GMC fitness to practise hearings

What is the GMC responsible for? 

There are a number of ways that matters are referred to the GMC such as patient complaints, concerns raised by NHS Trusts or employers as well as things outside medical practice such as health concerns, or police reports; however, the GMC will focus on four areas which are: 

• Misconduct — for example, allegations of dishonesty, allegedly inappropriate interactions with colleagues or behavioural concerns; 
• Performance or capability concerns — such as poor record keeping, perceived technical skill gaps or problems around prescribing; 
• Health problems — often involving drug and alcohol problems, or the mental and physical health of the doctor; and 
• Convictions and cautions — outcomes from court cases or police investigations will often be referred directly to a GMC hearing, and even if you are found not guilty, the case may still be investigated by the GMC. 

There will also be overlapping investigations — for example, a conviction or misconduct case that may also involve mental health problems. 

Some referrals are more challenging to deal with. For example, allegations of dishonesty are taken very seriously and if the facts are proven and the Tribunal determines the doctor’s fitness to practise is impaired, then the starting point for any sanction is erasure.

Health cases also fall into a particular category as a doctor whose fitness to practise by reason of adverse mental or physical health is unlikely to be raised unless there are other factors involved in the case.

In short, each case is unique and will raise particular points. However, our team have dealt with hundreds, if not thousands, of GMC cases over the decades and we are uniquely equipped to support and guide a doctor through a GMC investigation and any fitness to practise hearing.

What is the role of the GMC? 

The overarching purpose of the GMC is to protect patients, the public and to uphold the public interest, which includes maintaining the reputation of the professional as well as upholding and declaring proper standards of conduct.  

The basis for any GMC investigation is “Good Medical Practice” which sets out the standards to which doctors must adhere in return for the privilege of practising their profession.  Where concerns arise that a doctor may not have adhered to the required standards, then the GMC has the legal powers to investigate and take action where necessary. 

The GMC investigation process

GMC fitness to practise investigations are going to be a worrying and challenging time for a doctor, and they can take a long time to be concluded. Handled appropriately, most will close without referral to a hearing.  

Sometimes, the first time a doctor is aware that the GMC is looking into a concern is when they receive a Rule 4 letter from the Council notifying them of that fact. The GMC will initially gather information about the concern and then assess whether a formal investigation is required. If the Council decides to undertake a formal investigation, then the GMC will do so by obtaining documents, witness statements and expert reports. 

Once the fitness to practise investigation is completed, the GMC will usually send a Rule 7 letter to the doctor enclosing draft allegations and the evidence that it has gathered. The Rule 7 letter will invite the doctor to formally respond to the allegations and supporting documents. The registrant does not have to comment at this point, but this is a key moment in the process.

Our team of highly experienced lawyers are experts at preparing responses to allegations at this stage of the process — we know the approach that is most likely to result in a good outcome, and use that expertise to the benefit of our clients. The tone and content of any response to the GMC allegations can make all the difference to the outcome of the case as a whole. 

The GMC will then send the case papers and any representations made on behalf of the practitioner to the Case Examiners; they are key decision-makers who will decide if the case is referred to a hearing or not.   

The Case Examiners also have the option of inviting the doctor to agree undertakings at this stage — those restrict the doctor’s ability to practice — for example requiring supervision for a particular procedure, which can be agreed by the parties, usually in performance cases with a view to remediate the underlying concerns.

Undertakings are enforceable and action may be taken if the doctor does not comply with them. Generally, the undertakings will remain in place until the GMC determined they are unnecessary and can be revoked.

GMC fitness to practise hearings

If a referral to a fitness to practise hearing is made, then a preliminary meeting between the respective lawyers will take place where a hearing date will be set and a timetable of case management directions leading up to the hearing will be provided. 

The fitness to practise hearing process is managed by the Medical Practitioners Disciplinary Tribunal Service (or MPTS). 

A fitness to practise hearing takes place before a Tribunal which is usually made up of a legally qualified chair, a lay member and a doctor. The GMC will be represented by a lawyer and the doctor is entitled to be represented by a solicitor or a barrister.

Both the doctor and the GMC will be given the opportunity to present their cases — the burden of proving the case against the practitioner rests with the GMC.  Having considered the evidence and submissions, the Tribunal will first decide whether the factual allegations are found proven before assessing whether the doctor’s fitness to practice is currently impaired. Only if that is proven will the Tribunal then move on to consider what, if any, sanction should be imposed on the doctor, including:

• No further action; 
• A warning, where there has been serious misconduct found but no current impairment of the registrant’s fitness to practise; 
• Conditions — that outcome means that the doctor’s practice will be restricted and monitored for a defined period of time. The need for the conditions will be reviewed before they expire and a further Tribunal will assess the doctor’s compliance with the restrictions and their progress towards remediation. Non-compliance with the restrictions may result in a further investigation in some cases, but even a minor breach may have to be explained. 
• Suspension for up to 12 months — a practitioner who is suspended from the Register will be prevented from practising their profession for a defined period of time. This may result in loss of employment, loss of income, and reputational damage. Often, a suspended practitioner will be required to attend a review hearing before the suspension expires to judge whether they are fit to practise and therefore able to return to the Register. 
• Erasure — this is the most serious sanction that can be imposed as erasure removes a practitioner’s name from the Register altogether. Erasure is therefore reserved for the most serious of issues, such as serious dishonesty, serious misconduct and conduct fundamentally incompatible with professional registration. When considering erasure, professional regulators will prioritise the interests of the profession over individuals and whilst the Tribunal must act proportionately, little weight is usually given to the obvious personal consequences for a doctor who has been erased. 

Summary 

GMC fitness to practise investigations can have very serious consequences for a doctor, but if handled carefully and sensitively, a hearing can often be avoided, and a satisfactory outcome achieved. As industry-recognised experts in advising healthcare practitioners through all aspects of the fitness to practise process, we have the experience and knowledge to help you to navigate this worrying process.    

Our team is Tier 1 ranked in both the UK legal directories; we know the GMC, how they think and how they react to information provided and submissions made at each point in the process. We, therefore, know what approaches are most likely to be effective. We deploy that knowledge to our clients’ advantage throughout a fitness to practise investigation. We are ready to present a robust defence, but also know when demonstrating insight and remediation may be the best means of bringing an investigation to a swift and satisfactory conclusion.  

Taking early expert advice is crucial, as early intervention can make the difference between a short process and a protracted one, with the personal and financial impacts that entails.