Understanding sanctions the MPTS can impose after a GMC investigation
The Medical Practitioners Tribunal Service (“MPTS”) can impose various sanctions on doctors at different points in a fitness to practise investigation. This guide from Richard Nelson LLP will help you to understand what could happen at each stage of an investigation, what the different sanctions entail and why they might be considered by the investigators.
Remember, as a doctor under investigation your actions could affect the sanctions that are deemed appropriate. Both a successful defence and cooperating with the GMC can work in your favour, whilst a lack of engagement has the potential to make any sanctions more severe.
MPTS interim orders tribunal powers
The first sanctions that a doctor undergoing a GMC investigation could face are interim orders from the MPTS interim orders tribunal. These are put in place whilst a fitness to practise investigation is still ongoing. The appropriate order at an MPTS interim orders hearing is determined based on a risk assessment of the issues involved, balancing the need to protect the public, to maintain public confidence or if it is considered to be in the doctor’s interests.
At an interim orders tribunal hearing, the tribunal can:
- Impose no order;
- Impose an interim conditions order; or
- Impose an interim suspension order.
Interim conditions (up to 18 months)
Interim conditions can be imposed on a doctor for an initial term of up to 18 months, to restrict a doctor’s practice whilst the GMC’s investigation takes place. They are imposed when the Tribunal concludes that if the doctor continues to practise without restriction, this poses a real risk to the public, or could adversely affect the public interest or the interests of the doctor. They have to balance the interests of the doctor and the public to decide if an interim order is necessary.
There ARE a wide range of interim conditions that could be placed on a doctor. Some examples include different degrees of supervision, being accompanied by a chaperone when seeing a female patient, not taking short locum positions and not being a part of on-call rotas.
Interim suspension (up to 18 months)
Interim suspension orders are given for similar reasons as conditions but apply to situations where the panel considers any ongoing practice to put the doctor or patients at risk of harm. Temporary suspension from the GMC’s register means that the doctor will not be able to practise in any capacity for the order’s duration. As with conditions, the initial term for a suspension can be up to 18 months.
Review and continued sanctions
Interim sanctions given by the MPTS must be reviewed every six months to determine whether or not they need to continue. It is possible for sanctions to be changed or even removed at these reviews.
If the GMC wants an interim order to remain in place for more than 18 months, they must apply to the High Court for an extension. It is possible for the doctor to oppose the GMC’s application, particularly if the GMC’s primary reason is that the investigation has been delayed. The doctor should have expert advice and representation to ensure that their case is sound if opposing the GMC at this stage.
Possible sanctions from a GMC investigation
The next stage at which a doctor could face sanctions is at the conclusion of the GMC’s investigation. At this point, the Case Examiners will make a decision based on the findings of the investigation. It is possible for the case to close with a decision of ‘no case to answer’ or less severe sanctions at this point, though there is also the possibility that the Case Examiner will refer the doctor to the MPTS fitness to practise panel.
‘No case to answer’
At the conclusion of the investigation, the GMC’s Case Examiner may decide that the doctor has ‘no case to answer’ based on the evidence available to them. If this is the outcome, the case will close and the doctor will face no further sanctions.
A warning is the first level of severity in the sanctions available to the Case Examiners. It should be considered appropriate where the doctor has been found to have acted outside of Good Medical Practice, but not to such an extent that they will continue to put patients at risk or that they have brought the profession into public disrepute.
A warning will stay on the doctor’s record and remain publically available, but will impose no limits on their practice in and of itself.
One type of sanction that promotes cooperation between the doctor and the GMC is agreed undertakings. This outcome involves the doctor and the GMC jointly agreeing on a plan that will ensure that the public and the doctor will not be at risk should the doctor continue to practise.
Agreed undertakings could take a variety of forms, including a treatment plan for an illness that is impairing fitness to practise or a training scheme to get the doctor’s skills to an acceptable level. Agreed undertakings should be workable for the doctor and facilitate a full return to the profession.
MPTS fitness to practise panel referral
It is also possible for the Case Examiners to decide that a warning or agreed undertakings are not sufficient sanctions. They can refer more serious cases to the MPTS fitness to practise panel, who will review the case in more detail and determine the most appropriate outcome.
If your case progresses to this point, it is vital that you seek advice and representation if you haven’t done so already.
MPTS fitness to practise panel sanctions
If the MPTS finds allegations proven and that the doctor’s fitness to practise is impaired, the tribunal will then consider the most appropriate sanction to impose.
It is possible for the tribunal to dismiss the case with no action at this point, though it’s rare for them to do so.
Agreed undertakings are an option for the MPTS fitness to practise panel in the same way that they could be pursued by the Case Examiners.
Conditions on registration (up to 3 years)
If the doctor and the MPTS cannot agree undertakings or undertakings are considered to be inappropriate, the panel may impose conditions that will have a similar outcome. The doctor must comply with the panel’s conditions if they wish to continue to practise and the conditions could last for up to three years. The conditions available to the fitness to practise panel are similar to those which were available to the interim orders panel.
Suspension from the register (up to 12 months)
If the doctor’s continued practice poses an immediate threat to the public or themselves and there are no conditions that will mitigate the risk, the MPTS may decide to suspend the doctor from the register for up to 12 months. The goal of suspension is to remove the short term risk and make it possible for the doctor to return in the future when the risk has gone.
Erasure from the medical register
The most severe sanction that the MPTS fitness to practise panel can impose on a doctor is erasure from the medical register. Erasure prevents the doctor from earning a living from their medical profession. It will only be deemed necessary in the most serious of cases, such as those involving dishonesty.
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