Annex: Professionalism and fitness to practise processes for course providers, HEIs and employers
This annex gives an overview of fitness to practise processes for PA and AA courses. You can find more detailed information in the relevant guidance: Professional behaviour and fitness to practise: interim guidance for physician associate course providers and their students or Professional behaviour and fitness to practise: interim guidance for providers of GMC-regulated courses with employed students.
Health conditions and insight or management of these
- Failure to seek appropriate treatment or advice from an independent and appropriately qualified healthcare professional
- Failure to follow the requirement to tell your course provider or HEI if you have a serious health condition
- Refusal to follow medical advice or care plans, or to comply with arrangements for monitoring and reviews
- Failure to comply with reasonable adjustments to ensure patient safety
- Failure to recognise limits and abilities or lack of insight into health conditions
- Failure to be immunised against common serious communicable diseases (unless contraindicated)
- PA and AA course providers have a duty to award a qualification to only those students who are fit to practise as a PA or AA. Once regulation starts, this requirement is set by the GMC, which will be responsible for the quality assurance of all PA and AA courses in the UK. Because of this requirement, your course provider or employer will have ways to monitor students' behaviour and have a fitness to practise or professionalism process to deal with students who display unprofessional behaviour.
- We provide high-level guidance to PA and AA course providers on running these processes, but the processes themselves do vary between courses. This is because each course provider is unique in its size and structure and because of other factors, such as its relationship to its HEI. However, we have set out a broad framework for course providers to follow.
- For AA courses, the course provider should have oversight of the concerns process, working with the employer. This is in respect to the course you are studying rather than the role you are employed in, although the two may overlap.
Monitoring low-level concerns
- Low-level concerns are things like missing teaching sessions, failing to hand in work on time or failing to respond to communications from the course provider or employer. For PA students, course providers will monitor the behaviour of their students in relation to these types of concern; for AA students, the course provider and employer work together to monitor behaviour. One instance of this type of behaviour may not be enough to trigger a fitness to practise process - but if a student persistently exhibits these types of behaviour, the course provider will want to look at the concerns in more detail.
- For medicine courses, some medical schools have a committee to look at instances of this type of behaviour, while in other schools an individual may be responsible for this process. This is an opportunity to discuss with the student why they have acted in this way and to identify any underlying issues that indicate the student needs additional support, such as a health issue.
- These committees will also be able to advise students about the steps they need to take to avoid getting into further trouble in relation to their professional performance and can support students to help them do this.
- These committees can sometimes issue a warning to say that a student must improve their behaviour or face further action.
A formal fitness to practise investigation
- If a student does something more seriously unprofessional or exhibits persistent low-level unprofessional behaviour, including in relation to the management of their health condition, this could potentially mean their fitness to practise as a PA or AA is impaired. Their course provider or HEI will begin a process to investigate this behaviour. The investigation may conclude with no further action, a warning or referral to a fitness to practise panel or committee.
What is a fitness to practise panel or committee?
- A fitness to practise panel or committee is an impartial group of individuals that considers whether a student is fit to practise for the purposes of continuing their studies or for the purposes of qualification. Course providers/HEIs prepare evidence for the panel or committee to consider – students can also submit any evidence they feel is relevant.
- The course provider/HEI and student then present their evidence to the panel or committee, which makes a decision based on it. A panel or committee will seek to establish the facts of the case - they make their decision based on the balance of probabilities that the alleged incident occurred. They will then decide whether the student's fitness to practise as a PA or AA is impaired and make a decision on what, if any, sanction should be applied.
- The panel or committee will set out its decision in writing and explain the reasons for it. This decision letter will also give the student information on how they can appeal the decision of the panel or committee.
What support will I get during a fitness to practise investigation?
- Your course provider and HEI (and employer for AAs) will support you during fitness to practise investigations and hearings. The students' union may also be an important source of advice and support. You can also contact medical defence organisations, which can also provide support and guidance.
Some of the factors fitness to practise panels and committees consider
Patterns of behaviour
If you keep behaving in an unprofessional way, it can suggest you are not learning from your mistakes and can be evidence of an unprofessional attitude. This may also be considered in relation to your health - for example, if you show a pattern of not asking for help with a health condition.
Insight
This means you understand that what you have done is unprofessional and why it is unprofessional. Establishing whether you have insight is one of the key things panels and committees look at. Things like apologising for your behaviour and being open and honest about past mistakes to third parties can help demonstrate insight.
Remediation
This is the process where you take steps to show you have corrected your behaviour and are now fit to practise. Some examples of remediation might include:
- writing reflective essays on past unprofessional behaviour
- engaging with support provided by your course provider or employer
- being able to demonstrate a significant period of good behaviour
- engaging with activities such as random drug and alcohol screening that can be used to show a change in behaviour.
Mitigating factors
These are things that may help to explain the reasons for poor behaviour. For example, you may have experienced bereavement and this might have affected your behaviour. You should note that although mitigating factors might explain your behaviour, they might not necessarily reduce its impact or seriousness.
Aggravating factors
These are things that make an offence worse. For example, if you repeat behaviour you have previously received a warning for.
Your year of study
It is expected that you mature and learn about professionalism as you progress through your course. Therefore, some examples of behaviour could be considered minor misconduct if displayed when you are a new student, but would be taken more seriously if you were about to qualify. In addition, if you are nearing qualification you may not have time to show that you have remediated and this can make it hard for your course provider to allow you to qualify.
