Step 1: decide if the doctor's fitness to practise remains impaired

Text alternative: step 1: decide if the doctor's fitness to practise remains impaired

18. At stage one of an medical practitioners tribunal (MPT) review hearing, the MPT decides if the doctor’s fitness to practise remains impaired in relation to each of the relevant grounds of impairment upon which the previous MPT had found the doctor to be impaired.  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 of all the available relevant evidence.
    
    
19. 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.
    
    
20. On review, the following questions should be used to inform the MPT’s assessment of whether a doctor poses any current and ongoing risk to public protection requiring restrictive action in response, and if so, what level of risk (low, medium or high):
• What was the previous MPT’s assessment of risk and reasons given for it?
• What new evidence has been received since the previous MPT’s assessment of risk and what impact does this have?
• What evidence is there of insight and is the doctor’s insight genuine?
• What evidence is there relating to remediation, has the allegation now been remedied or is it still likely to be repeated?
• Has the doctor kept their skills and knowledge up to date?
• Has the risk to public protection that previously required restrictive action in response changed and if so, how?

21. The MPT will only make a finding that the doctor’s fitness to practise remains impaired 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.
    
    
22. The decision on whether the doctor remains impaired is one for the MPT alone, exercising their judgment. There is no burden or standard of proof.
    
    
23. Where an MPT or tribunal chair is reviewing a case on the papers, the parties will have agreed on whether the doctor’s fitness to practise remains impaired. The MPT or tribunal chair will need to satisfy themselves of the parties’ assessment of whether the doctor poses a current and ongoing risk to one or more of the three parts of public protection requiring restrictive action in response, and therefore whether their fitness to practise remains impaired. If they are not satisfied, or insufficient information has been provided, the MPT or tribunal chair must direct that a hearing should be held.
    
    
24. The MPT will always need to record reasons for their decision and be clear about which part(s) of public protection are engaged. Where the MPT’s decision departs from the principles in this part of the guidance the MPT must carefully explain how this is justified, given the specific circumstances of the case. They must also explain how the decision relates to any submissions made by the parties. In a review on the papers, the MPT or tribunal chair should confirm if they are satisfied with the basis of the agreement provided by the parties.