Fitness to practise explained

An introduction to fitness to practise

Doctors are one of many professions that are regulated in the UK and around the world. Regulation helps the public have trust and confidence in professionals. This is because one function of almost all regulators is to protect the public in some way. Regulators set the professional standards expected of a profession. They can also take action when individuals seriously depart from the standards, to minimise the risk to the public.

At some point in a doctor’s career, a concern may be raised about their performance, behaviour, or the impact that a health condition is having on their ability to practise safely. The concern may be raised directly with them, their employer, or to us, as their regulator.

Our role, as the UK’s regulator of doctors, is to act where there are concerns that patient safety, the public’s confidence in doctors, or the professional standards we set and maintain, may be at risk.

Professional standards

Good medical practice is our core guidance for all doctors. It sets out the standards of patient care and professional behaviour expected of all medical professionals registered with us.

If a doctor seriously departs from the standards, it can mean that they pose a current and ongoing risk to the public.

Protecting the public

We have a legal duty under the Medical Act 1983 to protect the public. The Act splits public protection into three distinct parts. It says that we must act in a way that:

• protects, promotes and maintains the health, safety and wellbeing of the public
• promotes and maintains public confidence in the profession
• promotes and maintains proper professional standards and conduct for members of the profession.

When we receive a concern about a doctor, we are legally required to assess if they pose any current and ongoing risk to one or more of the three parts of public protection.

If we need more information to make this assessment, we might carry out further investigations. That is where our fitness to practise process comes in.

What is fitness to practise?

Fitness to practise is an assessment of a doctor’s ability to practise safely and effectively. It includes considering a doctor’s overall ability to perform their individual role, their professional and personal behaviour, and the impact of any health condition on their ability to provide safe care.

We consider a doctor’s fitness to practise when they first apply to register with us, during revalidation, and if we receive a concern about them.

How we support doctors in our fitness to practise processes

We understand the impact that having a concern raised about them can have on a doctor. It’s likely they’ll be worried, and they may be unsure of what to do, or where to go for advice. We have a range of support that we offer to all doctors who are in our fitness to practise processes, including:

• asking doctors at the start of an investigation if we can call them rather than just writing them a letter. We let them know we are investigating a concern that has been raised and outline what will happen next
• giving every doctor a single point of contact so they can speak to the same person about their case throughout the process
• making sure specially trained colleagues are available to liaise with any doctor we know to be vulnerable
• funding an independent confidential support service run by the British Medical Association (BMA), that includes out of hours access to a 24 hour helpline. The service is for all doctors in our fitness to practise processes, whether they’re BMA members or not.

Find more information on the support that’s available for doctors.

How we assess if there’s a risk to public protection

To reach a decision on whether a doctor poses any risk to public protection, we consider:

The seriousness of the concern

This includes looking at how far a doctor has departed from the professional standards, or considering if a health condition is having an impact on their ability to practise safely.

We also take into account any specific factors that may impact on the seriousness of the concern. For example, if the behaviour was an isolated incident, whether it was premeditated or persistent, or whether it was an abuse of power.

Any relevant context

We consider any relevant context that we’re aware of. By ‘context’ we mean the specific setting or circumstances that surround a concern.

There are different types of relevant context. One example is a doctor’s working environment, including issues related to workload, and interpersonal factors such as the culture of the organisation they’re practising in.

How the doctor has responded to the concern

To be able to actively address a concern, a doctor must first recognise there’s an issue so that they can try to understand how it arose. They must then take steps to address the concern and learn from it.

We examine the evidence to establish if the doctor has:

• insight into their own practice and behaviour
• taken steps to remediate, such as participating in training, supervision, coaching or mentoring relevant to the concern raised
• kept their knowledge and skills up to date
• been working within their area of competence.

How we support safe and effective practice to protect the public

If we decide that a doctor does not pose any current and ongoing risk to one or more of the three parts of public protection, but has significantly departed from the professional standards, we may need to issue them with a warning. This is a formal way of indicating to the doctor that their behaviour or performance has significantly departed from the professional standards and should not be repeated.

If we decide that a doctor poses a current and ongoing risk to one or more of the three parts of public protection, we may need to restrict their registration. This may be through agreeing undertakings or putting in place conditions or a suspension. The purpose of this type of action is to protect the public until the doctor no longer poses any risk, and can return to unrestricted practice.

In a very small number of cases, we may remove a doctor’s registration. This type of action is rare and is reserved for the most serious cases.

How we make decisions in the fitness to practise process

We are legally required to make sure that our decisions in the fitness to practise process protect the public. It's also vital that both the public and doctors trust us to make the right decisions. In making our decisions, we follow these guiding principles.

• Being proportionate
  In each case we will determine what action is required, taking no more measures than necessary, and in a timely manner.
• Being transparent
  We're open about our process and the decisions we make. We explain our steps clearly and give reasons for our decisions so that everyone can understand them and hold us accountable.
• Being fair
  We make sure that anyone can raise a concern with us about a doctor. We gather relevant evidence to help us to reach a fair decision.

We are committed to seeking out potential bias and making sure our processes are fair. To help ensure this, we are implementing recommendations from independent reviews of our guidance and how we apply it. As part of this we’ve asked doctors, patients and organisations who support them, about their experiences of our processes.