Step 2a: decide whether there is a legal basis for considering impairment
The grounds of impairment
- An MPT must be satisfied that there is a legal basis for considering whether a doctor’s fitness to practise is impaired, meaning that there is a current and ongoing risk to public protection. The table below explains the grounds of impairment that apply to taking regulatory action in respect of doctors.
- A finding of impairment can only be made by an MPT where the facts found proved engage at least one of these grounds of impairment and the doctor is assessed to pose a current and ongoing risk to one or more of the three parts of public protection requiring restrictive action in response.
- The GMC will state the grounds for impairment in the allegations that are presented to the MPT. Although the MPT is not able to add or change any grounds of impairment, or add any additional allegations, they are able to amend the allegation provided it can be made without injustice to the doctor. Any amendment should have been made at stage one of the hearing.
The following are the different grounds of impairment, along with their descriptions:
Misconduct
This is about behaviour. It could consist of acts and/or omissions arising in or outside of a doctor’s working life and includes failing to act appropriately or demonstrating behaviour that falls short of what can reasonably be expected.
To amount to misconduct, the behaviour will be a serious departure from the professional standards, as set out in Good medical practice. This includes single clinical acts or omissions that are serious, or a limited number of clinical acts or omissions that taken together are serious.
Deficient professional performance
This is about professional performance. It could consist of acts and/or omissions and includes failing to act appropriately or being unable to provide care to the standard expected.
To amount to deficient professional performance, an assessment of a fair sample of a doctor’s work will show that the same clinical act or omission occurs more than once or there is more than one clinical act or omission. Taken together the departures from the professional standards are unacceptable and mean the doctor’s performance falls seriously below the standard(s) expected, as set out in Good medical practice.
Conviction or caution
A conviction or caution in the British Islands for a criminal offence, or a conviction elsewhere for an offence which, if committed in England or Wales, would constitute a criminal offence can indicate that a doctor poses a current and ongoing risk to public protection.
Adverse physical or mental health
While having a health condition does not of itself mean there is a departure from the professional standards, if it is not being appropriately managed then this may lead to a departure from the professional standards and/or may impact on a doctor’s ability to practise safely.
Not having the necessary knowledge of English
All doctors working in the UK must have the necessary knowledge of the English language in the areas of speaking, listening, reading and writing to provide a good standard of practice and care. This includes being able to effectively engage with patients and other healthcare professionals. If a doctor does not have the necessary knowledge of English language to communicate effectively, in all areas, they are unable to practise safely in the UK.
A determination by another health regulatory body
A determination by a health or social care regulatory body that a doctor’s fitness to practise is impaired can indicate that a doctor poses a current and ongoing risk to public protection. The determination can be from a body in the UK or overseas.
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If the MPT is satisfied there is a legal basis for considering the doctor’s fitness to practise, they will need to decide whether the doctor poses any current and ongoing risk to public protection.
- 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, and if so, what level of risk (low, medium or high):
- Where on the spectrum of seriousness does the allegation lie?
- What is the impact of any relevant context known about the doctor and/or their working environment?
- How has the doctor responded to the allegation?
- The MPT should answer these questions with reference to the facts found proved at the first stage of the hearing and any further relevant evidence considered at stage two of the hearing.