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Medical practitioners tribunal hearings

Step 2e: on the basis of the conclusions reached in steps 2b, 2c and 2d decide if the doctor poses any current and ongoing risk to public protection and make a finding on impairment

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Text alternative: step 2e: on the basis of the conclusions reached in steps 2b, 2c and 2d decide if the doctor poses any current and ongoing risk to public protection and make a finding on impairment

Deciding if the doctor poses any current and ongoing risk to public protection to reach a decision on impairment 

  1. If there is more than one legal basis for considering the doctor’s fitness to practise an assessment of current and ongoing risk must be made in respect of each of them.

  2. The medical practitioners tribunals (MPT’s) view on whether the doctor poses any current and ongoing risk to public protection, and if so, what level of risk (low, medium, or high), is based on considering the answers to the questions at steps 2b to 2d:
    • Where on the spectrum of seriousness does the allegation lie – lower end, mid-range, higher end? This provides the starting point for assessing current and ongoing risk to public protection – low, medium or high.
    • Is there relevant context known about the doctor or their working environment that impacted on the doctor’s behaviour, performance or health and what impact does this have on the assessment of current and ongoing risk – decreases risk, has no impact on risk, increases risk?
    • How has the doctor responded to the allegation and what impact does this have on the assessment of risk – decreases risk, has no impact on risk, increases risk?
  1. Each of the answers will need to be carefully considered and balanced against one another to inform the MPT’s view on risk.

  2. In cases where the allegation falls at the lower end of the spectrum of seriousness, and where there is evidence of relevant context about the doctor and/or their working environment and/or evidence of how the doctor has responded that decreases risk, a conclusion may be made that either the doctor does not pose any current and ongoing risk, or still poses a low level of risk, to one or more of the three parts of public protection requiring restrictive action in response. This often arises where there is a clinical concern or where the concern relates to the impact of a doctor’s health condition on their ability to practise safely and effectively.

  3. In cases where the allegation falls at the higher end of the spectrum of seriousness, the starting point for assessing current and ongoing risk to public protection will be high. Evidence of relevant context that decreases risk and evidence of insight and remediation that decreases risk may have less impact and carry less weight because these types of allegations can be more difficult to remediate. Evidence of the doctor having kept their knowledge and skills up to date may also be less relevant. This should be considered by the MPT when they are reaching a view on risk and a conclusion 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 may be needed, particularly as the allegation is likely to engage public confidence.

  4. Although cases of violence and dishonesty usually fall at the higher end of the spectrum of seriousness, they can involve a range of behaviour, with the circumstances giving rise to the allegation often occurring outside the doctor’s professional practice. In deciding whether there is any current and ongoing risk to public protection requiring restrictive action in response, the MPT will need to decide where on the spectrum of seriousness the violence or dishonesty sits. Where the violent or dishonest behaviour is at the lower to mid-range of the spectrum of seriousness, evidence of relevant context that decreases risk and evidence of insight and remediation that decreases risk may carry more weight and have more impact.

  5. The medical practitioners tribunal (MPT) must record reasons for their conclusion on whether the doctor poses any current and ongoing risk to one or more of the three parts of public protection requiring restrictive action in response, to explain their decision on impairment.

  6. Where the MPT reach a view that the doctor poses a current and ongoing risk to public protection requiring restrictive action in response, they should make a finding that the doctor’s fitness to practise is impaired. In doing so, they should be clear about which parts of public protection – patient safety, public confidence and/or upholding professional standards – are engaged, making reference to the general guidance and specific case types sections in the Introduction, as appropriate.

  7. The MPT should also state the level of risk they’ve identified – low, medium, or high. This is because the level of current and ongoing risk will be relevant to the MPT’s decision on what is a proportionate response. The MPT should then apply the guidance in Part C Step three: decide on sanction to decide what action is needed to protect the public.

  8. In cases where the MPT decides that the doctor’s fitness to practise is not impaired, they may give the doctor a warning as to their future behaviour or performance where the allegation falls below the professional standards expected. To decide whether a warning is a proportionate response, the MPT should apply the guidance in Part D Step three: decide if a warning is required.