Text alternative: process of decision making at an MPT hearing

1. Make findings of fact

• Consider and asses the evidence adduced by the parties with reference to the burden and standard of proof
• Give reasons for decision 

2. Make a decision on impairment

• If no facts found proved, confirm there is no factual basis for considering the doctors fitness to practise
• Where facts found proved, review findings as a basis for decision on impairment
• Follow steps 2a to 2e
• Decide if the doctor poses any current and ongoing risk to public protection and if their fitness to practise is impaired
• If impaired decide which parts of public protection are engaged, and why
• Give reasons for decision

2a. Decide whether there is a legal basis for considering impairment

• Do the proven facts engage one or more of the grounds for impairment?
• If so, follow steps 2b to 2e
• If not, confirm there is a legal basis for considering the doctors fitness to practise

2b. Decide where on the spectrum of seriousness the allegation lies

• Identify the starting point for assessing seriousness 
• Identify any features that increase seriousness 
• Confirm where on the spectrum of seriousness the allegation is (lower end, mid-range. higher end) and therefore what the starting point for assessing risk is (low, medium, high)

2c. Consider the impact of any relevant context

• Identify if there is any relevant context - working environment, role and experience or personal context
• Consider whether it directly or indirectly affected the doctor's behaviour, performance or health
• If so, is it appropriate to take that context into account?
• If so, confirm what impact it has on the level of risk (decreases, no impact, increases)

2d. Consider how the doctor has responded to the allegation(s)

• Consider what evidence there is relating to insight and assess if insight is genuine
• Consider what evidence there is relating to remediation to assess if the allegation is remediable, has been remedied and is likely to be repeated
• Consider if the doctor has kept their knowledge and skills up to date
• Confirm what impact these factors have on the level of risk (decreases, no impact, increases) 

If not impaired, consider if a warning is required.

2e. On the basis of the conclusions reached in steps 2b, 2c and 2d decide if the doctor poses any current and ongoing risk to public protection and make a finding on impairment 

• If no current and ongoing risk, make a finding of no impairment 
• If there is a current and ongoing risk to public protection, decide to which parts, state the level of risk (low, medium, high) and make a finding of impairment
• Give reasons for decision

3. Make a decision on sanction

• If impaired, consider what sanction is proportionate i.e. is needed but no more than necessary to protect the public
• Review decision on impairment and consider the level of current and ongoing risk the doctor poses to public protection 
• Refer to sanctions bandings (where available)
• Consider whether there is relevant evidence relating to the impact a certain type of sanction will have and/or relevant references and testimonials and what impact, if any, they have
• Decide on the type and length of sanction- stand back and check if it is proportionate to meet the level of current and ongoing risk posed to public protection
• Consider directing a review, whether an immediate order is needed and if action is needed in relation to an interim order
• Give reasons for decisions