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Medical practitioners tribunal hearings

MPT review hearings

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MPT review hearings 

General introduction

  1. The role of a medical practitioner’s tribunal (MPT) carrying out a review of a sanction of conditions or suspension is to decide whether a doctor’s fitness to practise remains impaired and if so, what restrictive action, if any, is needed to protect the public.

  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 wellbeing 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. A sanction of conditions or suspension must be reviewed where the MPT imposing the sanction directed a review1  or, in cases where a review was not directed by the MPT, the GMC has directed that a review is necessary,2 or where an early review has been directed by the GMC on the basis information has been received that makes an early review hearing desirable.3

  2. The purpose of this guidance is to support MPTs to make fair and consistent decisions when reviewing a sanction at a hearing.

Review hearings

  1. An MPT review hearing has two distinct stages:
    • Stage one: the MPT will reach a decision on whether the doctor’s fitness to practise remains impaired
    • Stage two: the MPT will consider their conclusion on impairment and decide what action, if any, is required in response.
  1. At stage one, to decide if a doctor’s fitness to practise remains impaired, the MPT must assess whether that doctor poses any current and ongoing risk to one or more of the three parts of public protection requiring restrictive action in response. This assessment must be made with reference to the findings of the original MPT, the findings of any MPTs who have conducted a previous review of the case, and any relevant new evidence presented to the MPT.

  2. 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 of impairment.

  3. 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.4 
  1. The MPT should assess whether the doctor’s fitness to practise remains impaired having regard to whichever ground of impairment the doctor was previously found to be impaired by. While they cannot add or consider new grounds for impairment in the absence of separate matters against the doctor having been referred for determination, the MPT should assess if the doctor is currently fit to practise by considering all the available relevant evidence.5 

  2. At stage two, the MPT will consider their conclusion on impairment and decide what action, if any, is required in response.

  3. At a review hearing, the MPT has the power to:
    • take no further action and let the current sanction expire
    • revoke the existing sanction of conditions or suspension for the remainder of the current period 
    • direct a further period of conditions or suspension
    • in a health or language case only, direct that the doctor’s registration be suspended indefinitely provided certain circumstances are met, or
    • except in a health or language case, direct that the doctor should be erased from the register.
  1. As part of preparing for the review, or during the review hearing, the GMC and the doctor may agree undertakings.6 In these circumstances, if they have made a finding of impairment, the MPT can take the undertakings into account and decide to revoke the current sanction or take no further action and let the current sanction expire. However, they should only do so if satisfied the undertakings are a proportionate response to address the current and ongoing risk to public protection posed by the doctor.

  2. The process that the MPT should follow at a review hearing to decide if a doctor’s fitness to practise remains impaired and what action to take, if any, is illustrated in diagram one.

Reviews on the paper

  1. Cases can be reviewed on the papers as an alternative to holding a hearing.7 Reviews on the papers can take place when the GMC and doctor agree on the outcome. This means the review will be conducted by an MPT or tribunal chair without the attendance of the parties. 

  2. When reviewing a case on the papers, the MPT or tribunal chair has the power to make a direction which gives effect to the agreed outcome.8  Alternatively, where the MPT or tribunal chair decides that the agreed outcome is not sufficient to address one or more parts of public protection, they can decide that a hearing should take place to consider the case.9

Review hearings where there are also new allegations

  1. Where new allegations about a doctor’s fitness to practise have been referred to an MPT hearing and the new matter and review have been listed to be determined together, the hearing will have three stages:
    • Stage one: the MPT will use the guidance in Part A: stage one – facts of the guidance for Medical Practitioner tribunal hearings to consider and decide the facts in the new matter
    • Stage two: the MPT will reach a decision on whether the doctor’s fitness to practise remains impaired, considering both their findings at stage one in relation to the new allegation and information relevant to the review which includes the findings of the original MPT, the findings of any MPTs that have conducted a previous review of the case, and any relevant new evidence presented to the MPT 
    • Stage three: the MPT will consider their conclusion on impairment and decide what action, if any, is required in response.
  1. If a new allegation has been referred to the MPTS shortly before a scheduled review hearing, with insufficient time for the new allegation to be prepared so the matters can be considered together, the MPT should adjourn the review hearing. In these circumstances, the MPT should extend the current sanction so that there is no public protection gap.

1 Under section 35D(4A) or (11A) of the Medical Act 1983 ‘the Act'.

2 Under section 35D(4B) or (11B) of the Act.

3 Rule 21 of the Fitness to Practise Rules 2004 ‘the Rules’

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

5 The MPT should refer to the section Review hearings where there are also new allegations where separate matters against the doctor have been referred for determination.

6 Undertakings restrict a doctor’s ability to practice and/or require them to do something to manage their health condition or address the deficiencies in their performance or knowledge of English language.

7 Rule 21B.

8 Section 35D(13a) of the Act Section 35D(13b) of the Act.