Guidance introduction

Case type 6: impact of a health condition

A health condition is a physical or mental condition, injury, or impairment that may be categorised as acute or chronic.
A health condition may also be classified as a disability but should not automatically be regarded in this way. For example, multiple sclerosis is both a health condition and a disability, but alcohol addiction is a health condition and not a disability. Equally, not all disabilities are a health condition. For example, there is no medical health element attributed to dyslexia.
A health concern does not automatically arise because a doctor has a health condition and/or a disability. There are many doctors with a health condition and/or disability that the GMC will never need to know about because it has no impact on that individual’s ability to work safely and effectively.
A health condition will only amount to a health concern where its impact on the doctor poses a risk to patients. Health concerns may arise in isolation but will often be seen alongside and/or as a contributory factor in other types of cases. The impact of a doctor’s health condition can often be managed at a local level or through the GMC agreeing undertakings with the doctor without the need for a tribunal hearing.

The professional standards doctors are expected to meet

Doctors should try to take care of their own health and wellbeing, recognising that if they don’t, they may not be fit for work. They should seek independent professional advice about their fitness for work, rather than relying on their own assessment.⁷⁸ If a doctor knows or suspects they have a serious condition they could pass on to patients, or if their judgment or performance could be affected by a condition or its treatment, they must consult a suitably qualified professional and follow their advice about any changes to their practice.⁷⁹
Doctors should be immunised against common serious communicable diseases unless contraindicated.⁸⁰
Doctors must be compassionate towards colleagues who have problems with their health.⁸¹

Seriousness

A view will need to be reached about where on the spectrum of seriousness the concern or allegation about the impact of a doctor’s health condition lies with reference to the nature and impact of the condition and considering the presence of any features that increase seriousness. A report from a GMC health assessor or the doctor’s treating practitioner may be available to assist with this depending on the stage of the fitness to practise process the matter has reached.
Features that may indicate the impact of a doctor’s health condition is serious include, but are not limited to, where:

the type and severity of the health condition means there is a clear risk to patients
there are, or have been, serious concerns about the doctor’s behaviour or performance and their health condition may be a contributory factor
the doctor’s health condition is serious, has only recently been diagnosed, is not well controlled and it is too soon to know if risks to patients can be appropriately managed by them seeking and following treatment and advice and/or engaging with local support and steps to manage risk
there is no adequate or effective local support plan in place
the doctor is (or was) part of a locally managed action plan but is intending to leave (or has left) employment while the existing employer believes that a risk to patient safety persists, and/or
the doctor is not in stable employment or training and is known to be seeking work.

Impact on public protection

In cases where there is an impact from a health condition, the different parts of public protection might be engaged as follows:

Protecting, promoting and maintaining the health, safety and wellbeing of the public (patient safety)

Where a doctor has a serious health condition that could be passed on to others, or if their behaviour or performance is affected by a health condition that is not being managed effectively, this may impact on the physical, emotional harm and/or psychological wellbeing of a patient, member of the public or the doctor themselves. This impact can be long lasting and may affect how a person accesses health services in the future.

Promoting and maintaining public confidence in the profession (public confidence)

The public must have confidence that doctors will not practise when their own health affects their ability to provide safe care and that they will make the care of their patients their first concern.

A doctor’s health condition will not on its own undermine public confidence in the profession. Trust in the doctor will only be called into question where the health condition has impacted, or is likely to have an impact, on the doctor’s behaviour or performance.

Promoting and maintaining professional standards and conduct (upholding professional standards)

Good medical practice requires a doctor to consult a suitably qualified colleague, and follow their advice, if the doctor’s judgment or performance could be affected by a health condition or its treatment. Not doing so will usually amount to a significant breach of the standards in cases where there may be, or has been, an impact on patient safety.

Decision on interim order

Where there are concerns or an allegation about the impact of a doctor’s health condition, the interim orders tribunal (IOT) must remember that its primary duty is to protect the public and the wider public interest, and not to assume responsibility for, or give priority to, the treatment or rehabilitation of the doctor. The IOT should carefully consider the impact on patient safety if the doctor were to continue working unrestricted pending resolution of the fitness to practise process.
More detail about when an interim order is likely to be appropriate in a case relating to the impact of a doctor’s health condition can be found in the specific case types section in Section 2: IOT hearings.

Decision on impairment

Allegations relating to the impact of a doctor’s health condition can fall at the lower, mid-range or higher end of the spectrum of seriousness depending on the circumstances of the case. This means the starting point for assessing current and ongoing risk to public protection could be low, medium or high.
In most health cases, evidence of relevant context known about the doctor and/or their working environment and evidence of insight and remediation that decrease risk, will usually have more impact. This is because the risk to public protection arising from the impact of a doctor’s health condition is generally easier to address.
In cases where there is cogent evidence that a doctor’s health condition resulted in an allegation arising about their behaviour or performance, the medical practitioners tribunal (MPT) may conclude that the impact of the doctor’s health condition poses a current and ongoing risk to one or more parts of public protection, but the other matter does not separately pose any current and ongoing risk and therefore does not require a separate finding of impairment.
Where an allegation about the impact of a doctor’s health condition leads to a finding of impairment, it may engage one or more of the three parts of public protection. Whilst the MPT must consider the individual circumstances of the case, it will be unusual for a proven allegation relating to the impact of a doctor’s health condition not to impact on patient safety.

Decision on whether a warning is required

Where the allegation relates solely to the impact of a health condition on the doctor’s ability to provide safe and effective care, a warning will not be appropriate due to the nature of the allegation and the specific purpose of warnings.

Decision on sanction

The proportionate sanction in response to an allegation about the impact of a doctor’s health condition will depend on the nature of the condition and the impact it’s assessed to have on each of the three parts of public protection.
Conditions will often be the proportionate response. They can help the doctor manage their health condition and/or remedy any related deficiencies in their practice, while protecting the public.
Conditions should include a requirement that the doctor has medical supervision, in addition to reporting or supervision at their place of employment. The period of conditions should be such as to enable the doctor to address the health condition and be able to return to work.
Suspension is only likely to be needed in a health case where:

the doctor’s judgment may be diminished and there is a risk to patient safety if they continued to practise, even with conditions, and/or
there is evidence the doctor lacks insight into their health condition and will put patients at harm, either directly or indirectly, which means they are not currently safe to practise with conditions, and/or
the doctor has not complied with previous restrictions or requirements put in place to manage the impact of their health condition.

Where the risk to public protection relates solely to the impact of a health condition, erasure from the medical register is not an option.
When deciding on sanction, the medical practitioners tribunal (MPT) should consider the sanctions banding for health cases in Part C of Section 3: MPT hearings.

Lower level of risk to public protection	Medium level of risk to public protection	Higher level of risk to public protection
Conditions 6 to 12 months	Conditions 12 to 36 months to Suspension	Suspension

Where there are also allegations about a doctor’s behaviour or performance that pose a current and ongoing risk to public protection, the medical practitioners tribunal (MPT) should refer to the guidance and bandings in the other specific case type section too, where available. Where there is more than one proven allegation, the MPT should impose the sanction that addresses the most serious findings.

⁷⁸Good medical practice, paragraph 78.

⁷⁹Good medical practice, paragraph 79.

⁸⁰Good medical practice, paragraph 80.

⁸¹Good medical practice, paragraph 51.

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