A Brief Overview of The GMC Fitness to Practise Process

30^th May 2023

Introduction

The General Medical Council (GMC) is the regulatory body for doctors in the UK. Its purpose is:

to protect, promote and maintain the health, safety and well-being of the public;
promote and maintain public confidence in the medical profession; and
promote and maintain proper professional standards and conduct for members of the medical profession.

This final function – fitness to practise – is what it is most well-known for.

In this article, we briefly describe the key stages of a GMC investigation, and points to consider if you are involved in one.

How does a Fitness to Practise case start?

Fitness to practise (FtP) cases commence either via complaints made to the GMC by third parties such as patients, employers, or police; via self-referral by the doctor concerned; or via the GMC itself deciding to open an investigation – for example, because of the GMC seeing a media report regarding a doctor’s activities. Members of the public (mainly patients) consistently make the largest number of FtP complaints about doctors.

Triage and investigation

Each complaint submitted to the GMC goes through a triage assessment process. Following triage, complaints are either closed, referred to the doctor’s employer for local-level action, or referred onwards for a provisional or full GMC investigation. It is only those complaints which are sufficiently serious to raise a concern about the doctor’s fitness to practise which progress to a GMC investigation.

Investigations by the GMC can include:

Obtaining independent expert evidence.
Taking witness statements.
Commissioning an assessment of the doctor’s health, performance, or knowledge of the English language

Rule 7

When the GMC has concluded its investigation, it will provide the doctor with fully particularised allegations, supported by a bundle of the GMC’s evidence which supports those allegations. This is known as Rule 7 stage and is a crucial point in the GMC FtP process, because it is the final opportunity for a doctor’s case to be resolved without a formal (and likely public) hearing before the Medical Practitioners Tribunal Service (MPTS).

It is important to fully engage with the Rule 7 stage, as a detailed response will often include items such as the doctor’s factual account and reflections, legal arguments, references and testimonials about the doctor, relevant CPD and expert evidence, to counter any obtained by the GMC.

Case Examiners

Once a doctor has submitted their Rule 7 response, the entire case will be considered by two GMC Case Examiners. Case Examiners are senior GMC decision-makers and each case is considered by one medically-qualified Case Examiner and one non-medical Case Examiner.

Essentially, the Case Examiners must grapple with what is known as ‘the realistic prospect test’. The realistic prospect test means that there must be a genuine (not remote or fanciful) prospect that both the factual allegations in the case and impairment of the doctor’s fitness to practise will be found proved if the case is referred forward for a hearing before the MPTS.

The six categories of fitness to practise impairment comprise:

Misconduct.
Deficient professional performance.
Adverse physical or mental health.
Lack of English language.
Conviction or caution.
Determination by another regulatory body.

The Case Examiners have a broad range of powers. Their options include:

Concluding the case with no action.
Issuing a Warning, which will be published against the doctor’s medical register entry.
Agreeing Undertakings, for example in a health case the doctor might undertake to abstain from the consumption of alcohol.
Referring the case forward for a hearing before the MPTS.

A minority of FtP cases progress to the final stage of a MPTS hearing.

MPTS Hearings

The MPTS is the independent adjudication limb of the GMC and hears all FtP cases against doctors. FtP hearings are divided into three stages:

Facts – which, if any, of the factual allegations against the doctor are found proved?
Impairment – as a result of the facts found proved, is the doctor’s fitness to practise impaired by reason of one of the categories of impairment (e.g. misconduct)?
Sanction – if the doctor’s fitness to practise is impaired, what sanction should be imposed?

At each stage of a MPTS hearing, both the GMC and doctor have an opportunity to present their evidence, examine witnesses and make legal submissions to the Tribunal. A doctor’s evidence is often the most crucial point in the defence case.

If a case progresses through to sanction stage, the sanctions available to the Tribunal range from taking no action, to imposing conditions of practice on the doctor’s GMC registration, to erasure from the medical register.

What to do if you receive correspondence from the GMC

If you receive correspondence from the GMC indicating that they have received a complaint or concerns about your fitness to practise, it is understandable that you may feel stressed or anxious. Try to:

Stay calm - in 2021, the GMC investigated just over 10% the enquiries they received, with the vast majority closed without any investigation¹. - ¹FTP Annual Stats Clean New Template Version 26072022 (gmc-uk.org)
Immediately notify your insurer or indemnifier of any correspondence intimating that the GMC has received a complaint or concern about you.
Reflect on the initial complaint or concern. You may wish to write down your thoughts on the nature of the complaint/concern, but do not send these to the GMC.
Ensure you have a good support network around you. Do not be afraid to reach out to organisations such as the Doctor Support Service, NHS Practitioner Health, or Doctors in Distress for support.

If you have any questions or require any further advice, then please reach out to your broker.