The GMC's Fitness to Practise Procedures

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					Fitness to Practise | Factsheet

  The GMC’s Fitness to
  Practise procedures
  1   This fact sheet provides an overview of the GMC’s                    whether there are any other concerns about the
      Fitness to Practise (FTP) procedures. Our Fitness                    doctor, before we decide whether we can conclude
      to Practise procedures allow us to respond to                        the case or whether we need to carry out other
      the most serious concerns, which call into question                  enquiries.
      a doctor’s fitness to practise and right to retain
      unrestricted registration.                                   7       Where the concerns potentially raise questions
                                                                           about the doctor’s fitness to practise, we will start our
  2   Our Fitness to Practise procedures are divided into                  investigation. Whenever we investigate concerns
      two separate stages: ‘investigation’ and                             further, we will disclose the complaint to the doctor
      ‘adjudication’. In the investigation stage we                        and his/her employer/sponsoring body. This ensures
      investigate cases to assess whether we need to refer                 that we have a complete overview of the doctor’s
      them for adjudication. The adjudication stage                        practice. This exchange also makes our information
      consists of a hearing by the Fitness to Practise Panel.              available to those responsible for local clinical
  3   The chart at the end of this document explains the
                                                                   8       At this stage the doctor will be given an opportunity
      various procedures and the way in which concerns
                                                                           to comment on the complaint.
      can be referred to the GMC.

                                                                   9       Our investigation will depend very much on the
  Investigation                                                            nature of the concerns raised with us. Our
  4   At an early stage we will decide whether there are                   Investigation Team will decide on the most effective
      issues which we need to investigate further, and if so,              form of investigation for the case. An investigation
      what form the investigation should take.                             may include:
                                                                           l obtaining further documentary evidence from

  5   In some cases, it will be clear from the start that it is              employers, the complainant or other parties
      not appropriate for us to investigate (for example,                  l obtaining witness statements

      because it is not about a doctor or because the case                 l obtaining expert reports on clinical matters

      clearly falls outside our criteria for taking action                 l an assessment of the doctor’s performance

      against a doctor).                                                   l an assessment of the doctor’s health.

  6   If the issues raised in the complaint do not                 10      If we consider that a doctor could be an immediate
      themselves raise questions about the doctor’s fitness                risk to patients, or it is in his/her interest or in the
      to practise, the action we take will depend on where                 public interest, we can take immediate action to stop
      the doctor is employed.                                              a doctor working by suspending them or by
                                                                           restricting them from practising while we continue
      If the doctor is employed within the NHS, we will                    our investigations.
      normally refer the matter to the doctor’s employer,
      so that they can take what action they consider              How long will the investigation take?
      appropriate under their local procedures and report
                                                                   11      The length of the investigation depends on the
      back to us where there are matters which require us
                                                                           complexity and seriousness of the concerns. We will
      to act to protect patients.
                                                                           complete the investigation as quickly and efficiently
                                                                           as we can and will keep the doctor and the person
      If the doctor works as a locum, or in a private setting,
                                                                           that raised the concern informed of progress.
      we will contact the doctor’s employers to establish

                                                           November 2009
                                             The GMC’s Fitness to Practise procedures

What will happen at the end of the                                What happens at the end of a Fitness to
investigation?                                                    Practise Panel hearing?
12   At the end of the investigation the case will be             18     At the end of the hearing the Fitness to Practise
     considered by two senior GMC staff known as case                    Panel may decide that the doctor’s fitness to practise
     examiners (one medical and on non-medical).                         is not impaired and will either take no action or issue
     They can:                                                           a warning. Where they make a finding that the
     l conclude the case with no further action                          doctor’s fitness to practise is impaired they may do
	    l issue a warning                                                   one of the following:
     l refer the case to a FTP panel                                     l put conditions on the doctor’s registration (this
	    l agree undertakings on health and performance                         might mean the doctor is only allowed to do
       issues following a health or performance                             medical work under supervision or restrict him/her
       assessment.                                                          to certain areas of practice)
                                                                  	      l suspend the doctor’s name from the medical
13   No case can be concluded or referred to a Fitness to                   register so that s/he cannot practise during the
     Practise Panel without the agreement of both a                         period of suspension
     medical and non-medical case examiner. If they               	      l erase (remove) the doctor from the medical
     fail to agree, the matter will be considered by the                    register so that he/she will not be able to work as
     Investigation Committee, a statutory committee of                      a doctor in Great Britain; the GMC’s intention is
     the GMC.                                                               that erasure should normally be for life.

14   If the case examiners or the Investigation Committee         19     If the panel decides to impose conditions on the
     decide that the doctor’s fitness to practise is not                 doctor’s registration, they may also impose an order
     impaired, they may issue a warning. A warning may                   for immediate conditions. If the panel directs that
     be appropriate where the concerns indicate a                        the doctor’s registration should be suspended or that
     significant departure from the standards set out in                 his/her name should be erased from the register,
     the GMC’s guidance, Good Medical Practice, or if                    they may also impose an order for immediate
     there is a significant cause for concern following                  suspension.
15   The Investigation Committee will also consider
     those cases where case examiners decide to issue a           20     A warning will be appropriate where concerns
     warning, but where the doctor has disputed the facts,               indicate a significant departure from the principles
     or requested that the matter be considered at a                     set out in the GMC’s guidance, Good Medical
     hearing of the Investigation Committee. The hearing                 Practice, or if there is a significant cause for concern
     will take place in public.                                          following assessment but a restriction on the
                                                                         doctor’s registration is not necessary.
16   We will inform both the doctor and the complainant/
     referring organisation of the case examiners’ decision       21     For more information on warnings please see the fact
     and their reasons.                                                  sheet which can be downloaded from our website.

Referring a doctor to a Fitness                                   Undertakings
to Practise Panel                                                 22     Undertakings are an enforceable agreement between
                                                                         the GMC and the doctor about the doctor’s future
17   Fitness to Practise Panels form the final stage of our
                                                                         practice. They allow the GMC to deal effectively
     procedures. A panel consists of specially trained
                                                                         with cases where the issues relate to a doctor’s
     people, both doctors and members of the public,
                                                                         health or performance without having to refer to a
     who will hear all the evidence and will decide at
                                                                         Fitness to Practise Panel. Such undertakings might
     the end of the hearing whether they need to take
                                                                         include restrictions on the practitioner’s practice or
     action against the doctor. The panels will act in
                                                                         behaviour, or commitments to have medical
     accordance with the standards and guidance
                                                                         supervision or retraining.
     published by the GMC. Hearings are held in public,
     unless they are hearing confidential evidence about
                                                                  23     For more information on undertakings please see the
     a doctor’s health.
                                                                         fact sheet which can be downloaded from our

                                                       November 2009
                                               The GMC’s Fitness to Practise procedures

Interim Orders Panel                                                What we cannot do
24   At any stage in the proceedings we may refer the               31     Our legal powers enable us to take action where
     doctor to the Interim Orders Panel (IOP). An IOP                      there is evidence that it is necessary to remove or
     can suspend or restrict a doctor from practising while                restrict the doctor’s right to practise. There are other
     the investigation continues.                                          areas where we cannot act. In particular we cannot:
                                                                           l deal with concerns or complaints about nurses,
     For more information on the Interim Orders Panel                        pharmacists, dentists, opticians, hospital or
     please see the fact sheet Investigating Concerns                        practise managers or administrative staff, or
     which can be downloaded from our website.                               anyone who is not a registered doctor (many other
                                                                             kinds of medical professionals have their own
Convictions and decisions by other                                           regulatory bodies and complaints procedures)
                                                                           l provide advice on standards of practice applicable
regulatory bodies                                                   	
                                                                             to other healthcare professionals (the regulatory
25   Our rules allow us to deal quickly with doctors who                     bodies for those professions will be able to help)
     have received a criminal conviction or who have                	      l arbitrate in practice or departmental disputes
     been subject to a decision by a regulatory body                	      l intervene in local disciplinary procedures
     either in the British Isles or overseas.                       	      l provide advice and support to doctors whose
                                                                             employers are considering action against them
26   We treat convictions and determinations by other                        (doctors in this position should consult their
     regulatory bodies as proof of that offence. In many                     medical defence organisation or the British
     cases, particularly where the doctor has received a                     Medical Association)
     custodial sentence, the case will be referred directly                l make a doctor apologise to a patient or
     to a Fitness to Practise Panel for a hearing.                           professional colleague
                                                                    	      l order a doctor to provide a patient with the
27   Certain categories of conviction cases (such as                         treatment they want
     parking offences) will be closed at a very early stage         	      l pay a patient compensation or fine a doctor.
     with no further investigation or action.

28   A doctor has 28 days in which to appeal to the
     High Court or Court of Session about any decision
     by the Fitness to Practise Panel. The panel’s decision
     will not take effect until either the appeal period
     expires or the appeal is determined. However, the
     panel can impose an immediate order of suspension
     or conditions if it believes this is needed to protect
     the public or is in the best interests of the doctor.

Council for Healthcare Regulatory
29   The Council for Healthcare Regulatory Excellence
     (CHRE) has the power to refer a decision by a Fitness
     to Practise panel to the High Court (or its equivalent
     throughout the UK) for the protection of the public,
     if it considers the decision is unduly lenient. The
     CHRE has 28 days to decide whether to refer a
     decision following the doctor’s 28-day appeal period.
     CHRE reviews all decisions of GMC Fitness to
     Practise panels that have not resulted in erasure.

Time limits
30   The GMC will not normally investigate complaints
     about matters that took place more than five years
     ago, unless it considers that it is in the public interest
     for the case to proceed.
                                                         November 2009
Dealing with concerns about a Doctor

                                                             Stage One                                                                                          Stage Two

Referral to the GMC                              Further Investigation                             Investigation Committee and                     Adjudication
It is often better for patients to raise their   Where a matter raises serious concerns about      Interim Orders                                  Fitness to Practise Panels comprise the final
concerns through local complaints procedures     a doctor’s practice, the GMC will undertake an    If both case examiners decide that a warning    stage of the GMC’s procedures.
in the first instance with the NHS Hospital      investigation. This may include an assessment     is appropriate, the doctor may exercise         All aspects of the doctor’s fitness to practise
Trust, Primary Care Trust (or equivalent) or     of the doctor’s health or performance, where      his/her right to an oral hearing before the     will be considered and there are no longer
Private Healthcare Body.                         appropriate. GMC case examiners will then         Investigation Committee. If the two case        separate streams for conduct, health and
                                                 decide what action to take, for example           examiners do not agree on the appropriate       performance.
     NHS                                         referral to a Fitness to Practise Panel. If the   outcome, the case will be decided by a
     Local Procedures                            case examiners cannot agree or a warning          meeting of the Investigation Committee.
                                                                                                                                                       k GMC
	    • Internal review                           is offered and the doctor refuses to accept
         o No action required                                                                                                                      	     •	Fitness	to	Practise	Panel
                                                 the warning, the case will be referred to the     k    GMC                                                The panel may decide to:
    k    o Internal/Local action                 Investigation Committee.                                                                                   o Issue a warning to the doctor
         o Information exchange                                                                    	    •	Investigation	Committee
         o Referral to the GMC                        GMC                                                   o No action required                            o Put conditions on the doctor’s
                                                 k                                                          o Warning issued                                  registration
     Private Health                              	    •	Further Investigation              k                o Referral to a FTP Panel                       o Suspend the doctor’s name from
     Local Procedures                                   The case examiners may decide to:                   o Undertakings agreed                             the medical register
	    •	Internal review                                   o Take no action                                   o Referral to the IOP                           o Erase the doctor’s name from the
         o No action required                            o Issue a warning                                                                                     medical register
         o Internal/Local action                         o Refer to a FTP Panel                         GMC
    k    o Information exchange                          o Agree undertakings
                                                                                                   	    •	Interim	Orders	Panel
         o Referral to the GMC                           o Referral to the Interim
                                                                                                            o IOP directs interim conditions
                                                           Orders Panel (IOP)
     GMC                                                                                                      (restricting practise)
     GMC Procedures                                                                                         o IOP directs suspension with
	    • Internal review                                                                                        immediate effect
         o Information exchange
         o Further investigation by the GMC
    k    o Conviction or decisions from
           another regulatory body

         o Inappropriate complaints would be
           closed at this stage                                                                                                                k

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