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  6. General introduction
Medical practitioners tribunal hearings

General introduction

  1. The role of a medical practitioners tribunal (MPT) is to protect the public by ensuring that where a doctor is not currently fit to practise, appropriate restrictions are put in place, or the doctor is removed from the medical register.

  2. References made to ‘public protection’ throughout this guidance refer to the GMC and MPTS’ legal duty to protect the public which is split into three distinct parts. It means an MPT must act in a way that:
    • protects, promotes and maintains the health, safety and well-being of the public
    • promotes and maintains public confidence in the profession, and
    • promotes and maintains proper professional standards and conduct for members of the profession.
  1. An MPT hearing has three distinct stages:
    • stage one: the MPT reaches a decision on the facts.
    • stage two: the MPT decides if the doctor’s fitness to practise is impaired.
    • stage three: the MPT decides what regulatory action, if any, is required.
  1. At stage one, the MPT will consider evidence provided by both parties (the GMC and doctor) to decide whether the allegations presented by the GMC are proved. To reach a decision the MPT will apply the civil standard of proof. This means the MPT must decide whether, on the balance of probabilities, the GMC is able to prove it is more likely than not that the matters occurred as alleged. If the MPT finds some, or all, of the facts are proved, they will go on to consider the doctor’s fitness to practise. Further information about the approach taken to stage one of the hearing can be found in Part A of this section of the guidance, Step one: make findings of fact.

  2. At stage two, to decide if a doctor is fit to practise, the MPT must assess whether that doctor poses any current and ongoing risk to one or more of the three parts of public protection. This assessment must be made with reference to the facts found proved at the first stage of the hearing and any further relevant evidence presented to the MPT.

  3. An MPT can only assess whether a doctor is fit to practise where there is a legal basis for doing so. There are six legal bases which are known as the grounds for impairment. These are:
    • misconduct
    • deficient professional performance
    • a conviction or caution
    • adverse physical or mental health
    • not having the necessary knowledge of English and
    • a determination.1
  1. Where there is a legal basis for considering a doctor’s fitness to practise, to assess whether that doctor poses any current and ongoing risk to public protection, an MPT will consider:
    • the seriousness of the facts found proved
    • any relevant context known about the doctor and/or their working environment, and
    • how the doctor has responded to the allegation(s).
  1. The MPT will only make a finding of impairment where a decision is reached that the doctor poses a current and ongoing risk to one or more of the three parts of public protection requiring restrictive action in response. Further information about the approach taken to deciding impairment can be found in Part B of this section of the guidance, Step two: make a decision on impairment. 

  2. At stage three, the MPT will consider their conclusion on impairment, and decide what regulatory action, if any, is needed to protect the public.

  3. Where the MPT has decided that the doctor’s fitness to practise is impaired, they will then go on to consider what restrictive action is required in response. This is known as a sanction. Further information about the approach to deciding what sanction is a proportionate response can be found in Part C of this section of the guidance, Step three: decide on sanction. 

  4. Where the MPT has decided that the doctor’s fitness to practise is not impaired, but they have found that the doctor has significantly departed from the professional standards, the MPT can decide to issue the doctor with a warning. This is a formal way of indicating that the doctor’s behaviour or performance significantly departed from the professional standards and should not be repeated. Further information about the approach to warnings can be found in Part D of this section of the guidance, Decide if a warning is required.

  5. The process that the MPT should follow to decide an allegation of impaired fitness to practise and what regulatory action to take, if any, are illustrated in the diagram that follows.

1 Section 35C(2) of the Medical Act 1983 (as amended).