For any doctor, being the subject of a complaint can cause great stress and anxiety. When an allegation results in a formal investigation by the General Medical Council (GMC), the process that follows can be daunting and confusing.
Early advice and support are crucial to ensure that a doctor’s career and ability to work are not unfairly disrupted. Equally, action taken at an early stage of an investigation can have important consequences in later fitness to practise proceedings, and in some circumstances, avoid the need for further proceedings to take place at all.
Referral to the GMC and investigation
Complaints against doctors can be referred to the GMC in several different ways, including through a complaint made directly to the GMC, or following an investigation by a local NHS trust or private healthcare provider. In addition, doctors have an obligation to inform the GMC without delay if, anywhere in the world:
- they have accepted a caution from the police or been criticised by an official inquiry
- they have been charged with or found guilty of a criminal offence
- another professional body has made a finding against their registration as a result of fitness to practise procedures
If a doctor finds themselves suspended by an organisation from a medical post, or has restrictions placed on their practice, they must inform any other organisations they carry out medical work for and any patients they see independently.
On receipt of a complaint or self-referral by a doctor, the GMC will decide whether to investigate, exercising its powers under the General Medical Council (Fitness to Practise) Rules Order of Council 2004 (as amended) (‘the GMC Fitness to Practise Rules’). Under GMC Rule 4, the GMC will write to the doctor to notify them that an allegation has been made and an investigation is being considered.
In some cases, the GMC will conduct a provisional enquiry to decide whether a full investigation is necessary. However, where an allegation raises concerns regarding a doctor’s fitness to practise, an investigation will almost always take place.
In conducting an investigation the GMC may take the following steps:
- review documentary evidence from a range of sources
- take witness statements
- obtain expert reports on clinical issues and performance
- conduct an assessment of the doctor’s performance
- conduct an assessment of the doctor’s physical and mental health
Following the referral of an allegation under GMC Rule 8, Rule 7 requires that the GMC must again write to the doctor:
- informing them of the allegation and stating the matters which appear to raise a question as to whether their fitness to practise is impaired
- providing them with copies of any documents received by the GMC in support of the allegation
- inviting them to respond to the allegation with written representations within the period of 28 days from the date of the letter
- informing them that representations received will be disclosed, where appropriate, to the maker of the allegation (if any) for comment
It is important to seek legal advice before responding to any request from the GMC for an account or representations. Effective representations at this stage may satisfy the GMC that further fitness to practise proceedings are not necessary.
Following an investigation, the findings are considered by two GMC Case Examiners, one medical and one non-medical. The Case Examiners will review the evidence and decide whether to:
- conclude the case with no further action
- issue a warning
- agree undertakings to address a problem, or
- refer the case to the Medical Practitioners Tribunal (MPT) for a hearing
Both Case Examiners must agree on the outcome. If they fail to agree, the case will be referred to the GMC’s Investigation Committee to decide on the outcome.
If at the end of the investigation the decision is made to issue a warning but the doctor disputes the facts, a hearing will take place to resolve the issue.
Referral to the MPT
The Medical Practitioners Tribunals Service (MPTS) runs fitness to practise hearings for UK doctors. The overriding objective of the MPTS in making procedural rules is to ensure that MPTs deal with cases fairly and justly. The GMC Fitness to Practise Rules are intended to achieve this objective.
Cases are either designated as 6-Month Cases or 9-Month Cases depending on whether the GMC’s investigation, case preparation, and disclosure are completed before or after the Case Examiners’ decision. Hearings in 6-Month Cases should start within six months of that decision, whereas hearings in 9-Month Cases should start within nine months.
Case management procedures apply to all matters before the MPT. Case management is intended to ensure that cases are heard within their target timescales and usually takes place during a telephone conference and/or pre-hearing meeting. Hearings take place at the MPTS hearing centre in Manchester, although in certain circumstances, participants may appear remotely by video or telephone.
Case management is the responsibility of a Case Manager. The process includes agreeing hearing dates and directions in relation to when the parties must disclose any evidence they propose to rely on.
Participation in case management procedures is voluntary however it is strongly in the interests of any doctor subject to proceedings to ensure they are represented during this process. If a party does not comply with directions made during the case management process, the MPT has discretion to draw adverse inferences, refuse to admit late evidence, and to award costs.
Interim Orders Tribunals
Upon application by the GMC, the MPT has the power to impose interim orders restricting a doctor’s practice while an investigation and proceedings are underway. In seeking restrictions, the GMC must set out the reasons why it is necessary to make or review an interim order.
Interim Orders Tribunals (IOT) are made of three tribunal members, one medical and one non-medical. The tribunal may make or review interim orders in person during a hearing, or following a review on the papers provided the GMC and doctor are in agreement.
Although subject to periodic review, interim orders imposed at an early stage in proceedings may remain in place for a significant period of time. Early advice and assistance in avoiding the imposition of interim orders that are disproportionate or unfair is crucial.
Fitness to Practise Tribunals
Fitness to practise hearings take place before an MPT, usually at the MPTS hearing centre in Manchester. As with IOTs, which consider interim orders, MPTs are made up of three members and include at least one medical and non-medical member.
In certain circumstances participants can appear remotely however it is generally expected that the parties, legal representatives, and witnesses will attend in person.
The tribunal will come to a determination in relation any factual issues having heard all the relevant evidence in the case. This can include live evidence from witnesses and experts, and documentary evidence presented by the parties. On hearing the evidence, the tribunal decides whether the alleged facts are proved on the balance of probabilities.
If the tribunal finds that the allegation is not proved, the proceedings will conclude without any finding against the doctor.
If the tribunal finds that the allegation is proved but that the doctor’s fitness to practise is not impaired, the proceedings will conclude, with or without a warning on the doctor’s registration.
If the tribunal finds that the allegation is proved and the doctor’s fitness to practise is impaired, it will continue to consider what sanction to impose.
A wide range of sanctions are available, including the following:
- undertakings between the doctor and GMC
- conditions on the doctor’s registration
- suspending the doctor from the medical register for a fixed period
- erasure of the doctor from the medical register (normally for life)
Both the doctor and GMC have 28 days to lodge an appeal against any decision of the tribunal. Appeals are heard by the High Court or the Court of Session.