Case type 8: criminal convictions, cautions, court sanctions and determinations by another body responsible for the regulation of a health or social care profession

232. Good doctors act with honesty and integrity and ensure their conduct justifies their patients’ trust in them and the public’s trust in their profession.⁹⁰
     
     
233. Doctors must tell the GMC without delay if, anywhere in the world: they have been charged with or found guilty of a criminal offence; they have accepted a caution from a prosecuting authority; they have been criticised by an official inquiry, including by a coroner at an inquest; another professional body has made a finding against their registration as a result of fitness to practise procedures.⁹¹

234. A wide range of behaviour and/or poor performance can be seen in cases where the doctor is the subject of a conviction, caution, court sanction or determination. 
     
     
235. A conviction or caution for a minor criminal offence resulting in a discharge or fine will usually fall at the lower end of the spectrum of seriousness. 
     
     
236. Very rarely, a doctor will be convicted for a criminal offence relating to their clinical practice. For example, conducting a clinical procedure without proper consent, or where a doctor’s intentional or reckless practice results in a conviction for assault. Exceptionally, in the case of a patient death, a doctor could be convicted of gross negligence manslaughter⁹² or culpable homicide.⁹³ Also very rarely, a doctor might receive a criminal conviction for encouraging or assisting suicide. 
     
     
237. Where this is the case, these matters will usually fall at the higher end of the spectrum of seriousness, along with cases in which the doctor received a criminal conviction or other court sanction resulting in a custodial sentence.
     
     
238. In a determination case, where the regulatory body ordered the suspension or erasure/removal of the doctor from the relevant register, this will usually fall at the higher end of the spectrum of seriousness.

In cases of criminal convictions, cautions, court sanctions and determinations by another body responsible for the regulation of a health or social care profession, the different parts of public protection might be engaged as follows:

239. Where the concern or allegation relates to criminal behaviour in the workplace or otherwise arising from the doctor’s professional practice, or the doctor is under police investigation, the interim orders tribunal (IOT) should carefully consider the public interest, and the impact on public confidence if the doctor were to continue working unrestricted pending resolution of the fitness to practise process.
     
     
240. Similarly, where the concern or allegation relates to a determination case where the regulatory body ordered the suspension or erasure/removal of the doctor from the relevant register, the interim orders tribunal should carefully consider the public interest, and the impact on public confidence if the doctor were to continue working unrestricted pending resolution of the fitness to practise process. Depending on the underlying reason for the determination, patient safety may also be a key consideration.
     
     
241. More detail about when an interim order is likely to be appropriate in these types of cases can be found in the specific case types section in Section 2: IOT hearings.

242. Where the allegation relates to a conviction, caution, court sanction or determination that falls at the higher end of the spectrum of seriousness, the starting point for assessing current and ongoing risk to public protection will be high.
     
     
243. Where this is the case, evidence of relevant context known about the doctor and/or their working environment and evidence of insight and remediation that decrease risk may have less impact because allegations falling at the higher end of the spectrum of seriousness can be more difficult to remediate. In such cases the medical practitioners tribunals (MPT’s) decision on risk should reflect this and a conclusion the doctor poses a current and ongoing risk to public protection may be needed even in cases where the doctor has shown insight and taken steps to try and remediate. Where the MPT concludes that the doctor poses a current and ongoing risk, this will result in them finding that the doctor’s fitness to practise is impaired.
     
     
244. While the courts distinguish between degrees of seriousness, any conviction for child sex abuse materials will mean the doctor presents a current and ongoing risk to public confidence in the profession, requiring a finding of impairment.
     
     
245. The level of risk associated with an allegation relating to a conviction, court sanction or determination will often be medium or high. 
     
     
246. Where an allegation about a conviction, caution, court sanction or determination leads to a finding of impairment, it may engage one or more of the three parts of public protection. Whilst the medical practitioners tribunal (MPT) must consider the individual circumstances of the case, it will be unusual for a proven allegation relating to a conviction, caution, court sanction or determination not to undermine public confidence in the profession.

247. Certain types of convictions, court sanctions and determinations will usually fall at the higher end of the spectrum of seriousness, and so a conclusion that the doctor poses a current and ongoing risk to public protection will often have been made. 
     
     
248. However, for other types of conviction, caution, court sanction and determination cases, where the circumstances of the case just fell short of a finding that the doctor’s fitness to practise is impaired, and there are no other proven allegations that require restrictive action to be taken, a warning may be appropriate to maintain public confidence in the profession and uphold professional standards.

249. The proportionate sanction in response to an allegation relating to a conviction, caution, court sanction or determination will depend on the extent of the doctor’s behaviour and the impact it’s assessed to have on each of the three parts of public protection.  
     
     
250. Where the level of current and ongoing risk to public protection is medium or high, this will require consideration of suspension or erasure.
     
     
251. While the courts distinguish between degrees of seriousness, any conviction for child sex abuse materials will undermine public confidence in the professions. The only proportionate action in these cases will usually be erasure and any departure from this will need to be carefully explained.
     
     
252. In a very exceptional case where the level of current and ongoing risk to public protection is assessed to be so low that conditions are being considered as the proportionate restrictive action to impose on a doctor who is registered as a sex offender, consideration should be given to including conditions that stipulate no contact with any patients or any category of patients. Consideration should also be given to imposing a condition requiring the doctor to undergo an assessment, for example by a clinical psychologist, to evaluate the risk they pose to patients before they may be permitted to resume certain forms of practice.
     
     
253. When deciding on sanction, the medical practitioners tribunal (MPT) should consider the sanctions banding for conviction, caution, court sanction and determination cases in Part C of Section 3: MPT hearings. 

254. In conviction, court sanction and determination cases falling at the higher end of the spectrum of seriousness, evidence about the impact of a specific type of restrictive action and references and testimonials, will have limited, if any, relevance to the medical practitioners tribunals (MPT’s) decision about what sanction is appropriate.  
     
     
255. When considering length of sanction, the tribunal should bear in mind that where a doctor has been convicted of a serious criminal offence resulting in an immediate or suspended custodial sentence, the impact on public protection means they should not be permitted to hold unrestricted practice until they have completed their sentence. Similarly, no doctor registered as a sex offender should be able to hold unrestricted registration. 
     
     
256. For convictions, cautions or determinations relating to sexual misconduct, dishonesty, violent or abusive behaviour, discrimination or clinical concerns, reference should also be made to the guidance and bandings set out in the relevant specific case type section. Where there is more than one type of allegation, the medical practitioners tribunal should impose the sanction that addresses the most serious findings.