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Medical practitioners tribunal hearings

Step 2: make a decision on impairment

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Deciding impairment

  1. At stage two of an medical practitioners tribunal (MPT) hearing, the MPT decides if the doctor’s fitness to practise is impaired.

  2. If the MPT has concluded at stage one that no facts have been proved, this means the GMC has not discharged the burden of proof in respect of the allegations that the doctor’s fitness to practise is impaired. The MPT should therefore confirm there is no basis upon which to make a finding of impairment, and the hearing will conclude.

  3. 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. 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.

  4. The decision on impairment is one for the MPT alone, exercising their judgment. There is no burden or standard of proof.

  5. 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.3
  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. If there is more than one legal basis for considering the doctor’s fitness to practise i.e. the allegations fall under more than one ground for impairment, an assessment of current and ongoing risk must be made in respect of each of them.

  2. The MPT will always need to record reasons for their decision on impairment 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.

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