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A guide for doctors referred to the GMC

This guide explains how we deal with complaints and concerns about doctors that have been reported to us by patients, employers, the police and other bodies.

As this is only a guide to our procedures, it is important to get independent advice from your defence organisation or solicitor.

When can the GMC take action?

We can take action if the doctor's fitness to practise is impaired. This may be for a number of reasons:

  • misconduct
  • poor 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)
  • physical or mental ill-health
  • a determination (decision) by a regulatory body either in the UK or overseas
  • lack of the necessary knowledge of English language to be able to practise medicine safely in the UK.

If we believe that a doctor's fitness to practise may be impaired we can:

  • agree undertakings with the doctor
  • place conditions on their registration
  • suspend their registration
  • remove them from the medical register.

If we believe their fitness to practise is not impaired but there has been a significant departure from the principles set out in our guidance, Good medical practice, we can issue a warning to the doctor.

What happens when a doctor is reported to the GMC?

We review all complaints carefully to see if there are issues that we need to investigate. In some instances, we may decide to carry out a provisional enquiry. A provisional enquiry is a limited, initial enquiry at the outset of the process which helps us to decide whether to open an investigation.

If we decide that we are not the right organisation to investigate the complaint, we may pass it to your responsible officer to consider as part of your wider practice. We may also ask you to pass the complaint to the local complaints procedure to be dealt with locally. Find out more about sending complaints to responsible officers.

If we believe potentially serious concerns are being raised, we will investigate further ourselves.

We do not normally investigate complaints about matters that took place more than five years ago, unless we consider that it is in the public interest to do so.

Legal advice

If you are reported to us, you should contact your medical defence organisation straight away. The defence organisations know our procedures well. They are a good source of advice and can offer you legal support if you need it.

If you are not a member of a defence organisation, you could contact the British Medical Association or another professional organisation of which you are a member. They may not be able to provide legal representation but they are a good source of expert advice and support.

Alternatively, you can get your own legal advice, at your own expense. Legal aid is not available to doctors being investigated under our procedures and you can’t claim costs from the other parties involved.

Emotional support and advice

Having your fitness to practise investigated can be a very stressful experience. We have commissioned BMA Doctors for Doctors to provide dedicated, confidential emotional support to any doctor involved in a fitness to practise case who would like it. The service is free of charge. You can find out more using our doctor support service or call the service now on 020 7383 6707.

Complaints we investigate immediately

Before we begin an investigation, we’ll tell you about the complaint that has been made about you and ask for details of your employer.

We’ll give you the opportunity to comment on the complaint. You don’t have to comment at this stage, but if you do, it may help us to resolve the case more quickly. We’ll give you another chance to comment later if there is any likelihood of the case being referred to a hearing.

Our guidance, Good medical practice, makes it clear that you must cooperate fully with any formal inquiry into the treatment of a patient and with any complaints procedures that apply to your work. You should contact your defence organisation for advice.

We’ll ask your employer, normally the chief executive or medical director of the relevant body, if they have any other concerns about your fitness to practise. This is to make sure we have a better picture of your fitness to practise and to allow us to feed into local clinical governance.

How we conduct our investigation will depend very much on the nature of the concerns. For instance, the investigation may involve getting:

  • further documentary evidence from, for example, your employer or the complainant
  • witness statements expert reports on clinical matters
  • an assessment of your performance
  • an assessment of your health
  • an assessment of your knowledge of the English language.

Interim orders tribunals

At any stage in the investigation, we can refer you to the Medical Practitioners Tribunal Service (MPTS) for an interim orders tribunal hearing. This tribunal can suspend you, or restrict you from practising while the investigation continues if they decide this is necessary to protect the public. For more information on MPTS interim orders tribunals, read our investigating concerns factsheet (pdf).

 

 

Complaints we send to your responsible officer or employers

If we consider that the complaint, even if proven, would not raise questions about your fitness to practise, we won’t take any further action. If, however, the complaint could raise concerns if it formed part of a wider pattern of concerns, we’ll let you know about the complaint to reflect on as part of your revalidation and ask you to confirm the details of your responsible officer. If we hold the wrong details, we will ask you to update them using GMC Online.

We’ll also tell you to pass the complaint to your local complaints body where the incident happened, or other relevant body, to be dealt with locally.

If, for any reason, you don’t have a responsible officer at the time that we receive the complaint, we’ll share the complaint with your employers and ask them if they have any wider concerns about your practice. The following guidance relates to those cases that we investigate immediately.

How long will the investigation take?

This depends on the complexity and seriousness of the concerns. We will complete the investigation as quickly and efficiently as we can, but it can take several months if we need to ask for information from other organisations or individuals. We’ll keep you, and your defence organisation if you have one, fully informed of progress.

What will happen at the end of the investigation?

At the end of the investigation, two senior GMC staff known as case examiners, one medical and one non-medical, will review all the evidence collected 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 MPTS for a medical practitioners tribunal.

The medical and non-medical case examiners must agree to close a case or refer it to the MPTS for a hearing. If they fail to agree, the case is considered by the Investigation Committee, a statutory committee of the GMC.

If the case examiners or the Investigation Committee decide that your fitness to practise is not impaired, but that you were in breach of our guidance, they can issue a warning.

The Investigation Committee will also consider a case when case examiners consider that a warning is appropriate, but the doctor has disputed the facts, or requested a hearing of the Investigation Committee. The hearing will take place in public.

Unless the case is about your health, we’ll tell you and the complainant what the case examiners’ decision is and their reasons. If the case is about your health, we’ll tell you and the complainant what the case examiner’s decision is, but will only give you their reasons. This is because we treat information about a doctor’s health as confidential.

Medical Practitioners Tribunal Service hearings

The MPTS makes decisions about doctors' fitness to practise. It is part of the GMC, but operationally separate and accountable directly to Parliament.

Medical practitioners tribunals consist of specially trained people, both lay and medical, who will hear all the evidence and decide at the end of the hearing whether the doctor’s fitness to practise is impaired. If it rules that it is, the tribunal will decide what sanctions may be needed to protect patients.

If we refer your case to the MPTS for a hearing, we’ll write to you to set out the allegations. Again, it is important that you seek advice from your defence organisation if you have one or from a solicitor.

Hearings are held in public, unless they are considering evidence about your health.

The MPTS aims, wherever possible, to make sure that cases are heard in line with the agreed service target. The tribunals are held at the MPTS hearing centre in Manchester.

What happens at the end of a MPTS hearing?

At the end of a hearing, the tribunal members may decide that your fitness to practise is not impaired and will either take no action or issue a warning. If the tribunal finds that your fitness to practise is impaired, they can do one of the following:

  • Place conditions on your registration so that you are only allowed to do medical work under supervision or so that you are restricted to certain areas of practice.
  • Suspend you from the medical register so that you cannot practise during the suspension period.
  • Remove you from the medical register so that you cannot work as a doctor in the UK for at least five years, and possibly for life.

Sanctions imposed by a tribunal normally come into effect 28 days after you receive a letter officially informing you of them, unless you appeal against the decision. However the tribunal can also impose an order for immediate conditions, suspension or erasure if they believe it is necessary.

If the Medical practitioners tribunal suspends or erases you from the register, we will automatically withdraw your licence. Where the medical practitioners tribunal imposes conditions or undertakings which restrict your practice, you’ll still be entitled to hold a licence but must continue to comply with any conditions or undertakings on your registration.

In deciding on the appropriate outcome, the medical practitioners tribunal may take into account any written undertakings that you make.

Warnings

A warning is appropriate if concerns indicate a significant departure from the principles set out in our guidance, , or if there is a significant cause for concern but a restriction on your registration isn’t necessary.

A warning can be issued by case examiners, the Investigation Committee or by an medical practitioners tribunal at a hearing. For five years after it is issued, we will disclose a warning to your employer and to anyone else who enquires.

A warning cannot be issued if the concerns relate exclusively to your physical or mental health.

For more information on warnings, read our Warnings factsheet (pdf).

Undertakings

Undertakings are an agreement between the GMC and a doctor about the doctor’s future practice. Undertakings may include restrictions on your practice or a commitment to practise under medical supervision or to undergo retraining. They allow us to deal effectively with certain types of case without having to refer the matter to a hearing.

Undertakings can be agreed with doctors at the end of an investigation.

Undertakings might include restrictions on your practice or behaviour, or commitments to having medical supervision or retraining.

For more information on undertakings, read our Undertakings factsheet (pdf).

Convictions and decisions by other regulatory bodies

Our rules allow us to deal quickly with doctors who have received a criminal conviction or caution, or who have been subject to a decision by a regulatory body either in the UK or overseas.

We treat convictions, cautions and decisions by other regulatory bodies as proof of an offence. In some cases, particularly if you’ve received a custodial sentence, we will refer the case directly to a MPTS hearing.

For less serious convictions, such as parking offences, we conclude the investigation at a very early stage and take no further action.

Appeals

You have 28 days in which to appeal to the High Court or Court of Sessions against any sanction issued by a medical practitioners tribunal. The tribunal's decision won’t take effect until either the appeal period expires or the appeal is complete. However, the tribunal can impose an immediate order for suspension or conditions if they believe they need to protect the public or if it is in the best interests of the doctor. A decision by the Investigation Committee or a medical practitioners tribunal to issue a warning can only be challenged by way of judicial review

The GMC also has the right to appeal the decision of a tribunal and, similarly, any such appeal must be lodged within 28 days of notification of the decision. If the GMC decides to lodge an appeal, the MPTS will inform you at the end of the appeal period. Thereafter, the GMC will serve you with a notice of appeal. Unlike the doctor process, if the GMC appeals, any substantive sanction will take effect once the 28 day period expires and continues until such time as the appeal is determined..

The GMC has a power to make an appeal where it considers that the decision of the MPT is not sufficient for the protection of the public, taking into account:

  • protecting the health, safety and well-being of the public;
  • maintaining public confidence in the medical profession; and/or
  • maintaining proper professional standards and conduct for members of that profession

Professional Standards Authority for Health and Social Care

If it considers that a decision made by a medical practitioners tribunal is not sufficient for the protection of the public, the Professional Standards Authority for Health and Social Care has the power to refer the decision to the High Court or Court of Sessions. The Professional Standards Authority has 28 days to refer a decision following the doctor's 28 day appeal period.