Fitness to Practise: An overview of GMC processes and common issues for independent practitioners

Due, in part, to the growing use of social media and media coverage of the healthcare profession, complaints to healthcare regulatory bodies are growing. The way in which these complaints are handled is continually evolving in order to manage the growing number of complaints.

Although all medical practitioners hope that they will never be the subject of fitness to practise proceedings, it is nonetheless advisable to have an understanding of the processes of the GMC. Such an understanding will not only assist if that practitioner is the subject of a complaint (or is the maker of or witness to a complaint); an understanding of the processes is part of the armour that will assist a practitioner in guarding against a complaint being made in the first place.

This article gives an overview of the processes in place at the GMC for dealing with complaints, and sets out some common issues which are of particular significance to independent practitioners.

The initial journey of a complaint

A complaint can be made to the GMC by any person or organisation. This includes patients and their relatives, a practitioner’s employers and their responsible officer. The GMC sometimes also become aware of issues from the media.

Upon receipt of a complaint, the GMC will determine whether the issues raised concern a practitioner’s fitness to practise. A practitioner is “fit to practise” when they are suitable to practise without restriction. If the GMC decide that they are not the appropriate organisation to investigate the complaint, they may pass it to the practitioner’s responsible officer to consider as part of their wider practice or pass the complaint back to local complaints procedures.

A practitioner’s fitness to practise can be impaired on a number of grounds:

  • Misconduct (defined as “serious professional misconduct”, which will include consideration of whether there has been a breach of the standards set out in the GMC’s Good Medical Practice);
  • Deficient professional performance;
  • A criminal conviction or caution in the UK (or elsewhere for an offence which would be a criminal offence if committed in the UK);
  • Adverse physical or mental health;
  • A determination by a regulatory body in the UK or overseas;
  • Lack of the necessary knowledge of the English language to be able to practise medicine safely in the UK.

The GMC will undertake an initial investigation of the complaint, which may include obtaining witness statements, expert reports or undertaking an assessment of the doctor’s performance, health or knowledge of the English language. Once that initial investigation is complete, the practitioner will be given the opportunity to submit comments and the matter will be considered by two Case Examiners (one medical and one lay).

The Case Examiners will consider whether there is a realistic prospect of establishing that the practitioner’s fitness to practise is currently impaired. This will involve consideration of whether they present any risk to the public and whether any shortcomings identified are remediable, have been remedied and are highly unlikely to be repeated. It will also involve consideration of the need to maintain public confidence in the profession.

The powers of the Case Examiners are to:

  • Conclude the case with no further action;
  • Issue a warning;
  • Agree undertakings with the practitioner; or
  • Refer the case to the Medical Practitioners Tribunal Service (MPTS) for a Medical Practitioners Tribunal (MPT) hearing.

Interim orders

It is important to note that, at any stage of the investigation, the GMC can refer a practitioner to an Interim Orders Tribunal hearing to determine whether it is necessary to suspend or impose conditions upon their practice while the GMC investigation is taking place.

Hearings before the MPTS

The MPTS was established in June 2012 and is the adjudicatory arm of the GMC. It has a degree of independence from the GMC. In relation to fitness to practise proceedings, the GMC has an investigatory function.

If a hearing takes place, it will ordinarily take place at a public hearing before a Tribunal consisting of at least three members, including a medical practitioner. They will hear evidence, which may include oral evidence on oath from the practitioner themselves, and determine whether the allegations have been proved (on the balance of probabilities). If so, they will determine whether the practitioner’s fitness to practise is currently impaired and, if current impairment is established, which sanction, if any, should be imposed. If a finding of no impairment is made, the Tribunal can nonetheless issue a warning. If a finding of impairment is made, they have the power to:

  • Take no action
  • Accept undertakings
  • Place conditions on the practitioner’s registration
  • Suspend the practitioner
  • Erase the practitioner from the register

Right of appeal

If adverse findings are made, a practitioner has the right to appeal the outcome of their hearing to the High Court.

Common issues for independent practitioners

  • You should ensure that you are fully insured/indemnified and should take care to check that your cover includes all roles and your entire scope of work;
  • It is wise to ensure that insurance/indemnity includes regulatory proceedings as well as civil (clinical negligence) actions;
  • Without the structure of the NHS behind you, it is important to ensure that your patients have adequate access to advice and care when you are not around – arrange with a colleague with admitting rights at the same private hospital to cover your patients when you are on holiday, for example;
  • Be careful with billing and coding – there is always the potential for allegations relating to financial dealings/fraud;
  • Take care not to carry out private work in NHS time without prior agreement from your employer;
  • Greater emphasis on “self-policing”:
    • Arguably a higher level of responsibility for an independent practitioner to keep their professional knowledge and skills up-to-date and monitor and improve the quality of their work, as you may have less peer support/scrutiny in the public sector;
    • Arguably a greater role in monitoring own health and well-being and notifying appropriate persons where a condition or its treatment could affect your judgment or performance;
    • Must self-refer to the GMC where appropriate, for example where charged with a criminal offence.

The most important thing to emphasise is that if a practitioner is ever the subject of a complaint, they should seek the advice of their indemnity organisation or other professional advisers at the earliest opportunity and engage fully with them.