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Medical practitioners tribunal hearings

Step 3: decide on sanction

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Decision on sanction

  1. At stage three of an medical practitioners tribunal (MPT) hearing, the MPT will consider what regulatory action, if any, is needed to protect the public.

  2. Where the MPT has decided that the doctor’s fitness to practise is impaired at stage two of the hearing, it will need to go on to consider what is a proportionate regulatory response to protect the public.7

  3. 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. At the sanction stage, the outcomes available to the MPT are to:
    • take no action 
    • impose conditions on the doctor’s registration for up to three years 
    • suspend the doctor’s registration for up to 12 months, or
    • erase the doctor’s name from the medical register.8
  1. When making their decision, the MPT should always remind themselves of their earlier conclusions at the facts and impairment stages to ensure that they have been, and remain, consistent with previous findings and have regard to the level of current and ongoing risk to one or more of the three parts of public protection posed by the doctor (low, medium, or high).

  2. In most hearings, the sanctions stage will follow immediately after the MPT has made its decision on impairment. But sometimes, in the event of a split listing or an adjournment, there is a time lapse prior to the MPT’s consideration of sanction. Where a time lapse occurs, the MPT will need to take particular care to remind themselves of their earlier conclusion on risk before considering what has happened since the case was last before them and assessing the impact of any relevant additional evidence. This amounts to the MPT conducting an updated assessment of the current and ongoing risk to public protection posed by the doctor.

  3. When conducting an updated assessment of risk, the MPT must avoid “double counting” evidence that previously informed, and was therefore taken into account in reaching, their earlier decision on impairment. Where there is relevant additional evidence, the MPT must consider it and identify any additional factors capable of increasing or decreasing the level of current and ongoing risk to public protection posed by the doctor. They should do this with reference to the guidance in Part B step 2: make a decision on impairment and clearly state the impact these additional factors have on their previous view of risk. It is this updated assessment of current and ongoing risk that should inform the MPT’s view on what sanction is a proportionate response.

  4. For some types of cases, sanctions bandings are available. The MPT should be mindful that these provide a guide, and there may be evidence relevant to the individual circumstances of the case that indicates the appropriate action should be lower or higher than that indicated by the bandings. This can include whether the type of sanction should be less or more restrictive, or where conditions or suspension are imposed, that the length should be longer or shorter than that stated. 

  5. The medical practitioners tribunal (MPT) will always need to record reasons for their decision on sanction. Where the MPT’s decision departs from the principles in this part of the guidance, which includes the sanctions bandings, 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.

Any sanction must be proportionate, transparent and fair

  1. A good decision about a doctor’s fitness to practise should protect the public, be proportionate, be transparent and be fair. In the context of deciding what sanction, if any, is required to address the level of current and ongoing risk to public protection posed by a doctor (low, medium or high), being proportionate means:
    • when deciding what is required but no more than necessary to achieve public protection, approaching the question by considering if the least restrictive action is appropriate, and not making a final decision until the options immediately above and below the action the MPT is minded to take, have also been assessed.
    • when considering the impact on those affected by the decision, the interests of individual patients and members of the public may include the impact that taking a specific type of action is likely to have on the delivery of health services in a particular speciality or within a defined geographical location. However, whilst there may be a public interest in facilitating a doctor’s return to safe practice, the decision on what sanction is required needs to reflect the level of current and ongoing risk to one or more of the three parts of public protection that has been identified, and which takes into account the seriousness of the allegations, and must be consistent with the GMC and MPTS’s legal role to protect the public.
    • the interests of the doctor will include the impact on their career. This means when deciding what sanction is required, it may be appropriate to consider any increased impact a specific outcome would have on an individual doctor compared to others, considering their specific circumstances. However, case law is clear that the need to protect the public always outweighs the interests of any individual medical professional. And while restrictive action is not put in place to punish or discipline a doctor, a sanction may have a punitive effect yet still remain necessary.
  1. When reaching a view on what is a proportionate sanction, the medical practitioners tribunal (MPT) must demonstrate they have considered any submissions made by the parties.

  2. Sanctions are published on the doctor’s entry on the register and disclosed in line with the GMC’s Publication and Disclosure Policy.

Outcomes available to the MPT at the sanction stage

Taking no action

  1. Where a doctor’s fitness to practise is impaired, it will usually be necessary for the medical practitioners tribunal (MPT) to restrict the doctor’s registration to achieve public protection. But there may be exceptional circumstances to justify an MPT taking no action. Exceptional circumstances are unusual, special, or uncommon, so such cases are likely to be very rare.

  2. When making their decision on impairment, the MPT will already have taken into account any relevant context and the doctor’s response to the allegation. Therefore, the presence of relevant context and insight and remediation are unlikely on their own to justify an MPT taking no action.

  3. Taking no action may be proportionate where the MPT is satisfied that undertakings agreed between the GMC and doctor are sufficient to protect the public. Undertakings can be agreed between a doctor and the GMC at a hearing after the MPT has made a finding of impairment.9 If undertakings are agreed, the MPT may take these into account when reaching its decision on sanction,10 provided that certain conditions are met.11

  4. Where an MPT decides to take no action, its determination must fully and clearly explain:
    1. what the exceptional circumstances are
    2. why the circumstances are exceptional
    3. how the exceptional circumstances justify taking no action.

Conditions

  1. Conditions are suitable for those cases where the doctor’s behaviour, performance, or the impact that a health condition is having on their ability to practise safely and effectively, is currently incompatible with unrestricted registration. This means the current and ongoing risk to public protection posed by the doctor needs to be managed by restricting their registration for a period of time, with the aim they should be able to safely return to unrestricted practice in the future.

  2. Where a sanction of conditions is imposed on a doctor’s registration, the medical practitioners tribunal (MPT) must specify the period for which it is to remain in force, up to a maximum of three years.12

What are conditions?

  1. Conditions restrict a doctor’s ability to practise and/or require them to do something. The purpose of putting in place a sanction of conditions is to provide a doctor with time to address identified failings to demonstrate they are fit to practise on an unrestricted basis, whilst ensuring that the current and ongoing risk posed to public protection is being adequately managed.

  2. Where conditions are put in place, they should be appropriate, workable, and measurable.
Appropriate
  1. To be appropriate, conditions must address the specific findings about the current and ongoing risk to public protection posed by the doctor.
Workable
  1. To be workable, conditions must be capable of producing the desired result of addressing the specific findings about the current and ongoing risk to public protection posed by the doctor.

  2. Conditions are likely to be workable where:
    1. the doctor has shown insight
    2. time is needed for the doctor to take steps to address the findings (remediate), for example through retraining, study, supervision and/or seeking medical treatment
    3. the doctor is willing to remediate
    4. the MPT is satisfied the doctor will comply with them.
  3. When deciding whether remediation is possible, the MPT should carefully consider any objective evidence that is available to them. This may include the outcome of assessments, or other independent evidence of the doctor’s performance, health, or knowledge of the English language.

  4. Sometimes evidence is provided that a doctor’s employer, or another relevant body, will not support certain conditions if they were to be put in place, which means that a specific condition(s) is not workable in that environment. Where alternative conditions can be identified that are workable, proportionate and achieve the overall aim of conditions, and they adequately address the current and ongoing risk to public protection posed by the doctor, consideration can be given to putting those in place instead.

  5. However, where alternative conditions are not appropriate or proportionate, the conditions considered necessary to protect the public in a timely way should be imposed, despite the fact they may not be supported by the doctor’s current employer or relevant body. A lesser or greater sanction than that which is necessary to protect the public should not be imposed simply because certain conditions may not be supported by a specific body.
Measurable
  1. A condition must be described in specific terms to make it measurable. Conditions must be measurable so that the doctor can be clear about what is required of them. Having measurable conditions also means that when an assessment of whether the doctor poses any current and ongoing risk to public protection is next made to reach a view on impairment, the extent to which the doctor has complied with the conditions, and the question of whether the conditions have had the desired result, can be considered.
When are conditions likely to be proportionate?
  1. Conditions may be proportionate in cases where the doctor has shown a degree of insight into the allegation and some, or all, of the following factors are present:
    1. the doctor has demonstrated they are willing and/or able to remediate
    2. identifiable areas of the doctor’s practice need prohibiting, monitoring, or retraining
    3. the doctor has demonstrated they are willing to be open and honest with patients and others they work with if things go wrong
    4. the doctor will not put patients at harm, either directly or indirectly, by having conditions on their registration.
  2. A doctor may have demonstrated they are willing and able to remediate where they’ve provided evidence that they’re committed to improving their knowledge and skills and keeping them up to date throughout their working life, improving the quality of their work and seeking and responding to feedback. They may not have demonstrated they are willing and/or able to remediate where there is evidence there have been previous unsuccessful attempts to remediate, or where there is evidence the doctor has been unwilling to engage.

  3. Conditions are unlikely to be a proportionate response in cases where the nature of the allegations about the doctor’s behaviour fall at the higher end of the spectrum of seriousness and/or suggest an underlying problem with their attitude.

Imposing conditions on a doctor’s registration

  1. When imposing conditions, as well as giving reasons for the need for this type of restrictive action, the objectives of the conditions should be clearly set out, so they are measurable.

  2. Conditions should be drawn from the suite of conditions detailed in the conditions bank Imposing conditions on a doctor’s registration. The wording of conditions in the bank should be retained unless, unusually, it is necessary to amend or add to them, considering the individual circumstances of the case.

  3. The MPT will need to decide the appropriate length of time that conditions should be put in place for, up to the maximum of three years. The following factors will be relevant:
    1. the assessment of the level of current and ongoing risk to public protection posed by the doctor (low, medium, or high)
    2. the reasons for assessing conditions as being the proportionate response
    3. the amount of time the doctor is likely to need to remediate, complete treatment for and/or recover from a health condition that is having, or is likely to have, an impact on their ability to practise safely and effectively, and/or
    4. the amount of time the parties will reasonably need to prepare for a review of whether the doctor continues to pose a current and ongoing risk to public protection requiring restrictive action in response, meaning their fitness to practise remains impaired, or is safe to return to unrestricted practice.
  4. Where a condition has been imposed that requires a doctor to complete an assessment of their performance, health or knowledge of English language, the time needed to complete the assessment should be accounted for.13

  5. Any time spent under an interim order of conditions or suspension is unlikely to be relevant to deciding the appropriate length of conditions. This is because the type of action and the length of time conditions are put in place for both need to adequately address the finding of impairment based on the decision that the doctor poses a current and ongoing risk to public protection requiring restrictive action in response.

  6. Interim orders serve a very different purpose to sanctions; when imposing an interim order, an interim orders tribunal (IOT) makes no findings of fact and the test for considering whether to impose an interim order is entirely different from the criteria that applies when considering what, if any, is an appropriate sanction to impose on a doctor’s registration following a finding of impairment.

  7. To take into account previous time spent under an interim order before any decision to impose a sanction of conditions is made, would likely leave a public protection gap, as reducing the length of time that any conditions are put in place for would not wholly reflect the assessment of the level of current and ongoing risk to public protection that has now been made by the MPT.

  8. The question of whether the doctor can safely return to unrestricted practice will need to be considered before a period of conditions concludes and so a review should be directed.

  9. Where an interim order is in place at the time that a sanction of conditions is imposed, this should usually be revoked. The exception is where the interim order relates to other concerns or allegations in the fitness to practise process that have not yet been determined.

  10. The MPT’s decision to impose a sanction of conditions will take effect at the conclusion of the 28-day appeal period. The MPT may impose an immediate order14 in the interim where they consider it is necessary to do so.

Suspension

  1. Suspension is for those cases where the doctor’s behaviour, performance, or the impact that a health condition is having on their ability to practise safely and effectively, is currently incompatible with unrestricted registration. This means the current and ongoing risk to public protection posed by the doctor needs to be managed by restricting their registration for a period, with the aim they should be able to safely return to unrestricted practice in the future.

  2. Where suspension is imposed on a doctor’s registration, the medical practitioners tribunal (MPT) must specify the period for which it is to remain in force, up to a maximum of 12 months.15

What is suspension?

  1. Suspension restricts a doctor’s registration and prevents them from practising during the period it is in effect. The purpose of suspending a doctor’s registration is to protect the public by removing them from practice to manage the current and ongoing risk they pose to public protection.

  2. Restrictive action of suspension is intended to address the level of current and ongoing risk to public protection and is not intended to be punitive. However, as it prevents a doctor from working and earning a living within that profession, it can have this effect. Suspension can also have a deterrent effect and be used to send a signal to the individual doctor, the profession and public about what is regarded as behaviour unbefitting a registered doctor.

When is suspension likely to be proportionate?

  1. Suspension may be proportionate in cases where some, or all, of the following factors are present:
    1. conditions are not appropriate, measurable and/or workable
    2. the level of current and ongoing risk to public protection is such that it cannot be safely managed with conditions and suspension is necessary to stop the doctor from working and putting patients at risk while they gain insight into any deficiencies and remediate, or undergo medical treatment, and/or
    3. the level of current and ongoing risk to public protection is such that, although patient safety is not an issue, suspension is needed to maintain public confidence in the profession and/or maintain professional standards.

Imposing suspension on a doctor’s registration

  1. The MPT will need to decide the appropriate length of time that suspension should be put in place for, up to the maximum of 12 months. The following factors will be relevant:
    1. the assessment of the level of current and ongoing risk to public protection posed by the doctor
    2. the reasons for assessing suspension as being the proportionate response
    3. the amount of time the doctor is likely to need to remediate, complete treatment for and/or recover from a health condition that is having, or is likely to have, an impact on their ability to practise safely and effectively, and/or
    4. the amount of time the parties will reasonably need to prepare for any review of whether the doctor continues to pose a current and ongoing risk to public protection requiring restrictive action in response or is safe to return to unrestricted practice.
  2. A short suspension may be appropriate in cases where: the doctor’s behaviour fell at the higher end of the spectrum of seriousness; there was evidence of relevant context and/or evidence of insight and remediation that decreased the level of current and ongoing risk to public protection such that there are no outstanding patient safety considerations; and suspension is being imposed on public confidence grounds and/or to maintain professional standards. It might also be appropriate in relation to a very small number of clinical cases where a doctor’s performance was such that although unlikely to recur, the nature of the allegation was so serious as to undermine the public’s trust in the profession.

  3. Where a doctor is suspended because of findings in relation to insufficient knowledge of English, a short suspension is unlikely to be suitable in the first instance because they will need sufficient time to improve their language skills, take an English language assessment and for the parties to consider the results.

  4. Any time spent under an interim order of conditions or suspension is unlikely to be relevant to deciding the appropriate length of a suspension. This is because the type of action and the length of time it’s put in place for both need to adequately address the decision that the doctor poses a current and ongoing risk to public protection requiring restrictive action in response.

  5. Interim orders serve a very different purpose to sanctions; when imposing an interim order an IOT makes no findings of fact and the test for considering whether to impose an interim order is entirely different from the criteria that applies when considering what, if any, is an appropriate sanction to impose following a finding of impairment. To take into account previous time spent under an interim order before any decision to impose a suspension is made would likely leave a public protection gap, as reducing the length of time that suspension is put in place for would not wholly reflect the assessment of the level of current and ongoing risk that has now been made.

  6. However, time spent under an interim order of suspension may be relevant when determining the proportionate period of suspension to be imposed purely on the grounds of public confidence. In many of these cases, given the different purposes of interim orders and sanctions, a previous interim order of suspension is unlikely to have a significant impact. Nevertheless, it must still be considered.

  7. The question of whether the doctor can safely return to unrestricted practice will need to be considered before a period of suspension concludes and so a review should be directed. The exception to this is where a short suspension (usually three months or less) has been imposed on public confidence grounds and/or to maintain professional standards.

  8. Where an interim order is in place at the time that suspension is imposed, this should usually be revoked. The exception is where the interim order relates to other concerns or allegations in the fitness to practise process that have not yet been determined.

  9. The MPT’s decision to impose a sanction of suspension will take effect at the conclusion of the 28-day appeal period. The MPT may impose an immediate order in the interim where they consider it is necessary to do so.

Erasure from the medical register

  1. Erasure is action available for those cases where a doctor’s behaviour, performance, or the impact that a health condition is having on their ability to practise safely and effectively,16 is incompatible with continued registration at this point in time. It means the level of current and ongoing risk the doctor poses to public protection is so significant that they should not be allowed to practise.

What is erasure?

  1. Erasure takes away a doctor’s registration which means they are no longer entitled to practise in the UK at all, or anywhere else where they are required to hold GMC registration. It is used to protect the public in the most serious cases. It also has a deterrent effect as it sends a signal to the individual doctor, the profession and public about what is regarded as behaviour unbefitting a registered doctor.

When will erasure be the only proportionate response?

  1. Erasure may be the proportionate response where:
    1. conditions are not appropriate, measurable and/or workable and suspension is not sufficient to protect the public
    2. the doctor’s behaviour or performance is such that it caused serious harm, and the risk of harm recurring cannot be mitigated sufficiently through putting conditions or suspension in place
    3. the doctor has shown a persistent lack of insight into the seriousness of the allegation about their behaviour or performance and the potential or actual consequences, and/or
    4. the seriousness of the facts found proven and/or impact of any relevant context that increased the current and ongoing risk to public protection mean the effect of the doctor continuing to hold registration is such that it will undermine public confidence in the profession.

Erasing a doctor from the medical register

  1. The medical practitioners tribunals (MPT’s) decision to erase a doctor will take effect at the conclusion of the 28-day appeal period. The MPT may impose an immediate order of suspension in the interim where they consider it is necessary to do so.

  2. Where an interim order is in place at the time that erasure is imposed, this should usually be revoked. The exception is where the interim order relates to other concerns or allegations in the fitness to practise process that have not yet been determined. This is to avoid a public protection gap in the event the doctor appeals the decision to erase them from the register.

Sanctions bandings for specific case types

  1. At the impairment stage, the medical practitioners tribunal (MPT) will have assessed the current and ongoing risk to one or more of the three parts of public protection arising from all the facts found proved. Sometimes those facts and the finding of impairment will relate to a range of allegations. Where this is the case, the MPT should consider, where available, the sanctions bandings for all the specific case types relating to the proven allegations.

  2. When assessing the level of current and ongoing risk to public protection, the MPT will have considered the seriousness of the facts found proved, any relevant context known about the doctor and/or their working environment and how the doctor responded to the allegation. The level of risk (low, medium, high) identified by the MPT should be used to inform where within the sanctions bandings the case falls.

  3. Below are the sanctions bandings for some case types commonly seen at hearing.
     
Case type Lower level of risk to public protection Medium level of risk to public protection Higher level of risk to public protection
Sexual misconduct Suspension up to 6 months Suspension 6 to 12 months Suspension 12 months to Erasure
Dishonesty Suspension up to 3 months Suspension 3 to 9 months Suspension 9 months to Erasure
Violent or abusive behaviour Suspension up to 3 months Suspension 3 to 12 months Suspension 12 months to Erasure
Discrimination Conditions up to 12 months to Suspension 3 months Suspension 3 to 9 months Suspension 9 months to Erasure
Clinical concerns Conditions 12 to 24 months Conditions 24 to 36 months to Suspension 6 months Suspension 6 months to Erasure
Impact of a health condition Conditions 6 to 12 months Conditions 12 to 36 months to Suspension Suspension
Insufficient knowledge of English language Conditions up to 6 months Conditions 6 to12 months Suspension
Convictions, cautions, misconduct arising from breach of court sanctions and determinations by other regulatory bodies Conditions up to 12 months to Suspension up to 3 months Suspension 6 to 12 months Suspension 12 months to Erasure
  1. In all cases, once the MPT has identified the level of banding, they will need to decide the appropriate length of sanction to impose within that range provided they are satisfied it is the most proportionate type of action considering the individual circumstances of the case. The following factors will be relevant to deciding the appropriate length of time that conditions or suspension should be put in place for:
    1. the reasons for assessing conditions or suspension as being the proportionate response
    2. the amount of time the doctor is likely to need to remediate, complete treatment for and/or recover from a health condition that is having, or likely to have, an impact on their ability to practise safely and effectively
    3. where a condition has been imposed that requires a doctor to complete an assessment of their performance, health or knowledge of the English language, the time needed to complete the assessment, and/or
    4. the amount of time the parties will reasonably need to prepare for a review of whether the doctor continues to pose a current and ongoing risk to public protection requiring restrictive action in response or is safe to return to unrestricted practice.
  2. Once the MPT has applied the bandings to reach a provisional view on what sanction is appropriate, before finalising their decision they must consider if there is any additional evidence that may be relevant to deciding what sanction is proportionate. They should also remind themselves of their decision on how the case engaged one or more of the three parts of public protection with reference to their decision on impairment and the general guidance and specific case types section in the Introduction.

  3. Where the type of case is not covered by the sanctions bandings, the MPT should apply the general guidance on Outcomes available to the MPT at the sanction stage.

Additional evidence that may be relevant to the decision on what sanction is proportionate

  1. The following matters are not relevant to the assessment of current and ongoing risk to public protection which will have informed the medical practitioners tribunals (MPT’s) decision on impairment, but can be considered at this stage when deciding what sanction is proportionate:
    1. evidence about the impact that taking a specific type of action may have on patients or members of the public, or the doctor themselves, and/or
    2. references and testimonials about the doctor’s character.
  2. Where the MPT considers it is appropriate to take such evidence into account, they must explain the weight given to it and the impact this has had on their decision on sanction. This will include justifying any departure from a sanctions banding, if one is available for the specific case type.

Evidence about the impact of a specific type of action

  1. The following should inform the MPT’s consideration of whether evidence about the impact of a specific type of action is relevant to the decision on what sanction to impose:
    1. the extent to which the information provided can be corroborated or verified, and
    2. what is known about the doctor’s future career plans and prospects.
  2. Evidence about the impact a specific type of action will have on patients and members of the public will usually only be relevant where it is likely the doctor will stay working in their area of specialty or the same geographical area.

  3. Where the MPT concludes that the impact a specific type of action will have is relevant to their decision on sanction, the weight to be given to it is a matter for their judgment, having regard to their earlier assessment of the current and ongoing risk to public protection posed by the doctor. But in most cases, particularly those where the allegation fell at the higher end of the spectrum of seriousness, this type of evidence may have limited, if any, impact because it will be outweighed by the need to protect the public.

References and testimonials

  1. References and testimonials may support the doctor and/or provide a view on their character. The following should inform the MPT’s consideration of whether any references or testimonials are relevant to the decision on what sanction to impose:
    1. whether the reference or testimonial is relevant to the specific findings about the doctor’s fitness to practise – to be relevant, the person providing the reference or testimonial needs to be fully aware of the circumstances of the allegation(s)
    2. the extent to which the views expressed in the reference or testimonial are supported by other available evidence
    3. how long the author has known the doctor and the relationship between them
    4. how recently the author has had experience of the doctor’s behaviour or performance at work, and
    5. whether there is any evidence that the author has a conflict of interest in providing the reference or testimonial.
  2. Whilst greater emphasis can usually be placed on testimonials that have been verified,17 the question of how much weight to be given to evidence provided in references and testimonials is a matter for the MPT’s judgment, having regard to their earlier assessment of the level of current and ongoing risk to public protection posed by the doctor. But in most cases, particularly in those where the allegation fell at the higher end of the spectrum of seriousness and the level of current and ongoing risk to public protection remained high, this type of evidence may have limited, if any, impact because the need to protect the public will outweigh any relevant evidence about the doctor’s character.

  3. An adverse inference should not be drawn in cases where references and testimonials are not presented by the doctor. This is because there may be a range of reasons why they are not available, including, but not limited to:
    1. a variation in the quantity, quality and spread of references and testimonials between cases does not necessarily relate to the doctor’s character
    2. there may be cultural reasons for not requesting references and testimonials – for example some doctors may be less likely to discuss the fact they are under investigation with colleagues because of the significant reputational consequences for their family and networks in their communities, and/or
    3. those who qualified outside of the UK and have just started working in the UK may find it more difficult to obtain them, as may individuals who have recently changed employer or are working on a locum basis.

The MPT’s determination on sanction

  1. The medical practitioners tribunals (MPT’s) determination should show that the MPT has considered their earlier conclusions at the facts and impairment stages and had regard to the level of current and ongoing risk posed by the doctor (low, medium, or high) with reference to the parts of public protection that are engaged; patient safety, public confidence and/or maintenance of professional standards.

  2. The MPT should give reasons as to why the selected sanction is sufficient to protect the public, and why a more restrictive sanction is not necessary. The decision should include a separate explanation as to the length of sanction and why it should last for a particular period, if relevant.

  3. Where the MPT’s decision is to impose a sanction that is lower, or higher, than that suggested by this guidance and any relevant sanctions bandings, the MPT should provide reasons as to why this is justified given the individual circumstances of the case. They must also explain how their decision relates to any submissions made by the parties.

  4. Any decision not to direct a review of a sanction of conditions or suspension should also be clearly recorded and explained.

Immediate and interim orders following sanction

  1. A sanction imposed by an medical practitioners tribunal (MPT) only takes effect at the end of the 28-day appeal period. Therefore, where the MPT imposes a sanction, it must consider if an immediate order is needed and/or if any action is required in respect of any existing interim order that may be in place.

Immediate orders

  1. The MPT may impose an immediate order where it is necessary to protect members of the public, or is otherwise in the public interest, or is in the best interests of the doctor.18 Where the MPT has imposed a sanction of conditions, it may impose an immediate order of conditions. Where the MPT has imposed a sanction of suspension or erasure, it may impose an immediate order of suspension.

  2. In the context of an immediate order, the best interests of the doctor includes avoiding putting them in a position where they may come under pressure from patients and/or may repeat the behaviour or poor performance giving rise to the allegation, particularly where this may also put the doctor at risk of committing a criminal offence. It may also include where the doctor’s ability to practise safely and effectively may be impacted by an ongoing health condition.

  3. When deciding if an immediate order is needed, the MPT should balance these considerations against the other interests of the doctor, which may be to return to work pending the outcome of any appeal, and against the wider public interest which may require an immediate order is put in place.

  4. Representations are sometimes made by the doctor that no immediate order should be imposed by the MPT on the basis the doctor needs time to make alternative arrangements for the care of their patients before a sanction of suspension or erasure takes effect. Whilst the issue of how much weight to attach to representations made by the parties is a matter for the MPT, this argument is unlikely to be persuasive. This is because the doctor will have been aware of the date of the hearing for some time, and consequently of the risk of a sanction being imposed. The doctor will therefore have already had reasonable time to plan for the care of patients before the hearing, should the need arise. Additionally, the GMC also notifies the doctor’s employers or, in the case of general practitioners, the relevant body, of the date of the hearing. They themselves have a duty to make sure that appropriate arrangements are in place for the care of the doctor’s patients should an immediate order be imposed.

  5. The decision whether to impose an immediate order is at the discretion of the MPT based on the facts of the case. When deciding if an immediate order is needed the MPT should consider the seriousness of the proved allegation and the level of current and ongoing risk to public protection posed by the doctor.

  6. It will not usually be appropriate for a doctor to hold unrestricted registration until a sanction takes effect in cases where:
    1. the doctor poses a risk to patient safety
    2. the risk to one or more parts of public protection is high, and/or
    3. immediate action is needed to maintain public confidence in the medical profession.
  7. The MPT must give reasons for their decision on whether to impose an immediate order, with reference to any submissions made by the parties. The MPT should also refer to its decision on sanction and the reasons for it and ensure that any decision reached on whether to impose an immediate order is consistent.

  8. Where the doctor is present and/or represented at the hearing, any immediate order imposed on their registration will take effect immediately. Where the doctor is not present or represented, the immediate order takes effect once notification of the order is served.

Interim orders

  1. Interim orders are used to manage risk while a concern or allegation about a doctor’s behaviour, performance or the impact of a health condition goes through the fitness to practise process.

  2. Where an interim order is in place at the time that a sanction is imposed at the conclusion of the fitness to practise process, this should usually be revoked and any immediate risk to one or more parts of public protection should be managed through an immediate order. The exception is where the interim order relates to other concerns or allegations in the fitness to practise process that have not yet been determined.

7 Section 1(1) of the Medical Act 1983 describes this as the overarching objective of the GMC and MPTS.

8 Except in cases relating solely to a doctor’s health and/or knowledge of the English language.

9 Undertakings can also be agreed by the doctor and GMC case examiners before a matter is referred to a hearing.

10 Provided for by Schedule 4 paragraph 1(2C) of the Medical Act 1983 (as amended). 

11 The MPT should consider the guidance Undertakings at medical practitioner tribunal hearing and undertakings should normally follow the wording in Agreeing a doctor’s undertakings. 

12 Section 35D(2)(c) of the Medical Act 1983 (as amended).

13 Usually nine months for performance assessments and three months for health and English language assessments.

14 Under section 38 of the Medical Act 1983 (as amended).

15 Section 35D(2)(b) of the Medical Act 1983 (as amended).

16 The sanction of Erasure is not available where the only grounds for impairment are adverse physical or mental health and/ or not having the necessary knowledge of English; Erasure is available when there is one or more additional grounds for impairment found.

17 The GMC will confirm whether testimonials have been verified. This involves checking they are authentic, and the authors are aware of the circumstances of the allegation(s) about the doctor’s fitness to practise. Verification may have been completed by the GMC or the doctor’s legal representative.

18 Section 38 of the Medical Act 1983 (as amended).