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  5. Guidance introduction
  6. Protecting the public
Guidance introduction

Protecting the public

  1. MPTS tribunals have a legal duty to protect the public.1 The Medical Act 1983 (the Act) splits public protection into three distinct parts. It means that tribunals must act in a way that:
    • protects, promotes and maintains the health, safety and wellbeing of the public (patient safety)
    • promotes and maintains public confidence in the profession (public confidence), and
    • promotes and maintains proper professional standards and conduct for members of those professions (uphold professional standards).
  1. To protect the public, tribunals must consider the relevance of, and impact on, each of the three parts of public protection when they make decisions. 

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

  1. To protect, promote and maintain the health, safety, and wellbeing of the public, it is necessary to manage any risk posed by a doctor to patients or members of the public. Members of the public includes colleagues, family members and any other ordinary person.

  2. A doctor’s behaviour, poor performance, or unmanaged health condition can result in harm being caused to a patient or member of the public or can create a risk of harm. Types of harm include physical, emotional, psychological, and financial. Psychological harm is often considered a part of emotional harm and is where someone’s way of thinking and interpreting situations has been altered.

  3. Harm to patient safety can arise from a doctor’s failure to act as well as from actions they may take. While harm caused in the past is an important factor, the risk of future harm to patients and members of the public associated with the risk of repetition of the doctor’s actions or omissions is the key consideration.

  4. When making decisions about interim orders, interim orders tribunals (IOTs) will need to consider if the doctor poses any real and immediate risk to patient safety.
     
  5. When making decisions on impairment, medical practitioners tribunals (MPTs) need to assess if there is any current and ongoing risk to patient safety posed by the doctor. The MPT’s decision will be based on considering the circumstances in which the allegation arose and what has happened since. The assessment is therefore not about the risk posed by the doctor to patient safety at the time the events occurred. It’s about the risk posed at the time of deciding whether any action is needed. This is to mitigate against harm occurring now and in the future.

  6. A doctor’s response to an allegation about their behaviour, poor performance, or the impact a health condition has had, or may have, on patient safety, is important to the assessment of current and ongoing risk. Where a doctor can show they’ve taken relevant steps which have addressed and successfully reduced any risk of repetition and harm, it’s less likely the medical practitioners tribunal will need to act solely to protect patients or members of the public. This applies even where harm occurred.

  7. In all cases where patient safety is not engaged, tribunals should still consider whether the doctor poses any current and ongoing risk to the other parts of public protection, which may require action to be taken.

Promote and maintain public confidence in the profession (public confidence) 

  1. Patients and members of the public must be able to trust doctors with their lives, including their health. Trust in the profession is essential so that when individuals need medical care, they have confidence in those who provide it. This ensures they will not be put off from seeking care. It also prevents barriers to accessing the care they need and eliminates fear of receiving less favourable treatment than others. Doctors’ colleagues must be able to trust them to support effective team working and to deliver safe patient care. 

  2. Doctors must ensure their actions and behaviour justify the trust placed in them and their profession. Tribunals will need to consider any risk associated with behaviour or poor performance that undermines, or is capable of undermining, the trust that a fully informed and reasonable member of the public, or a colleague, places in the profession.

  3. Tribunals maintain and uphold public confidence by taking interim or substantive action where an individual doctor’s behaviour or poor performance could undermine trust in their profession. The types of behaviour or poor performance that are capable of undermining public confidence in the profession may vary or develop over time in response to changes in wider society.

  4. Doctors must follow the law,2 and so behaviour that leads to a criminal conviction or caution can undermine public confidence, including some behaviours arising outside a doctor’s professional practice. A doctor’s behaviour can undermine the public’s trust in the profession and impact on public confidence in the following circumstances:
    • where the specific nature of behaviour in a doctor’s private life indicates a high level of seriousness
    • where the behaviour is such that the public would view it as a fundamental breach of trust, and/or
    • where it would make a member of the public or colleague question how the doctor would act in their professional capacity.
  1. A tribunal may still need to consider imposing a sanction even where a doctor has successfully taken relevant steps to address a risk of harm to patient safety arising from their behaviour or poor performance. This is because the seriousness of the allegation itself could affect the public’s trust in the profession and pose a risk to public confidence. In some specific case types, steps to address a risk of harm to patient safety will generally be insufficient on their own to address the risk to public confidence.

  2. A doctor’s health condition will not on its own undermine public confidence. Trust in the doctor will only be called into question where the health condition has impacted, or is likely to have an impact, on their behaviour or performance. In these circumstances it is the concern about the doctor’s behaviour or performance, and the impact it has on trust, that may undermine public confidence in the profession.

Promote and maintain professional standards and conduct (uphold professional standards) 

  1. Good medical practice sets out the principles, values, and standards of care and professional behaviour expected of all doctors registered with the GMC. It is an ethical framework, which supports doctors to deliver safe care to a good standard, in the interests of patients. Good medical practice is supported by a range of more detailed guidance which expands on some of the standards it sets out. 

  2. If a doctor seriously departs from the professional standards, it can mean that they pose a risk to public protection.

  3. To assess how serious an allegation is, tribunals will need to look at the extent of any departure from the professional standards along with specific factors that may impact on seriousness. This includes, but is not limited to, if the concern is about an isolated incident, behaviour or performance that has been repeated, was premeditated, persistent, or an abuse of power.3

  4. A departure from the professional standards may require regulatory action to be taken to uphold them. This is because regulatory action sends a message to the individual doctor, the wider profession, patients and members of the public about the principles, values, and standards of care and professional behaviour expected of doctors.

1 Section 1(1) of the Medical Act 1983 describes this as the over-arching objective of the GMC and MPTS. 

2 Good medical practice, paragraph 4.

3 Further guidance on seriousness is provided in Section 3: Medical Practitioners Tribunal hearings.