Gateways guidance: 3.2 Disability, ill-health and fitness to practise

It is important to differentiate between disability and ill-health in relation to fitness to practise. Having an impairment does not mean that a person is in a permanent state of poor health.

However, it must be recognised that the term 'disabled person' in the Equality Act 2010 covers people with long-term health conditions; and that means they are protected by its provisions on disability discrimination.

A disabled person can be in good or poor health. Some impairments, such as some mental health conditions, however, are also illnesses. Some impairments, such as HIV or AIDS, can also be infectious. Other conditions can fluctuate or deteriorate which may affect performance.

Good Medical Practice does not stipulate that a doctor has to be in good health in order to practise. However, the GMC states strongly that, if necessary, doctors must seek and follow advice from a suitably qualified professional about their health.

This point is reinforced in Medical students: professional values and fitness to practise, published by the GMC and the Medical Schools Council (revised in 2009). This sets out how medical schools are expected to behave, bearing Good Medical Practice in mind. The guidance points out that ‘Poor health can affect a student’s fitness to practise either directly or by being a cause of misconduct’ (paragraph 5). The guidance refers explicitly to the Gateways guidance as having ‘particular relevance to the section on the scope of fitness to practise’ (paragraph 6). That section (paragraphs 39 to 61) emphasises the relationships between health, disability and fitness to practise with reference again to the Gateways guidance. ‘In most cases, health conditions and disabilities will not raise fitness to practise concerns, provided the student receives the appropriate care and reasonable adjustments necessary to study and work safely in a clinical environment’ (paragraph 50).

In particular, paragraph 38 of the 2009 edition of that guidance says that:

• students should be willing to be referred for treatment and to engage in any recommended treatment programmes
• students do not have to perform exposure prone procedures (EPPs) in order to achieve the expectations set out in Tomorrow’s Doctors; students with blood-borne viruses (BBVs) can study medicine but they may have restrictions on their clinical placements, must complete the recommended health screening before undertaking EPPs, and will need to limit their medical practice when they graduate.

In 2008, the Medical Schools Council and other bodies published guidance on health clearance. Testing for blood-borne viruses can take place after the admission of students to medical courses although it ‘should be performed during the initial stages of medical training, before students have the opportunity to undertake EPPs’. Normally medical students will be screened for hepatitis B, hepatitis C and HIV. ‘It is expected that the majority of students will agree to undergo testing.’ Students who decline testing or who are found to be infected by a BBV will need to accept formally that they will not be allowed to perform EPPs which may have implications for other vaccinations and placements.