A guide for doctors referred to the GMC
This guide 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.
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:
- 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.
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. If we decide that we are not the right organisation to investigate the complaint, we may pass it to the doctor’s employer so that it can be handled locally in the first instance. 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 previously, unless we consider that it is in the public interest to do so.
If you are reported to the GMC 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 cannot 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 at www.gmc-uk.org/doctorsupportservice or call the service now on 020 7383 6707.
Complaints we investigate immediately
Before we begin an investigation, we will inform you of the complaint that has been made about you and ask for details of your employer.
We will give you the opportunity to comment on the complaint. You do not have to comment at this stage, but if you do, it may help us to resolve the case more quickly. We will give you another opportunity 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 will 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 ensure that we have a better picture of your fitness to practise and also allows us to feed into local clinical governance.
How we conduct our investigation will depend very much on the nature of the concerns raised with us. 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.
Interim orders panel
At any stage in the investigation we can refer you to the Medical Practitioners Tribunal Service (MPTS) for an interim orders panel hearing. This panel can suspend you or restrict you from practising while the investigation continues if they decide this is necessary to protect patients. For more information on the MPTS interim orders panel, please see the factsheet Investigating concerns, which can be downloaded from the GMC’s website at www.gmc-uk.org/concerns
Complaints we pass to your employer
If we consider that the complaint, even if proven, would not mean your fitness to practise is impaired, we will write to you letting you know about the complaint and asking for details of your employer. We will then refer the matter to your employer or contracting body. We will ask them to report the matter back to us if they identify any concerns that mean we may need to take action. 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 will 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 hearing.
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.
Except for cases concerning a doctor’s health, we will inform both the doctor and the complainant of the case examiners’ decision and their reasons. Where the case concerns a doctor’s health we will inform the doctor and the complainant of the case examiner’s decision but their reasons will only be given to the doctor. 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.
MPTS panels 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 and, if so, what sanction may be needed to protect patients.
If we refer a case to the MPTS for a hearing, we will write to you setting 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, except when they are considering evidence about a doctor’s health.
The MPTS aims, wherever possible, to ensure that cases are heard in line with the agreed service target. The hearings are held at the MPTS hearing centre in Manchester.
What happens at the end of the MPTS hearing?
At the end of a hearing, the panel may decide that the doctor’s fitness to practise is not impaired and will either take no action or issue a warning. If the panel finds that the doctor’s fitness to practise is impaired they can do one of the following:
- place conditions on the doctor’s registration so that they are only allowed to do medical work under supervision or so that they are restricted to certain areas of practice
- suspend the doctor’s name from the medical register so that they cannot practise during the suspension period
- remove the doctor’s name from the medical register so that they cannot work as a doctor in the UK for at least five years, and possibly for life.
Sanctions imposed by a panel normally come into effect 28 days after you receive a letter officially informing you of them, unless a doctor appeals against the decision. However the panel can also impose an order for immediate conditions, suspension or erasure if they believe it is necessary.
Where the MPTS panel suspends or erases a doctor from the register, we will automatically withdraw a doctor’s licence. Where the MPTS panel imposes conditions or undertakings which restrict their practice, the doctor will still be entitled to hold a licence but must continue to comply with any conditions or undertakings on their registration.
In deciding on the appropriate outcome, the MPTS panel may take into account any written undertakings made by the doctor.
A warning is appropriate if concerns indicate a significant departure from the principles set out in our guidance, Good Medical Practice, or if there is a significant cause for concern but a restriction on the doctor’s registration is not necessary.
A warning can be issued by case examiners, the Investigation Committee or by a MPTS panel at a hearing. For five years after it is issued, we will disclose a warning to a doctor’s employer and to anyone else who enquires.
A warning cannot be issued if 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 at www.gmc-uk.org/concerns
Undertakings are an agreement between the GMC and a doctor about the doctor’s future practice. Undertakings may include restrictions on a doctor’s 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 the doctor’s practice or behaviour, or commitments to having medical supervision or retraining. For more information on undertakings please see the factsheet, which can be downloaded from our website at www.gmc-uk.org/concerns.
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 when a doctor has 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.
A doctor has 28 days in which to appeal to the High Court or Court of Sessions against any sanction issued by a fitness to practise panel. The panel's decision will not take effect until either the appeal period expires or the appeal is complete. However, the panel 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 fitness to practise panel to issue a warning can only be challenged by way of judicial review.
Professional Standards Authority for Health and Social Care
If it considers that a decision made by a fitness to practise panel is unduly lenient, 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.