Appendix 1: Further background

A1.47 On 1 November 2004, new rules came into force which fundamentally changed the way allegations against doctors were considered and determined. Although there have been further amendments and changes since, the general framework introduced in November 2004 has remained.

A1.48 Previously, in a conduct case, the panel had had to decide if there had been “serious professional misconduct”.¹²

A1.49 The General Medical Council (Fitness to Practise) Rules 2004 introduced the concept of “impaired fitness to practise”. Rather than engaging separate rules (and separate panels) for cases of conduct, performance and health, the question now was whether the doctor’s fitness to practise was “impaired”.

A1.50 Screeners and the Professional Conduct Committee were replaced with Case Examiners and the Investigation Committee.

A1.51 As before, a case is considered first by a Registrar. If the Registrar decides that the allegation falls within circumstances which mean that a doctor’s fitness to practise could be regarded as impaired, the case is investigated.

A1.52 The case is referred to a Medical Case Examiner and a Lay Case Examiner to decide how to proceed. Case Examiners are officers of the Council.

A1.53 Case Examiners can: direct that the allegation should not proceed further; issue a warning to the doctor; refer the allegation to the Investigation Committee to consider the appropriate outcome; refer the allegation for determination by a Fitness to Practise Panel (or Medical Practitioners Tribunal after June 2012); or invite the doctor to comply with undertakings.

A1.54 The Case Examiners set out in writing all the matters that they have taken account of, and full reasons for the decision that they take.

A1.55 Considerable guidance is now given to the Investigation Committee and Case Examiners on the types of practice or behaviour that may result in a finding of impaired fitness to practise by the GMC. That guidance is available on the GMC website.¹³

A1.56 Members of the GMC did not sit on Fitness to Practise Panels.

A1.57 Where the facts alleged by the GMC were disputed by the doctor, evidence was called and the panel would consider and announce its findings of fact.

A1.58 Once the facts had been determined, the Fitness to Practise Panel would consider whether the doctor’s fitness to practise was impaired. This process could involve the calling of further evidence and the making of submissions.

A1.59 If the panel decided that the doctor’s fitness to practise was impaired, it would receive further evidence and hear further submissions. It would then decide if a sanction or warning should be imposed.

A1.60 The panel could: direct that a doctor’s registration become conditional; order a suspension of his or her practising certificate; or order the practitioner’s erasure from the register.

A1.61 The GMC did not have a direct right of appeal for any decision that it considered to be too lenient or that did not protect the public. The GMC had to make representation to the Council for Healthcare Regulatory Excellence, which would consider the case and decide if an appeal to the High Court should be made.

A1.62 Cases referred by the Preliminary Proceedings Committee before 1 November 2004 were covered by the Transitional Provisions (GMC101125, pp263–8). These set out that the cases would be heard applying the ‘old rules’ (GMC101068, pp211–22). In other words, the rules that had been in place at the time when the doctor had been referred.

A1.63 Cases put before a Registrar after 1 November 2004 would be considered as set out above and heard applying the new rules.

A1.64 The Shipman Inquiry’s Fifth Report was not alone in criticising the lack of independence caused by the fact that Fitness to Practise Panel members came under the umbrella of the GMC.

A1.65 In an email dated 22 July 2011, Niall Dickson, GMC’s Chief Executive, said that he was not responsible for selecting panel members. He stated:

A1.66 On 1 January 2016, the Fitness to Practise Panels were replaced with Medical Practitioners Tribunals.

A1.67 Tribunal members are medical and lay people appointed by the Medical Practitioners Tribunal Service. This was set up in 2012 and is independent of the GMC.

A1.68 A tribunal must consist of at least three members, including one lay and one medical member.

A1.69 The general framework for referral to the Medical Practitioners Tribunal and the conduct of hearings has remained largely unchanged.

A1.70 There are rights of appeal against a final decision made by the Medical Practitioners Tribunal for doctors, the GMC and the Professional Standards Authority. These appeals are heard in the High Court and are governed by the Civil Procedure Rules 1998.