Professional behaviour and fitness to practise

Fitness to practise throughout undergraduate education

  1. Under the terms of the Medical Act 1983, a registered doctor’s fitness to practise may be impaired by reason of:
    • misconduct
    • deficient professional performance
    • a conviction or caution in the British Isles (or a conviction elsewhere for an offence which would be a criminal offence if committed in England or Wales)
    • adverse physical or mental health
    • not having the necessary knowledge of English
    • a determination (decision) by a regulatory body responsible for regulation of a health or social care profession, either in the UK or overseas, to the effect that their fitness to practise as a member of the profession is impaired.
  2. The GMC uses these reasons for impairment when it applies the test of fitness to practise to registered doctors and those applying for registration. Medical schools may also wish to refer to these reasons for impairment when they make decisions about a student’s fitness to practise.
  3. Medical schools and universities should be aware that fitness to practise concerns can involve issues that fit into more than one category. Where there are multiple issues (for example, health and misconduct), the medical school must consider all matters and must take account of the cumulative effect of all impairing factors. It’s important to make sure the student is given appropriate support and, where a health condition is involved, the opportunity to seek appropriate treatment.
  4. Deficient professional performance, in the context of medical students, refers to unsatisfactory academic competence and progression. As such, this is unlikely to be a reason for impairment of fitness to practise in medical students, and will be dealt with by the university or medical school’s academic procedures.
  5. A health condition alone is not sufficient to conclude impairment. Provided there are no concerns about the student’s conduct, they are seeking and following treatment and advice, and taking steps to manage any potential risks to patients, it’s unlikely their fitness to practise will be called into question.
  6. Not having the necessary knowledge of English should also not normally be an issue for students working towards a primary medical qualification in the UK, because medical schools require proof of English language skills at the point of entry to the course. Students will also be subject to ongoing assessment of their language and communication skills to meet the outcomes of undergraduate medical education.

Fitness to practise at graduation

  1. Medical schools must not graduate students where fitness to practise concerns have been raised or are under consideration. Therefore, medical schools must have considered all fitness to practise concerns and reached a determination on them before they allow a student to graduate. By graduating a student with a recognised primary medical qualification, the medical school is declaring them fit to practise as a doctor.

How fitness to practise affects GMC provisional registration

  1. Medical graduates who wish to work in the UK must apply to the GMC for provisional registration and answer questions about their health, conduct and any criminal record, which will help the GMC decide if they meet the requirements for registration. The GMC has a statutory duty to register only those doctors whose fitness to practise is not impaired. The GMC must reach this decision and cannot simply accept a decision made by another authority. If there are any concerns, the GMC will assess these and will decide whether to grant provisional registration.
  2. The law doesn’t let the GMC make a conditional grant of registration, or register a doctor and consider their fitness to practise afterwards. At the time of application, a doctor is either fit to practise or not fit to practise.
  3. Medical schools should tell students that the GMC is responsible for decisions about registration, and that this includes a separate test of fitness to practise. They should highlight this in admissions procedures, student handbooks and in fitness to practise guidance and procedures.
  4. Medical schools must make clear to students that the GMC will consider any issue that calls their fitness to practise into question when they come to apply for provisional registration. In exceptional circumstances, this may include incidents that happened before they entered medical school as well as incidents that occur during their undergraduate years.
  5. Medical schools should make students aware, before they apply for provisional registration, of the requirements in the GMC’s declaration of fitness to practise. Any disciplinary or fitness to practise action taken by a medical school or university that led to a formal process – for example, any issue considered by a formal panel, committee or hearing – should be declared to the GMC, unless the outcome of the formal process was no further action. Medical schools may keep a record of any concerns, for their future reference, that haven’t led to a formal investigation process or referral to a panel/committee or hearing. Medical schools should remind students that if they have any concerns about what they should declare to the GMC, they should refer to the GMC’s guidance ‘What to tell us when you apply’ in the first instance.
  6. If there is a concern that a student may be refused registration, the GMC may be able to give advice on the possible outcomes of an application based on the disclosed facts of the case. It is important to note that this would not bind the GMC to a particular decision at the point of registration. If students, medical school or university staff, or any other person have concerns, they should seek advice as early as possible.