Fitness to Practise | Factsheet
The GMC’s Fitness to
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
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
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
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.
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.
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.
• 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