees
  • Acknowledgement during discussions
  • Introducing departmental or team initiatives to celebrate good practice and desired values/behaviours
  • Special mention at department or team meetings
  • Nominating employees for good practice awards (local, regional or national, e.g. Skills for Care’s national social care ‘Accolades’ or the NHS Leadership Recognition Awards)
  • Recognising good practice in a newsletter or professional journal, where appropriate
  • Setting developmental objectives at appraisal

How to manage excellent performing employees

As a manager your role is to support employees to reach their full potential.

A high-performing employee will stand out to you. They consistently exceed expectations, and are the person you call upon because they have a track record of getting the job done. They’re great at their job and take responsibility for it, they are willing to ‘go the extra mile’ and take pride in their accomplishments.

If you take over responsibility for managing employees, you might find it helpful to see what your predecessor says about the team; knowing what past performance looked like can be an indicator to future performance.

While this information is helpful, always come to your own conclusions about each employee and their ability.

Helpful hints

  • Get to know your team. Find out what motivates them and what their aspirations are so you can support, encourage and help them to develop

  • Think of the ways in which you can give recognition. Be mindful of the ways in which employees prefer to receive recognition – some will not appreciate the ‘limelight’ of other team members being around

  • Excellent employees will not require as much direction or coaching, but it is important to monitor pressures on them and to pay attention to their wellbeing

  • Your team will have varied skills, creativity, and perspectives, ask them what they think from time- to-time, and listen to what they have to say

  • The way you manage employee performance should be inclusive and fair to everyone and decisions should be based on merit

Maintaining excellent performance

If you consider that managing employee performance is only focused on challenging underperformance, you will miss so many opportunities to help your employees thrive and reach their potential.

Managing performance is also about identifying employees who are performing highly, offering them regular recognition, support and encouragement.

You can encourage employees to maintain high performance and help them to achieve their best by:

  • Recognising and rewarding the good practice of employees
  • Having regular discussions and conducting formal performance reviews. Excellently performing employees may not require as much direction or coaching, but it is important to monitor pressures on them and to pay attention to their wellbeing
  • Talking to employees about what motivates them, offering opportunities to stretch and challenge them to keep them with your organisation longer
  • Working with employees to identify development needs. Show an interest in their career goals and aspirations and make clear what opportunities exist to keep them invested in your organisation


Managers in the NHS – refer to your organisation’s policies and processes on performance and talent management in the first instance. There may be tools and resources to support you to have open and constructive conversations with your employees around their potential and their aspirations.

The NHS Leadership Academy also has a free talent management conversation toolkit which can support you to have conversations with your employees.

Managers in social care – who have an HR department and polices on performance management and talent management should look at these first. Other resources to look at include Skills for Care’s Finding and Keeping Workers resource and other programmes such as I Care...Ambassadors.

Part 6

Conversations about people performance

How you communicate your expectations, provide constructive feedback and recognise good performance is essential to effectively motivating your employees.

It can be easy to get caught up in the daily activities of your job and to appear too busy for the employees around you. By putting conversations with employees at the top of your ‘to do’ list you will show employees that you value them, increase employee and team morale, have better outcomes and experiences for people being supported by health and social care services, make a positive difference in organisational performance and have happier, more engaged employees and possibly lower sickness absence rates.

Constructive feedback is critical when managing employee performance.

Open and honest conversations will also help you to get to know your employees, and by developing your working relationships in this way you will observe changes in their behaviours and their performance at an earlier stage.

How to approach managing an employee who is underperforming is covered in detail in the ‘managing different types of performance’ section.

Giving constructive feedback

All feedback should be constructive. The purpose of feedback is to reinforce good practice or behaviour or to highlight where improvements or changes are needed.

With this in mind, when giving constructive feedback:

  • Focus on the facts and what you have seen
  • Give it as soon as possible
  • Keep it straightforward
  • Clarify performance standards and expectations
  • Motivate the employee to think about what they could do differently

See part 4: Reviewing employee performance

Constructive feedback may go along the lines of:

Discussing underperformance

Not all underperformance will need a formal conversation within the disciplinary process. However, it is advisable to keep a note of all conversations you have with employees about their performance, in case more formal steps are needed.

In many cases an informal chat is all that is needed to improve employee performance. Often being very clear and explicit with an employee about what is expected of them can have a positive impact on performance. If you are having an informal chat you might choose to take a conversational and relaxed approach. This is a decision based on a judgement that only you can make depending on the nature of the underperformance.

As a result of your conversation you may need to put training or support in place for the employee, or it may prompt further discussion for example about the health and wellbeing of the employee or a disability.

In some situations, conversations with employees have to take a more formal approach. See the ACAS guide ‘Challenging conversations and how to manage them’.

If you need to have a conversation of this nature, see the checklist on ‘how to approach a conversation about underperformance’.

Ways to introduce underperformance conversations

Be prepared with helpful phases

Discussing concerns following a serious incident

Your organisation will have clear ideas about what constitutes a serious incident. It will include risks to people who use services or other employees and risks to the organisation’s reputation. You need to be aware of what a serious incident is in your organisation and what the procedure is for managing and reporting it.

A serious incident must be managed using formal procedures to investigate them. As a manager you will be involved in the investigation of the incident and interviewing employees.

You should bear these points in mind:

  • Are external agencies such as the police involved? If they are, there may be limits to what you can say and do
  • Be clear with people that you are using the formal procedures and make sure you understand them fully
  • Seek support and advice from your line manager or the HR department
  • Be clear about how the information you have gathered from employees will be used
  • Be clear about the implications of serious or continuous underperformance
  • Seek advice about whether a period of suspension is necessary while investigations are carried out

For more information, tools and resources see the ‘managing underperformance’ section.

Following a serious incident, it is important to learn from what went wrong. Creating a just and learning culture is a collection of resources from the Social Partnership Forum that will help managers and staff to share learning in these instances.

Praising the positive

Praising your employees is a must and should never be overlooked. Active performance management is about the things that have been done well, as well as encouraging performance improvements.

Conversations about good performance can have a big impact on employee morale, motivation and engagement and potentially on the people receiving care and support.

When was the last time you showed genuine appreciation for an employee’s contribution at work?

Positive conversations about performance could include saying thanks for a job well done, giving praise for solving a problem, congratulating and acknowledging achievements, saving discussions about career development and recognition of desired values and behaviours.

Helpful hints

  • Your praise should always be genuine: an individual thanks will be more appreciated than blanket praise

  • Your comments could be informal and should be as frequent as appropriate

  • Be spontaneous with your appreciation; show praise in the moment when you see employees doing something good

  • Be mindful of the ways in which employees will prefer to receive praise – some will not appreciate the ‘limelight’ of other team members being around

  • It is important not to focus your praise only on big achievements; recognising the day-to-day contributions of consistently well- performing employees is just as essential

Praise can also be more formal and reflective, for example during a performance review meeting or a one-to-one (supervision) meeting, where you may want to talk about achievements and discuss:

  • What went well?
  • What did they do?
  • How did they do it?
  • Why did they do it?
  • How did they feel when doing it? what have they learned?
  • Show your appreciation and reinforce their achievement

Record praise in writing. This can be helpful when you are preparing for annual performance reviews and looking for success and examples of good practice.

For further support, information, tools and resources see the ‘how do I review performance’ section.

Part 7


In this section, we explore a range of scenarios that may face line managers and how they can overcome particular challenges around performance. 

Scenario one: managing underperformance (conduct)

Barbara had been in post for a number of years when a new manager was assigned to the department. The manager found Barbara had, for a long time, been left to her own devices. Barbara was not meeting her objectives and had been spoken to on a number of occasions about her not completing routine duties. Other performance concerns included not being polite or helpful to relatives and visitors. There were also a number of low level complaints about her attitude over a number of years. Her colleagues often said “That’s just how Barbara is, she is grumpy by nature.”

How do you manage an employee like Barbara?

Don’t delay – start taking action

Use your observations to make a list of the specific problems that are evident from Barbara’s performance at work, and the reasons why they are not acceptable.

Ask yourself:

  • How serious is the problem?
  • How long has the problem existed?
  • How significant is the difference between what is expected of the role and what is being done by the employee?


Make sure you know what might be causing Barbara’s poor performance

In the first instance, use your one-to-one (supervision) meetings to discuss your concerns informally and to allow Barbara the opportunity to give her perspective. Check to make sure there is nothing at work or at home that is impacting on Barbara’s performance, such as bereavement or health concerns or working relationships.

Express your concerns and record them, together with Barbara’s responses

Help Barbara to deal with anything affecting her performance, be supportive but also clear that her standard of performance is not where it should be. If there are no extenuating circumstances then be clear and objective with your feedback, focus on behaviours (and your observations) and not her personality. Inform Barbara that her performance is not at the right standard and attempt to jointly agree an action plan for improvement. Ensure that all your conversations about performance with Barbara are documented and agreed with Barbara in case you need to take more formal action in the future.

Help put performance back on track

Suggest a plan of support in areas where Barbara is not currently meeting expectations. This could involve training, coaching, mentoring, shadowing or a mixture of these.

Be clear why the further development is needed and what success will look like at the end of the plan (e.g. clinical standards being met, patient care improved). Support Barbara to embed her learning by meeting with her and discussing what she has learned and wants to put into practice and ask how you can help further.

It is important to agree SMART objectives to assess Barbara’s performance in a measurable way.

For example:

  • Hand gel dispensers should be stocked at all times and checked at 9am, 1pm and 5pm every day
  • 100 per cent of people being cared for, relatives and visitors should be greeted with a smile
  • Always introduce yourself to patients with “Hello my name is Barbara”, and an explanation of why you are there and what you are about to do

Barbara should be made aware that if she is unable to meet the action plan, formal disciplinary action may need to be commenced.

I can but I won’t – I want to but I can’t?

If there is no improvement following your action and attempts to support Barbara, then it’s time to take formal action. Is Barbara’s poor performance as result of:

  • Her attitude “I can but I won’t” (conduct)
  • Her ability “I want to but I can’t” (capability) – for example may be due to a lack of knowledge or skills, a disability for a learning difficulty

This will tell you which procedure to follow. We will assume that for Barbara the problem is conduct.

Help is at hand for managers

If you have HR support they can work with you to plan and commence a formal conduct process. Check your managing performance procedures if you have them, and look at the performance or conduct section.

If you don’t have an HR department or formal policies in place, consider other sources of support, for example, there may be a senior manager or director you can seek advice from in your organisation. There are also a range of external organisations who can offer support and guidance to managers, such as ACAS.

Follow your procedures to the letter; if you don’t have a specific procedure then this is what you could do:

Arrange a performance improvement meeting

Discuss your concerns more formally and ensure Barbara is clear about what the problem is and:

  • Why it is a problem
  • How it impacts on colleagues, patients and the organisation or service
  • Why there is a concern and the consequences if her performance does not improve
  • Refer to specific examples, and previous attempts to support Barbara
  • Agree a plan of action for improvement
  • Monitor Barbara’s performance against the action plan and continue to offer regular feedback
  • Give Barbara a reasonable timeframe for improvement, say over two or three months with regular review meetings
  • Keep a record of all meetings

If Barbara’s attitude does not improve then you may find it necessary to proceed to a formal disciplinary hearing. You should follow the advice set out in the ACAS Code of Practice on disciplinary and grievance procedures.

See part 4: How to manage underperforming employees

What if?

Scenario two: sickness absence

Chris has worked in the health and social care sector for over 20 years, and has previously held some senior positions, such as team leader. Chris joined your organisation two years ago after being made redundant from his last job, and now works in the role of healthcare assistant.  

Chris’ performance in his role started off as average, but following a major team restructure six months ago, his standards seemed to dramatically slip, leading to two serious complaints from patients, and numerous instances of Chris’ colleagues complaining to managers about his mistakes and lack of contribution to the team.

Following an investigation into the latest complaint from a patient, Chris was invited to a formal disciplinary meeting in line with the organisation’s procedures. Chris called in sick two days before the meeting, and has subsequently provided a medical certificate from his GP confirming he is suffering from stress and as such is likely to be off work for at least another six to eight weeks.

How do you manage an employee like Chris?

Don’t delay – start taking action

The medical certificate confirms that Chris has a genuine medical reason to be away from work on long-term sick leave. You will need to make a judgement on whether to proceed with the formal performance management process without delay whilst recognising his right to put his case forward. This judgement should take into account the nature of his illness. Chris is not fit to work, but he may still be fit enough to attend a disciplinary meeting. You will need to consider if any reasonable adjustments should be made – such as visiting him at home or at a neutral location in order to facilitate his attendance or conducting the meeting by telephone.

In this instance Chris is not well enough to attend a disciplinary meeting, so you will need to put the performance management process on hold temporarily. It is important to clarify for Chris that it is a temporary postponement rather than a cancellation of the meeting while he gets better. Remember that although there may be concerns about his performance at work you still need to act as a good employer with regards to his health and welfare and to treat him with dignity and respect in your communications with him as he recovers.

Initiate the absence management policy if you have one and follow that process. If there is no formal policy in place, your organisation should have some form of guidance in place regarding staff absence. This scenario has the potential to lead to a situation where Chris is ultimately dismissed because of absence. However, if he returns to work the performance management process should be resumed.

An episode of absence, whether due to stress or any other condition, cannot be used as justification to avoid or mishandle a performance issue that puts patients or services at risk. However, you must balance this by acting fairly and reasonably in the circumstances.

Keeping in touch and record keeping

You need to respect the fact that Chris is currently unwell. Any contact made with Chris to enquire about his health or recovery needs to stick to that purpose. For example, you might make a weekly courtesy call to Chris to enquire about his health, but you should not use the opportunity to start talking about the disciplinary matter.

As this situation develops, all your communications with Chris – whether formal or informal, need to be recorded. If you have an HR department they will be able to provide advice to help you. If you do not have HR support or an occupational health team, it is your duty as Chris’s manager to keep accurate and appropriate records.

Help put performance back on track

If and when Chris does return to work, a phased return or other occupational health support may be required. NHS Employers’ Managing Sickness Absence toolkit can be used to manage Chris’ sickness as well as support him in his return to work.

Quick tip

If you don’t have occupational health support then you could write to Chris’s GP for a medical report. The Access to Medical Reports Act 1988 allows you to do this and ACAS can give advice on drafting the letter and provide a template on their website. There will be a charge for the report which you need to pay. Chris will have to give his permission in writing for you to ask for a report and has a right to see the report that is written about him.

Depending on the severity of the concerns that led to the need for a disciplinary meeting and the extent of any immediate safeguarding or patient care risks, a decision may be taken that the disciplinary process needs to be completed immediately before Chris can resume his duties, or otherwise at an agreed time shortly after his return to the workplace.

Once Chris is declared fit to be at work, your focus needs to shift back to the performance-related issues, which may involve focusing on objective-setting, learning and development or a further progression or escalation of the formal performance management process.


From a manager’s perspective, this scenario may be frustrating. You may even have suspicions that the timing of the sickness absence is a deliberate means for Chris to avoid the disciplinary process. However, you must ensure you act fairly and reasonably, stay professional, use fact and evidence, not unproven suspicions and respect any authorised sickness absence. It may be that Chris is experiencing a mental health condition that requires empathy and support from you as his manager. Remember what your objectives are: a resolution of the performance issues and for Chris to get better and return to work. Refusing to acknowledge the illness or trying to fight against the enforced absence could ultimately prevent you from achieving these objectives and lead to claims of unfair treatment, including bullying and harassment.

See the NHS Staff Council’s Health, Safety and Wellbeing Partnership Group’s infographic on tackling bullying in the NHS.

You should also be aware that some illnesses including mental illness may be defined as a disability and lead to a legal complaint of discrimination under the Equality Act if not handled correctly. For more information see the Equality Act guidance from the Equality and Human Rights Commission and see NHS Employers’ dedicated disability support web pages.

See part 4: How to manage underperforming employees

Scenario three: conduct or capability

You manage a long-serving support worker called Shona. Up until two years ago Shona had been a very dedicated and trustworthy employee. However, over the last two years Shona has become a very difficult employee to manage.

If you ask Shona to undertake tasks that she considers to be beneath her, such as cleaning, she refuses stating that it is not in her job description. Shona will do only the absolute minimum amount of work necessary; you often find her sitting down flicking through the pages of gossip magazines when she is on duty. Shona has recently decided to become a vegetarian and has started to tell people being supported by the service that they “should not be eating dead animals”.

You also notice that Shona is swapping shifts with other staff members and that she prefers to work later in the day. On a couple of occasions when she was on the early shift Shona was half an hour late for work and the night staff had to stay on after a busy night for her to arrive.

How do you manage an employee like Shona?

The questions you need to ask yourself

Has anything happened at work or home that could explain or partly explain Shona’s failing performance at work? For example:

  • Has the content of Shona’s job changed in the last two years?
  • Have the needs of the people being supported by the service changed in the last two years; for example, more acute or more complex needs?
  • Are you aware of anything outside work that might affect Shona’s ability to do her job?
  • Does her sickness absence reveal an underlying health problem?
  • Look back over the period when Shona’s attitude and performance started to decline and read supervisions and appraisals: are there any clues there?
  • Is Shona adequately supported to deliver her role? Has she had the appropriate training?
  • How are Shona’s working relationships? Is there any indication of bullying or harassing behaviour?

Don’t delay – start taking action

Plan to meet with Shona to discuss the changes you have noticed in her work performance. Have the facts about these changes at your fingertips, including all her:

  • Sickness absence
  • Late arrivals at work
  • Dates and times of inappropriate conversations with people

Ask her why she thinks these changes in her work performance have come about and allow her time to respond and then decide on whether it is a question of her conduct or capability.

If its conduct (I can; but I don’t want to) - Agree a performance improvement plan and be clear about what has to improve and by when. Agree the support you will put in place to help her succeed and what monitoring you will undertake. Explain clearly the consequences of failing to improve.

If it’s capability (I want to,but I can’t), you will need to consider:

  • What is it that is preventing Shona from doing the job?
  • Is there a lack of clarity in her role?
  • Is she unclear about your expectations of her?
  • Does she need some training or other support?

You need to provide the support to address the need and then set a timetable for performance improvement with a clear statement of what success will look like and how her performance will be monitored monitored. Shona should be made aware that if she is unable to meet the action plan, formal disciplinary action may need to be commenced.

There could be circumstances outside work, such as a complex domestic situation or a long-term health problem (physical or mental). In this case you need to be much more creative. Your role is to assist the employee to return to full performance. However, you may need to refer to other services where help can be obtained, adjust her rota on a temporary basis (be clear how long temporary is) or make reasonable adjustments to her duties. You can access advice from the ACAS website. Other useful links here might include Access to work and the Equality Act.

What if?


Is there anything Shona’s manager could have done to prevent this scenario? For example:

  • Could a performance conversation have taken place sooner with Shona?
  • Was Shona clear about what she was doing and why, was she fully knowledgeable, skilled and developed to be able to carry out her work?
  • Was Shona’s contribution acknowledged when she was performing well?

See part 4: How to manage underperforming employees

Helpful hints

  • If you have HR support they can work with you to plan and commence formal processes. Check your managing performance procedures if you have them, and look at the performance or conduct section

  • Follow your procedures to the letter. Procedures can be contractual and not following the procedure could lead to a breach of contract

  • If you don’t have an HR department or formal policies in place, consider other sources of support, for example, there may be a senior manager or director you can seek advice from within your organisation. There are also a range of external organisations who can offer support and guidance to managers, such as ACAS

Scenario four: attitude adjustment

Meena has been a community mental health nurse for fifteen years and is a firm advocate of hard work and commitment to patients. She is consistently up to date with all her mandatory training, manages her fair share of the team’s caseload and is a very experienced and knowledgeable member of staff. Meena is due to have her appraisal in the next few weeks, is at the top of her pay band and has indicated that she would like to retire in the next year or so.

Meena views the next year or so as a ‘count down’ to retirement, is not engaged in the appraisal process, and sees no value in any form of objective setting. Meena believes her patients are her priority and this is where her focus remains, sometimes to the detriment of colleagues around her.

Meena is not viewed as a team player by her colleagues and has become known to be un-cooperative and unsupportive and this gives cause for concern for her line manager. Although Meena is committed to her patients, her attitude towards her colleagues is known to be a disruptive factor and is affecting the work of other team members.

How would you manage an employee like Meena?

Don’t delay – start taking action

It is important to reach your own conclusions about Meena’s performance based on facts and evidence. Use your observations to make a list of the specific problems that are evident from Meena’s attitude at work, and the reasons why it is not acceptable. While it is good that Meena appears to be committed towards the individual patients she sees, her attitude is obviously impacting on the rest of the team and therefore will be affecting overall team performance. The negative implications for service performance and patient experience need to be addressed by you as Meena’s manager.

Record your concerns and Meena’s responses

In the first instance, use your one-to-one (supervision) meeting to discuss concerns informally and to allow Meena the opportunity to give her perspective. Be understanding of Meena’s personal learning and development needs, which may be quite different to other colleagues’. For example, you could ask Meena what she thinks she could do to make her last year at work a really memorable one and jointly agree an action plan for improvement.

A firm but collaborative approach could be beneficial for you.

Help Meena to understand how her lack of interest and perceived disregard for the whole team is affecting the team’s performance. Make sure you focus on Meena’s attitude (and your observations) and not her personality. Ensure that all your conversations about performance with Meena are documented in case you need to take more formal action in the future. Copies of the records you make of your conversations should be shared with Meena.

Help put performance back on track

Inform Meena in advance of your annual performance review meeting (appraisal) that you will be agreeing SMART objectives that will encourage her to feel a more integral and valued member of the team. In preparation for the meeting, start to compile a list of short-term actions that could help Meena have a good appraisal. Also ask Meena to come prepared with her thoughts on how she thinks the previous review period has gone and with ideas about what she would like to achieve in the period ahead, so you can agree motivating goals and objectives.

Meena clearly has some significant strengths – she is very experienced, works hard and keeps up-to-date with her mandatory training. Be sure to acknowledge and praise these underlying positives in your conversations about her performance.

If Meena’s attitude does improve - Consider ways to continue encouraging the desired attitude and to increase Meena’s contribution to the team. Is she willing to share her vast experience by becoming a mentor for newly qualified or less experienced staff?

If Meena’s attitude does not improve - It is time to take more formal action. If you have HR support they can work with you to ensure you follow your organisation’s procedures. If you do not have HR support, consider other sources of support: there may be a senior manager or director you can seek advice from. There are also a range of external organisations who can offer support and guidance to managers for example, ACAS.

Follow your organisation’s procedures exactly. If you don’t have specific procedures then this is what you could do:

Arrange a formal performance improvement meeting

Discuss your concerns more formally and ensure Meena is clear about:

  • What the problem is
  • Why it is a problem
  • How it impacts on colleagues
  • Why there is a concern and the consequences if her attitude does not improve

Refer to specific examples, and previous attempts to support Meena. Agree a plan of action for improvement and monitor Meena’s performance against the action plan, while continuing to offer regular feedback. Give Meena a reasonable timeframe for improvement, say over two or three months with regular review meetings.

What if?


Is there anything Meena’s manager could have done to prevent this scenario? For example:

  • In the past has Meena’s contribution been recognised, acknowledged and rewarded to make her feel valued and part of the team?
  • Have poor past experiences led to Meena’s lack of value in the formal performance review (appraisal) process?
  • Could a performance conversation have taken place sooner with Meena, to prevent her attitude affecting the work of other team members?

See part 4: How to manage underperforming employees

Scenario five: acting quickly

Olu had been recently recruited and confirmed in post as a care assistant. When his manager returned from maternity leave she found he had been left to his own devices for a long time. He often failed to attend training and cancelled supervisions. His written communication was poor and his willingness to go beyond his job description was limited to say in the least.

Other performance concerns included not being proactive enough to order maintenance to attend the service, support plans not being read and the communication book not updated with information on the people he supported except when he could remember to do so.

How do you manage an employee like Olu?

Don’t delay – start taking action

Compile a list of the three to five most common examples of Olu’s performance that are giving you cause for concern, investigate them as far as possible to discover what happened and why.

Record your concerns and Olu’s responses

Use supervision (one-to-one) meetings to discuss your concerns and to make sure there is nothing at work or at home that is impacting on his performance, such as bereavement or health concerns or working relationships that aren’t working. If he is regularly cancelling supervision meetings, book them in advance and put the responsibility on him to reschedule, as regular supervision is a requirement of his role. This could be one of his targets.

Encourage Olu to deal with anything affecting his performance, be supportive but also clear that his standard of performance is not where it should be. If there are no extenuating circumstances then be clear and objective with your feedback, focus on behaviours not personality.

Inform Olu that his performance is not at the right standard, set and monitor objectives to address poor performance and make sure they are SMART, for example:

  • Complete the communication book at the end of every shift
  • Ensure that Yvonne (a person Olu supports) is able to regularly attend the craft club she enjoys every Wednesday morning by planning your time so that you help her get ready for the community bus at 10 am

Record keeping

Record in supervision meeting notes that Olu’s performance is not up to standard. Take time to observe Olu’s professional practice with colleagues and people being supported and feed back to him what you have seen. Share any supervision notes with him so that there are ‘no surprises’ later if it becomes necessary to take formal action.

Help put performance back on track

Suggest learning and development solutions such as training, coaching or mentoring in areas where Olu is showing a lack of skill and knowledge. Be clear why the additional support is needed and share with him what success will look like by the end of
it. Support Olu to embed his learning by meeting with him and discussing what he has learned and wants to put into practice and ask how you can help.

I can but I won’t – I want to but I can’t?

If there is no improvement then it’s time to get formal. Is Olu’s poor performance as result of:

  • His attitude “I can but I won’t” (Conduct)?
  • His ability “I want to but I can’t” (Capability)?

This will tell you which procedure to follow. We will assume that for Olu it is capability.

Help at hand for managers

If you have HR support they can work with you, if you don’t then it’s time to call on
your line manager to support you. Check your disciplinary procedures and look at the performance or capability section of it. There should be something about performance improvement planning.

Follow your procedures to the letter; if you don’t have a specific procedure then this is what you do:

Arrange a formal performance improvement meeting

  • Call a formal meeting and address your concerns, describe the gap in performance – making use of those specific examples – refer to supervisions and other support used to help get Olu up to standard
  • Set a performance improvement plan that sets out what is to be achieved and by when, what support will be put in place for example, increased supervisions, shadowing, etc, and – crucially – the consequences for Olu if the desired improvement is not achieved
  • Provide Olu with a reasonable timeframe for example, a maximum of three months to deliver to the plan

See part 4: How to manage underperforming employees

What if?

Scenario six: managing performance of an employee with a disability

Jordan is part of a team whom you manage and you are concerned about him. Jordan has missed three out of four deadlines, he has also produced reports that are poorly written, containing spelling and grammatical mistakes. When you talk to Jordan about his work he becomes very upset and he tells you that it had been suggested to him at college that he might be dyslexic. He scraped through college and has never had an assessment for dyslexia.

How do you manage an employee like Jordan?

Don’t delay – start taking action

All employees should be encouraged to look after themselves physically and mentally. Where you have cause for concern about an employee, or reason to believe they may have a disability which is having an impact on their performance, it is your duty as a manager to act. Have an open and honest conversation with Jordan, perhaps discuss what he can do to improve his work and achieve the right standards. Be understanding of Jordan’s personal learning and development needs, which may be quite different to those of his colleagues.

You could also discuss with Jordan the possibility of making contact with Dyslexia Action or the British Dyslexia Association for specialist help and advice. They can provide a dyslexia assessment for Jordan; this will help you both to make decisions about how best he can be supported at work.

Help put performance back on track

You should support employees with mental health or learning disabilities in the same consistent way that you would physical health problems. It is likely that Jordan’s dyslexia is a disability – in other words, it affects his ability to carry out his day-to-day activities and is long term. Therefore, you will have to consider making reasonable adjustments to help him stay in work. You may also need to monitor Jordan’s workload a little more closely, to ensure that what he is expected to deliver is realistic within the timescales available and he has appropriate support.

A government Access to Work grant can help to provide practical support for people with a disability, health or mental health condition to help them stay in work. For example, in this situation you could help Jordan apply for a grant to provide coaching sessions or computer software to make it easier for him to read text and reduce mistakes in his writing.

Make sure you manage performance fairly

You must ensure you manage underperformance due to disability fairly and consistently. Reasonable adjustments is an area that sometimes causes concern for managers due to the requirements of the Equality Act. However, if you discuss reasonable adjustments openly, seeking advice where necessary from occupational health or other experts, then this should help you handle the process with confidence.

Help at hand for managers

If you have HR support they can work with you to plan and introduce reasonable adjustments. Check your organisation’s managing performance procedures if you have them, and follow them to the letter.

If you don’t have an HR department or formal policies in place, consider other sources of support. There may be a senior manager or director you can consult within your organisation. There are also a range of external organisations that can offer support and guidance to managers, such as ACAS and organisations that specialise in particular medical conditions or disabilities.

See part 4: How to manage underperforming employees

Scenario seven: managing underperformance due to health

It is December and Magda has had four episodes of sick leave so far this financial year. Sickness has occurred in April, June, September and December (one week ago), each episode lasting between three to four days. Magda appears to be struggling with some of her duties when she is at work, and there are gaps in her understanding of certain team processes. From overhearing conversations you know that some team members don’t like working with Magda, and she is thought of as being unreliable due to her frequent absences.

How do you manage an employee like Magda?

Don’t delay – start taking action

All employees should be encouraged to look after themselves physically, emotionally and mentally. Where you have cause for concern about an employee, or reason to believe ill-health is having an impact on them or their team’s performance, it is your duty to act. Frequent short-term sickness absence can be disruptive to teams and services. It can also indicate a bigger problem for the employee or wider problems within your team, so it is important for you to take action.

Look for patterns in Magda’s absence – is there a collection of Fridays or Mondays or days after a bank holiday? Also look for themes in the reasons she gives for absence and review any fit notes for recurring information.

Help put performance back on track

Put yourself in Magda’s shoes and think about how you might feel and what you would want your manager to say and do. Discuss what you have noticed with Magda and try to find out if there are any underlying causes for her absence. You should take a supportive but firm approach in your conversations with Magda. Keep in mind that she may be nervous about meeting with you. It might be the first time a manager has ever asked to speak to her about this; she might even sense she is at risk of losing her job.

Just having an informal conversation may be enough to alert Magda to the need to address any underlying causes of her underperformance. Perhaps discuss how she is looking after her health and wellbeing and refer her to any initiatives your organisation offers, for example, counselling, weight management, exercise classes or discounts for gyms.

What if no underlying issue is evident?

You should be clear with Magda that her attendance needs to improve, how this will be measured, and the consequences if it does not. Monitor the situation and agree trigger points towards more formal action.

What if there are underlying health problems (or this is suspected)?

You might uncover an underlying physical or mental health problem, difficulties within the team or a problem with the working environment. Putting the right support in place early, for example referring Magda to occupational health services or physiotherapy, can help to minimise any potential future absence.

Magda may be able to continue working, however if her health condition is classed as a disability, then the Equality Act requires you to consider any reasonable adjustments that could be made to assist Magda’s continuing employment, such as allowing time for medical appointments, reduced duties, change in hours, extra training or modified equipment.

See NHS Employers Everything you need to know about sickness absence toolkit for more detail.

Make sure you manage performance fairly

You must ensure you manage employee underperformance due to health fairly and consistently regardless of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation.

Reasonable adjustments for employees who have a disability is an area that sometimes causes concern for managers due to the requirements of the Equality Act. To help you handle the process with certainty, you should discuss reasonable adjustments openly, seeking advice where necessary from occupational health or other experts.


Is there anything Magda’s manager could have done to prevent this scenario? For example:

  • Could problems have been spotted earlier by keeping accurate records of sickness and regularly reviewing absence history?
  • Was a return to work interview conducted with Magda?
  • Why were concerns from team members not formally reported? Has Magda’s manager addressed the apparent team culture of gossiping and whispering about colleagues?
  • Did Magda’s manager proactively discuss health and wellbeing in supervision meetings and encourage her to be aware of looking after herself physically and mentally?
  • Did Magda’s manager lead by example by following policies and taking breaks etc?

See part 4: How to manage underperforming employees

Scenario eight: starting the PPM conversation in a large organisation

You have just been appointed as the ward sister on Rosemary Ward which specialises in patients with heart conditions. The ward is situated in one of three hospitals run by an NHS trust. The trust has more than two million patient contacts a year and employs around 12,000 employees.

The hospital nursing director has briefed you about historic problems with leadership and management of Rosemary Ward, for instance she shares with you examples of:

  • staff not following the latest best practice
  • inadequate supervision and support for newly qualified or less experienced employees
  • employees not feeling as engaged as they wanted or needed to be.

You have been asked to improve the performance of the team and the standards of care.

How will you approach the management of performance on Rosemary Ward?

Don’t delay – start taking action

Start by finding out what mechanisms and processes already exist in the organisation to provide structure to your conversations about performance with staff on Rosemary Ward. For instance, you should familiarise yourself with your organisation’s systems and procedures for formal performance appraisals and supervision meetings.

Look back

  • What was done to manage employee performance in the past?
  • How it was done?

Look forward

  • Can you identify any areas for improvement?
  • What changes do you need to make to systems, processes or team culture?

Follow procedures to the letter but look for other opportunities

Be sure to follow your organisation’s policies and procedures to the letter, and seek support and advice from the HR department.

Think about other day-to-day opportunities (outside of the formal performance management processes) to maintain or improve employee performance on Rosemary Ward; for example, through regular feedback and informal reviews of performance. It’s helpful to view performance management as a two-way, open and honest conversation that goes on throughout employment.

Be a leader and role model

You think that it is important you work alongside team members as a role model and mentor. You see that developing clinical competences and leadership skills within the team as a priority, as well as ensuring that the caring culture expected of the team is being maintained.

You decide that you need to take a more supervisory role and not be office bound, which happened with the previous ward sister. You are going to ensure that you know about the care plans relating to every patient on your ward and that you will be visible and approachable to patients and staff alike.

What is performance management? Why it is needed?

To encourage the support and engagement of the team for the changes you are going to make, you need to be able to clearly explain what performance management is and what the benefits are to the Rosemary Ward team, and particularly why it’s a benefit to patients.

You are not going to do it alone; you have sought support from colleagues, your manager and other relevant sources of support such as your HR department.

How will you manage unsatisfactory performance from an employee?

You will deal with unsatisfactory performance by:

  • Setting clear objectives and competences that you and each team member agree on
  • Giving regular, informal feedback and coaching to help team members reach their objectives
  • Holding regular appraisal reviews to discuss any help or training needed or any problems achieving these objectives

There may sometimes be an overlap between performance management and your disciplinary process.

For example, if you have tried to improve unsatisfactory performance informally but it has not worked, you may need to start a formal disciplinary process.

Be prepared to take steps

For many managers it can be difficult to judge when a performance issue becomes a disciplinary issue. If you notice that an employee is failing to meet their objectives, you need to ask yourself:

  • What is the nature of the problem? If it is a very serious issue that is potentially damaging to your organisation, it will need to be dealt with urgently. In these cases you may instigate formal disciplinary action much sooner
  • How long has it been going on? If you have already discussed the issue at performance review meetings and attempted to resolve the problem, you may decide it is time to follow your disciplinary procedure
  • What is causing the problem? If it is beyond the employee’s control, for example, the lack of adequate training, this needs to be addressed before you begin any formal action
  • Is the employee capable of meeting their targets? If they are capable of meeting their targets, then their failure to do so may be due to a lack of motivation or hard work
  • Is there a pattern of unsatisfactory performance? If you notice that an employee has a pattern of only meeting their objectives as a last resort, when all other options are exhausted, you may decide that an informal approach is not working

If you need to use formal procedures, follow your organisation’s processes to the letter and seek advice from your HR department if you need support.


Think about the journey you and your team have been on.

  • What worked well?
  • What worked less well and shouldn’t be repeated?
  • What lessons have you and your team learned?
  • Does everyone know what is expected of them now?
  • Is the right training and support in place?

Scenario nine: starting the PPM conversation in a small organisation

You have just been appointed as the Registered Manager for Grange House,a residential care home supporting 11 people with a range of learning disabilities. Having observed and assessed the performance of the employees in your team, you are concerned about the performance of two employees: Ivan (a senior care worker); and Jo (a care worker).

Ivan is not completing rotas properly or allocating responsibilities when he is shift leader. People who work with Ivan are telling you that he can appear chaotic and they often feel unsupported.  

Jo doesn’t work on Ivan’s shift pattern.  She is more often on the shift led by May-Li who is generally very organised and diligent in her duties.

You have already observed that Jo is often late by ten minutes at the start of the shift and is not keen on housekeeping tasks and avoids them, preferring to take service users out on activities instead.  You are not sure whether observations about performance have been discussed with Ivan, Jo or May-Li in the past or whether any structures for the management of individual performance are already in place.

How will you start the people performance management (PPM) conversation at Grange House?

Don’t delay – start taking action

Make sure you are clear on what expectations your employer has of you in relation to the management of employees and their performance and familiarise yourself with existing organisational policies and procedures.

As a Registered Manager what does CQC expect of you in performing your role?

As the recently appointed Registered Manager, take the opportunity of being new to ‘start as you mean to go on’ in the area of good performance management both at a team level and on an individual basis.

The aim of both your performance and disciplinary systems is to improve future performance rather than punish past performance.

ACAS, managing performance for small firms

Starting the PPM conversation at team level

Each team situation will be different but you may find it useful to first:

  • Consider what good people performance management (PPM) looks like in practice
  • Find out about how PPM has been approached in the past at Grange House and reflect on any ways in which it could be improved upon
  • Engage your team in the two-way PPM conversation; envisage what you propose to do differently in the future together and how you will know when you have achieved it
  • Know where you can go for information and support 
  • Think carefully about getting it right from the start
  • Make a plan and embark on a continuous journey of PPM improvement as a team

Helpful hint

Longer serving managers can also take steps to introduce or change people performance management processes at any time in the spirit of continuous improvement.

Some helpful questions to ask may be:

  • What specific PPM structures are in place already to help you manage performance?
  • To what extent have they been used in the past?
  • How have they been used and when?
  • What sort of culture is there within the team? Why?
  • Do employees know and understand the organisation’s objectives?
  • Think about your employees not just as employees but as people
    • Have they been supported to do their job?
    • Have they been given regular feedback on their performance?
  • Are the team aware of the direct link between their performance and the quality of the service that service users receive?
  • How will I engage the team in talking about people performance management and introducing any changes together?

Engaging your team

One way of engaging staff in a two-way, open and honest conversation about performance could be by holding a dedicated team meeting. You might first encourage the Grange House team to think about the bigger picture and their shared goal of providing excellent services for the people with learning disabilities in your care.

In preparing for this conversation you may find it helpful to ensure you first fully understand (and are able to clearly explain):

  • What PPM is; and
  • What the benefits of good PPM are to everyone involved

See the checklist on exploring some of the benefits of good PPM to the key people involved in the delivery of care. You may find it useful as a starting point when exploring PPM with your team. One approach could be to ask employees what potential benefits they think there are and develop the checklist further together.

It may also be appropriate to highlight early on that regular one-to-one supervision is their right as an employee.

Ensuring the right performance management system is in place

Since arriving at Grange House you have found that some PPM processes are already in place but they have not been consistently used or communicated. You have discussed the benefits of good PPM with the owner of Grange House (who is also your line manager). She agrees with you that improvements to the people performance management system are necessary to ensure high quality care and that good PPM is important.

They are pleased with your suggestions and proposed approach and have asked you to ensure that an appropriate, fair and robust system is put in place and adhered to as soon as possible. This will involve you ensuring that:

  • The right system is designed and well communicated
  • The team are involved in this journey of improvement from the beginning
  • That organisational policies and procedures are clearly updated to reflect any changes
  • You prioritise and plan in adequate time for good PPM in your schedule and actively role model the right behaviours to ensure it is positively embedded

In doing so, you might wish to explore this toolkit for signposts to information and examples on getting people performance management systems right. 

ACAS provides a helpful series of guides that can support you with the basics of performance management and help you to introduce a process to review and manage employee performance. Further supporting documents and templates can be found on the ACAS website under the section ‘Managing staff’.


Helpful hints

  • Be sure to listen. Good two-way communication is key – it can start at any time

  • Your employees know what it is like to do their job – it may be beneficial to ask them what they think works well and what not so well in relation to performance, taking constructive suggestions on board and the opportunity to address any concerns

  • A trait of good leadership involves supporting people to find the answers for themselves as much as possible – empowering people to take the lead can be very effective in achieving meaningful and sustained improvements

  • There is an opportunity to focus on what has impressed you about the service or perhaps some good overall performance you have observed first before you raise areas for improvement with the team. Remember to be fair and balanced in your constructive feedback at all times, including in a team setting

Starting the PPM conversation at an individual level

You may find it helpful to have a one-to-one supervision with the people you line manage as soon as possible to talk about PPM and communicate the standard you expect them to meet.

Examples of approaches and actions that may be appropriate are as follows.

  • Set clear objectives that you both agree on; check your employees have understood them and feel supported to achieve them
  • Let them know what they should do if they are finding it difficult to meet their objectives and that PPM is a two-way conversation
  • Be clear about what will happen if employees don’t meet their respective objectives
  • Ensure employees are aware of any monitoring of their performance you will undertake in assessing their performance
  • Take the opportunity to get to know your team and establish a professional relationship with them as people
  • Identify any learning and development needs and put the appropriate support in place (on or off the job) to provide the employee with the skills, behaviours and confidence to continuously improve and reach their full potential
  • In the case of employees like Ivan and Jo where there is already evidence of unsatisfactory performance, you should feedback to them regarding your observations without delay and check they are aware of the required standard and that they are equipped to achieve it
  • If people reporting to you are responsible for leading others, as in the case of May-Li, talk to them about good PPM, ensuring they are clear of your expectations of them and that they are adequately trained and supported to deliver good PPM themselves
  • Keep the conversation going and embark on a series of positive, two-way, open and honest conversations
Part 8

Help in a hurry

Find answers to common questions, checklists to support your performance management processes and quick links to further sources of advice and guidance.

Questions and answers

  • Refer to the toolkit section on managing underperformance for a definition of what constitutes underperformance. 

  • Refer to the toolkit section on managing underperformance for information and resources on handling underperformance. Also see the toolkit scenarios on managing underperformance. 

  • Refer to the toolkit section on talking about performance for hints and tips on approaching a conversation about underperformance.

  • See guidance provided by ACAS on taking disciplinary action when a member of staff is off ill. 

    NHS Employers has produced a guide to managing sickness absence for its line managers which covers this topic. 

    A supporting scenario is provided which explores when a member of staff goes off on long term sick just as a formal performance process is about to start or has started.

  • See guidance from ACAS on handling a grievance during disciplinary proceedings.

  • See guidance provided by ACAS on preparing for a formal disciplinary meeting. 

  • See guidance provided by ACAS on conducting a formal disciplinary meeting.

  • See guidance by ACAS on the specific issues of age and the workforce which includes examples.

    In light of changes in the law, retirement is no longer a fair reason for dismissal. You should be aware of the law regarding age discrimination. 

    Also refer to the toolkit section on managing underperformance and supporting scenarios. 

  • See guidance provided by ACAS on fair and unfair dismissal.

  • See guidance provided by ACAS on keeping written records of performance related matters.

  • See guidance provided by the national whistleblowing helpline on managing a member of staff who has blown the whistle during a disciplinary or capability process. 

    See e-learning and educational tools on raising and responding to concerns provided by NHS England.

    Refer to toolkit scenarios on managing performance. 

  • See information provided by NHS Employers on how to recognise and tackle bullying

    See e-learning and educational tools on raising and responding to concerns by NHS England.

    Refer to the toolkit scenarios on managing underperformance.


  • Sometimes there may be an overlap between performance management and your disciplinary process. For example, if you have tried to improve performance through your appraisal and supervision processes but it is not working, you may decide to start a formal process by putting your concerns in writing to an employee.

    This might be then followed by a meeting where you jointly agree a performance improvement plan. This is a written plan for each individual which states:

    • the performance issue
    • what action you have already taken to help the employee to meet the standards for their job
    • what else needs to be achieved (within a specified time scale)
    • what support you will put in place or continue to give
    • the potential outcome of any further failure to meet performance standards.

    If after this, the employee is not meeting the performance standards you have set, it may be appropriate to either put the employee on a further performance improvement plan or consider instigating formal disciplinary procedures.

    Always consult your organisation’s policies and procedures and HR team first for support.

    ACAS provides some questions to ask yourself to help you in your decision making in such instances. It also provides advice via its telephone help lines.


  • Preparation before the conversation:

    • Understand the real issues
    • Take advice from HR or a senior manager
    • Think about how the employee might respond / react
    • Consider what you would like to achieve
    • Practise how and what you are going to say
    • Allow enough time for the conversation
    • Choose the right place for the conversation (private and comfortable place away from distractions)

    During the conversation:

    • State the issues clearly and honestly
    • Explain why it is important
    • Provide specific examples
    • Listen well and be open minded
    • Ask questions
    • Allow for the employee to be heard

    Agree an action plan:

    • Jointly agree a way forward
    • Agree what is to be achieved and by when
    • Consider if any support can be provided
    • Scheduled discussions to review progress
    1. Identify and then assess the problem (what is the problem? how serious is the problem? how long has the problem existed?)
    2. Discuss the problem through your usual management procedures – perhaps in a regular one-to-one supervision meeting
    3. Conduct the discussion in a private, comfortable and quiet location. Explain your concerns to the member of staff in specific terms
    4. Ensure the member of staff clearly understands what is expected of them
    5. Give the member of staff a genuine opportunity to respond
    6. Clearly outline the improvement required and the consequences of continued poor performance
    7. Talk to the member of staff about options for improving performance
    8. Develop an action plan which includes time frames for further review
    9. Schedule another meeting to review their performance against the agreed action plan
    10. Keep written notes of all discussions in case more formal action is needed
    11. Monitor the member of staff’s performance and continue to provide feedback. Where an informal approach fails, take more serious formal action
    12. Be certain to follow any steps set out in the employer’s policies and procedures and the member of staff’s employment contract
    13. Always act fairly and reasonably. Follow the advice set out in the ACAS Code of Practice on disciplinary and grievance procedures if formal action is needed
  • There could be many reasons for the underperformance (work and non-work related). It is important to determine what the reason is so you can discuss practical solutions with the employee.

    Reasons for underperformance could include:

    • A lack of training
    • Equipment issues
    • Problems with supervision
    • Lack of feedback on how well they are doing
    • Lack of understanding of the requirements of the job
    • Workload issues
    • Conflicting deadlines
    • Poor working relationships or bullying and harassment policies or procedures which are barriers to performance
    • Ill-health
    • Personal issues outside work

    To help you investigate the causes for underperformance consider the following:

    • Does the employee have the skill to perform the duties of the role?
    • Has the employee performed to the required standard before?
    • Does the employee believe they have the necessary ability?
    • Does the employee have the interest to perform to the required standard?
    • Have objectives and expectations been communicated clearly?
    • Are the objectives SMART? (i.e. Specific, Measurable, Achievable, Realistic and Time-bound)
    • Does the employee have the tools and support required to perform the role?
    • Is the employee motivated by the rewards for performing well?

    (Adapted from Personnel and Human Resource Management)

  • Preparation before the appraisal conversation:

    • Give the employee at least two working weeks notice of an appraisal conversation
    • Gather information ahead of the meeting
    • Reflect on the employee’s performance during the year
    • Encourage self-assessment by the employee

    During the appraisal conversation:

    • Listen and question but support the employee to do most of the talking
    • Start by discussing strengths and positives
    • Discuss areas for development
    • Consider if any support can be provided
    • Review and evaluate progress against their past objectives
    • Agree new objectives which are SMART (i.e. Specific, Measurable, Achievable, Realistic and Time-bound)
    • Give opportunity for concerns or worries to be raised
    • Formally rate the employee’s level of performance (if your organisation uses rating scales)

    After the appraisal conversation:

    • Schedule discussion to formally review performance (i.e. at three or six months intervals)
    • Keep a written record of the conversation
    • Return a copy of the paperwork to your HR department (where appropriate)
    • Encourage ongoing, open and honest conversations about performance
    • During the course of the year, record changes to objectives or priorities on the employee’s performance paperwork


  • Benefits for organisations:

    PPM is the system you use to align your organisation’s goals with the work of your employees to:

    • Get better results for your organisation
    • Monitor and improve individual and team performance
    • Understand individuals and how they need to develop

    Where a PPM system is working well, employees are more likely to engage with the goals of the organisation. If employees are engaged in their work they are more likely to be doing their best for your organisation. An engaged employee is someone who:

    • Takes pride in their job and shows loyalty towards their line manager, team and organisation
    • Goes the extra mile - particularly in areas where employees need to be creative, responsive or adaptable

    Benefits for line managers:

    Managing the performance of your employees will enable you to:

    • Lead from the front - you might have a clear idea of where your organisation is going, but do your employees understand your vision and does it tie in with their daily activities?
    • Listen to your employees’ real concerns and pick up on their ideas - employees will feel happier and perform well if they have a recognised system for talking to their line manager, getting feedback and help to improve and develop.
    • Understand what makes your employees tick and how they contribute to your organisation’s success - this understanding can only really develop through the kind of regular, open and honest conversation provided by performance management. 
    • Achieve results - if you buy a new piece of equipment or machinery, it usually comes with a manual that explains how to get the best out of it. It is not so simple with people. To work at their best, your employees need an ongoing system of adjusting and reviewing the way they work in order to continually improve. 

    Benefits for employees:

    From an employee perspective, the benefits of good performance management might include:

    • A clear understanding of where they fit into the organisation and their role in achieving the organisation’s goals
    • A greater understanding of the skills, competences and behaviours needed to fulfil their role
    • Having a recognised system for talking to their line manager
    • Being appropriately supported to fulfil their potential within a positive workplace environment
    • Feeling happy and performing well at work

    (Adapted from ACAS website)

  • Always consult your organisation’s learning and development procurement policies and procedures first and follow them (where they exist).

    Where applicable it may also be helpful to:

    • Research the market, look for learning providers from the private, public and voluntary/community sectors and see what they can offer
    • Seek word of mouth recommendation, talk with other organisations, colleagues, workers and professional networks to see if they have any recommendations
    • Consult trusted national organisations, their registers and reports:
    • Refer to Skills for Care’s workforce learning and development page to support you when choosing and commissioning learning and development providers

    (Adapted from Choosing workforce learning, Skills for Care)

Other useful checklists

  • See checklist provided by the ACAS on the specific issue of age and the workforce.

  • See the ACAS ‘recruitment and induction’ booklet for a checklist to help you put together a programme of induction.

  • See resources provided by NHS Employers for managers on what to do when a worker reports a concern.

  • See the ACAS ‘health, work and wellbeing’ booklet for a checklist to help you measure the health and wellbeing of your employees.

Additional support tools

Managers guide to supporting workplace mental wellbeing

NHS Employers

Skills for Care