Glossary of terms when dealing with health regulators
02 Jun 2020
The following is a list of some of the more commonly used terms and acronyms which you might encounter in dealings with your medical regulator.
The Administrative Division of the High Court of Justice is where appeals against the decision of a Fitness to Practise Panel are heard.
An Assistant Registrar is usually an experienced member of GMC staff who has a delegated authority to make decisions as per the criteria set out in the Fitness to Practise Rules 2004.
Burden of Proof
The burden of proof in fitness to practise proceedings (with the exception of restoration cases) is on the GMC to prove their case.
A Case Examiner is a paid employee of the GMC who has experience in complex decision-making. They can be medical or lay. When determining whether a doctor should be referred to a Fitness to Practise Panel, both a lay and medical Case Examiner will review the allegations and apply the realistic prospect test.
As part of the Medical Practitioners Tribunal Service case management procedures, either party has the right to request a case review. This involves a legally qualified independent person, chairing the meeting that takes place by way of telephone conference. The case manager has specific powers set out in Rule 16 of the Fitness to Practise Rules 2004. These include the power to make directions relating to disclosure, witness evidence and admissions.
Council for Healthcare Regulatory Excellence (CHRE)
The Council for Healthcare Regulatory Excellence oversees the decisions of the Fitness to Practise Panels and has the power to appeal a case to the High Court if they feel a Panel has been unduly lenient, made an error in law and/or the GMC have under prosecuted the case. For further details see the article section of this website Who are the CHRE?
Care Quality Commission (CQC)
The Care Quality Commission has incorporated the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. They are responsible for the regulation of health and social care services as well as protecting the rights of those detained under the Mental Health Act.
Deaneries are the bodies that deal with postgraduate education for doctors. The Fitness to Practise Panel has the power to refer a doctor to the Postgraduate Dean for a remediation package to be put in place.
Fitness to Practise Panel
A Fitness to Practise Panel has the power to hear cases referred by Case Examiners or the Assistant Registrar. They will make a decision on the facts of the allegation, then if found proven they will decide if the doctor’s fitness to practise is impaired. If they find impairment, they will then decide on the appropriate sanction.
Good Medical Practice
Good Medical Practice is a publication by the GMC, setting out the standards of practice expected of a doctor.
The GMC has the power to order a doctor to be assessed by two medical examiners. The medical examiners are not employees of the GMC but are independent practitioners. The GMC will ask the doctor to consent to the examiners having access to their medical records.
The GMC obtain reports from two examiners and the process usually consists of an instruction by the GMC (including a bundle of information), an interview with the doctor and the production of a written report with a recommendation on whether the doctor is fit to practise. They can be called to give live evidence if the reports are used in fitness to practise proceedings. There is nothing to stop a doctor from obtaining their own health evidence.
The term impairment does not have a conclusive definition, but essentially, it means that a Panel has decided that action needs to be taken against the registration of the practitioner. The justification for this does not just relate to patient safety as factors such as the public interest and the reputation of the profession will also be considered.
At the end of each stage in proceedings, a Panel will ask parties to leave the room whilst they have discussions and formulate a decision on the case. This is known and referred to as in camera discussions. The GMC will also sit in private when they are hearing evidence regarding the health of a doctor.
Indicative Sanctions Guidance
This is a GMC publication referred to in fitness to practise proceedings. It is referred to extensively during the sanction stage of proceedings and sets out guidance to the Panel on the appropriate sanction to impose.
Interim Orders Panel (IOP)
The Interim Orders Panel can impose an order of suspension or conditions on a doctor’s registration where it is in the public interest, the interest of patient safety and/or the interests of the practitioner.
Investigation Committee (IC)
The Investigation Committee will determine matters where the Case Examiners disagree. Also if a doctor is offered a warning by the Case Examiners which the doctor does not wish to accept, the doctor can ask for their case to be reviewed by an Investigation Committee.
Judicial Review (JR)
A judicial review is a petition to the High Court asking it to look at, and potential review, a decision made by a public body. For further details, see the article What is Judicial Review? in the articles section of this website.
A Legal Assessor sits with Panels to advise them on points of law. They can only advise the Panel and cannot make rulings. The Panel are expected to follow the advice of the Legal Assessor but are not obligated to do so.
Medical Practitioners Tribunal Service (MPTS)
This is the adjudication service for the regulation of doctors. The MPTS took over all fitness to practise cases from the GMC in June 2012.
Observed Structured Clinical Examination (OSCE)
Occurring in performance cases, an OSCE occurs where an assessor observes a doctor at a skills station where a doctor performs set tasks or carries out an examination. There is a clearly defined set of criteria the doctor is expected to meet. It is common for most doctors to experience this type of assessment at medical school as well as in postgraduate study.
The GMC has a statutory power to invite a doctor to be assessed in accordance with schedule 1 of the General Medical Council (Fitness to Practise) Rules 2004. The assessment is extremely detailed and consists of two stages:
Stage 1 involves an assessment team going into the doctor’s last place of work and carrying out a record review, third party interview and a case based discussion with the doctor.
Stage 2 is more objective and can involve a test of competence; OSCE’s and/or simulated surgeries depending on the speciality of the doctor. The Assessment Team will produce a report with a recommendation on whether the doctor is fit to practise.
Doctors will need to demonstrate they are practising in accordance with the standards set out in Good Medical Practice. They will also be required to produce information about their practice. This includes CPD, appraisal and audit and patient/colleague feedback.
The Responsible Medical Officer will need to confirm to the GMC that there are no outstanding concerns about their fitness to practice. If a doctor wants to exercise privileges such as prescribing and signing death certificates etc, they need to have a licence as well as registration.
This will require doctors to demonstrate periodically that they remain fit to practise in accordance with the standards set by the GMC. This will take place via an enhanced form of annual appraisal.
Record of in-training assessment (RITA)
These records are used to document the progress of trainees through their speciality training programmes. The review is carried out by the Deanery Speciality Training Committee or the Regional Speciality Advisor. The actual form is usually completed jointly by the trainee and the postgraduate Dean.
Each medical speciality is presided over by a Royal College who set the standards and work with the Deanery and the GMC in setting standards for specialist further training.
This refers to Rule 7 of the General Medical Council (Fitness to Practise) Rules 2004. It is a key stage in the investigation of a doctor’s case as it is the point where the GMC disclose their evidence, together with a set of allegations to the doctor. The doctor then has 28 days to comment before the matter is reviewed by the Case Examiners to determine whether a referral to a Fitness to Practise Panel is appropriate. They can also decide that a case can be concluded with no further action, invite the doctor to accept a warning, or agree undertakings with the doctor.
This refers to Rule 8 of the General Medical Council (Fitness to Practise) Rules 2004. It is a key stage in proceedings as the decision made at this stage determines whether a doctor has been referred to a Fitness to Practise Panel. The GMC normally send out a “Rule 8 Letter” notifying a doctor of the Case Examiners decision. It is sensible to request disclosure of the full decision particularly if the matter is complex.
Specialist Health Advisor
A specialist health advisor can be appointed to sit with a Fitness to Practise Panel to advise them on allegations that concern a doctor’s health. They do not form part of the Panel’s decision making. The issue of whether it is appropriate to have one is determined at the stage 1 telephone conference.
Specialist Performance Advisor
A specialist performance advisor can be appointed to assist a Fitness to Practise Panel where they are considering the results of a GMC performance assessment. The advisor should be the same speciality as the doctor.
Standard of Proof
The standard of proof for all GMC matters is the civil standard. This is more commonly referred to as determining matters on the balance of probabilities.
This is usually a reference to the Medical Act (as amended) 1983. This is the primary piece of legislation that gives the GMC its powers in relation to its various functions.
In GMC proceedings this is a reference to the General Medical Council (Fitness to Practise) Rules 2004. These rules govern how the GMC investigate complaints and information that is passed to them. The Rules also detail how the adjudication process functions.