A guide for doctors referred to the GMC
This page explains how the General Medical Council (GMC) deals with complaints and concerns about doctors that have been reported to us by patients, employers, the police and other bodies.
Contents
Introduction
This is only a guide to our procedures. It is not a substitute for obtaining 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;
- deficient performance;
- a criminal conviction or caution in the British Isles (or elsewhere for an offence which would be a criminal offence if committed in England or Wales);
- physical or mental ill-health;
- a determination (decision) by a regulatory body either in the British Isles or overseas.
Where a doctor's fitness to practice is found to be impaired, we can suspend or remove a doctor from the medical register or place conditions on the doctor's registration.
We can also issue a warning to a doctor where the doctor's fitness to practise is not impaired but there has been a significant departure from the principles set out in the GMC's guidance for doctors, Good Medical Practice.
What action will the GMC take?
The GMC's procedures are divided into two separate stages:
- Investigation: We investigate cases to assess whether we need to refer them for adjudication
- Adjudication: This consists of a hearing of the cases which we have referred to a Fitness to Practise panel.
The Interim Orders Panel can also suspend or place conditions on a doctor's registration while the GMC's investigation continues.
Investigation
We review all matters referred to us to assess how the case should best be handled. In particular, this process enables us to identify:
- cases that appear to require GMC investigation into potentially serious concerns (known as Stream 1 cases);
- cases where we consider that investigation locally by the doctor's employer would be more appropriate, at least in the first instance (known as Stream 2 cases).
The GMC will not normally investigate complaints about matters that took place more than five years ago, unless it considers that it is in the public interest for the case to proceed.
Stream 1 cases
If we proceed with an investigation, we will inform you of the complaint and request details of your employer(s).
You will also be given an opportunity to comment on the issues at an early stage. You are not under an obligation to comment at this stage and you will be given a further opportunity to respond to formal allegations if there is any likelihood of the case proceeding to a hearing. However, providing your comments may help resolve the matters more quickly.
The GMC's guidance to doctors, Good Medical Practice, makes it clear that doctors must co-operate fully with any formal inquiry into the treatment of a patient and with any complaints procedures that apply to their work. You should contact your defence organisation for advice.
We will ask your employer(s) (normally the chief executive or medical director of the relevant Trust) if they have any other concerns about your fitness to practise.
This ensures that we have a fuller picture about your fitness to practise and also allows us to feed into local clinical governance.
Our investigation will depend very much on the nature of the concerns raised with us. We will decide on the most effective forms of investigation for the case. An investigation may include:
- obtaining further documentary evidence from employers, the complainant or other parties;
- obtaining witness statements;
- obtaining expert reports on clinical matters;
- an assessment of the doctor's performance;
- an assessment of the doctor's health.
How long will the investigation take?
The length of the investigation depends on the complexity and seriousness of the concerns. We will complete the investigation as quickly and efficiently as we can and will keep you informed of progress. We aim to complete our investigations within six months.
Interim Orders Panel
At any stage in the proceedings we may refer the doctor to the Interim Orders Panel (IOP). An IOP can suspend or restrict a doctor from practising while the investigation continues.
For more information, please see our section on the Interim Orders Panel. These procedures operate in tandem with any substantive action we may take.
Stream 2 cases
In many cases, where we do not consider that the allegations - even if proven - would require us to take formal action, we will refer the matter to the doctor's employer or contracting body. They can then consider what action, if any, they should take. We will ask them to report the matter back to us if they identify any concerns that might require us to take action. As we do not maintain records of doctors' employers we will write to you to obtain their details.
At the end of the investigation
At the end of the investigation by the GMC, the case will be considered by two senior GMC staff known as case examiners (one medical and one non-medical).
They can:
- conclude the case with no further action;
- issue a warning;
- refer the case to a Fitness to Practise; or
- agree undertakings on health and performance issues following a health or performance assessment.
No case can be concluded or referred to a Fitness to Practise panel without the agreement of both a medical and non-medical case examiner. If they fail to agree, the matter will be considered by the Investigation Committee, a statutory committee of the GMC.
If the case examiners or the Investigation Committee decide that the doctor's fitness to practise is not impaired, they may issue a warning.
The Investigation Committee will also consider cases where case examiners consider that a warning is appropriate, but where the doctor has disputed the facts, or requested a hearing of the Investigation Committee. The hearing will take place in public.
In all cases we will inform both the doctor and the complainant of the case examiners' decision and their reasons.
Referring a doctor to a Fitness to Practise panel
Fitness to Practise panels form the final stage of our procedures. A panel consists of specially trained people who will hear all the evidence and will decide at the end of the hearing whether they need to take action regarding the doctor's registration.
If we refer a case to a Fitness to Practise panel, we will write to the doctor setting out the specific allegations and explaining the process leading up to the panel hearing. Again, it will be important to seek advice from your defence organisation.
Fitness to Practise panels will normally be held in public, except where a panel is considering evidence about a doctor's health. We also have special arrangements for vulnerable witnesses.
It can take some time to arrange a hearing. We aim to hold all FTP panel hearings within eight months of the decision to refer the case forward.
At the end of a Fitness to Practise panel hearing
At the end of the hearing the Fitness to Practise panel may decide that the doctor's fitness to practise is not impaired and will either take no action or issue a warning.
Where they make a finding that the doctor's fitness to practise is impaired they may do one of the following:
- put conditions on the doctor's registration (this might mean the doctor is only allowed to do medical work under supervision or might restrict him/her to certain areas of practice);
- suspend the doctor's name from the medical register so that s/he cannot practise during the period of suspension;
- remove the doctor's name from the medical register so that s/he will not be able to work as a doctor in Great Britain for at least five years; the GMC's expectation is that removal should normally be for life.
In deciding on the appropriate outcome, the panel my take into account any written undertakings made by the doctor.
If the panel decides to impose conditions on the doctor's registration, they may also impose an order for immediate conditions. If the panel directs that the doctor's registration should be suspended or that his/her name should be erased from the register, they may also impose an order for immediate suspension.
Read more about the Fitness to Practise panel.
Warnings
A warning will be appropriate where concerns indicate a significant departure from the principles set out in the GMC's guidance for doctors, Good Medical Practice , or if there is a significant cause for concern following assessment but a restriction on the doctor's registration is not necessary. Warnings may be issued both by the case examiners and the Investigation Committee at the end of our preliminary investigation or by a Fitness to Practise panel. A warning will be
disclosed to a doctor's employer and to any other enquirer during a five-year period. A warning will not be appropriate where the concerns relate exclusively to a doctor's physical or mental health.
For more information on warnings please see the factsheet which can be downloaded from our website.
Undertakings
Undertakings are an enforceable agreement between the GMC and the doctor about the doctor's future practise. They allow the GMC to deal effectively with cases where the issues relate to a doctor's health or performance without having to refer to a Fitness to Practise panel.
Undertakings may be agreed by the case examiners, following an assessment of a doctor's health or performance. Undertakings might include restrictions on the practitioner's practice or
behaviour, or commitments to have medical supervision or retraining. For more information on undertakings please see the factsheet which can be downloaded from our website.
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 British Isles or overseas.
We treat convictions and cautions and determinations by other regulatory bodies as proof of that offence. In many cases, particularly where the doctor has received a custodial sentence, the case will be referred directly to a Fitness to Practise panel for a hearing. Certain categories of conviction cases (such as parking offences) will be closed at a very early stage with no further investigation or action.
Appeal
A doctor has 28 days in which to appeal to the High Court or Court of Sessions against any decision by a Fitness to Practise panel. The panel's decision will not take effect until either the appeal period expires or the appeal is determined. However, the panel can impose an immediate order for suspension or conditions if it believes it needs to protect the public or if it is in the best interests of the doctor.
Council for Healthcare Regulatory Excellence
The Council for Healthcare Regulatory Excellence (CHRE) has the power to refer a decision by a Fitness to Practise panel to the High Court (or its equivalent elsewhere in the UK) for the protection of the public, if it considers that the decision is unduly lenient. The CHRE has 28 days to decide whether to refer a decision following the doctor's 28-day appeal period.
Advice
If you are subject to investigation or action by the GMC you should contact your medical defence organisation straight away. The defence organisations know our procedures well and are a good source of advice. They 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. You cannot claim costs from the other parties involved.
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