Adjournments

56. When considering an application to adjourn an interim order tribunal (IOT) hearing, the IOT should consider the circumstances in the individual case, the submissions made by both parties and the following non-exhaustive list of factors:
• whether the hearing can fairly proceed, including the effect any delay may have on the fairness of the proceedings and on fairness to all parties


• the need for urgency, including the potential risk to members of the public, the public interest and/or to the doctor’s interests, and whether the benefit of granting the application outweighs the effect of a delay on both the responding party and the public interest in hearings proceeding as soon as is fairly possible


• the remit of the interim order tribunal (IOT) being to assess the risk of the doctor remaining in unrestricted practice, and not to make findings of fact – this factor will be particularly relevant where a request is based on the need to prepare or to obtain further evidence or await the outcome of other proceedings, where the reasonableness of such a request will also be an important factor


• the ability of the interim order tribunal (IOT) to undertake an early review hearing where new information becomes available after the scheduled IOT hearing


• where a request is based on a representative’s availability, the complexity of the case and the nature and extent of that representative’s prior involvement


• where a request is based on a participant’s health, whether independent medical evidence has been provided confirming any relevant medical condition and why that condition prevents participation in the hearing


• in review hearings, whether granting the application would prevent review of the interim order in compliance with statutory requirements, and


• any other relevant considerations.

57. When considering an application to adjourn an medical practitioners tribunal (MPT) hearing, the MPT should consider the circumstances of the individual case, the submissions made by both parties and the following non-exhaustive list of factors:
• whether the hearing can fairly proceed, including the effect any delay may have on the fairness of the proceedings and on fairness to all parties


• the impact and relevance of other ongoing legal proceedings, including criminal proceedings or Coroner’s inquests


• whether the benefit of granting the application outweighs the effect of delay on the responding party, any witnesses and the public interest in hearings proceeding as soon as is fairly possible


• where a request is based on the need to prepare or to obtain further evidence, the reasonableness of such a request, taking account of the reasons provided, the length of time since the relevant event(s) and the time already afforded to parties to prepare


• where a request is based on a representative’s availability, the complexity of the case and the nature and extent of that representative’s prior involvement


• where a request is based on a participant’s health, whether independent medical evidence has been provided confirming any relevant medical condition and why that condition prevents participation in the hearing


• whether the doctor is subject to an interim order


• in review hearings, the expiry date of the doctor’s existing sanction and whether granting the application would prevent review of the sanction before expiry, and


• any other relevant considerations.

58. In all cases, where there is unlikely to be a change in position later if the application for an adjournment is granted, this will weigh towards refusal.
    
    
59. The tribunal may decide on its own to adjourn a hearing once it has started. This may be necessary where the hearing will not be able to be concluded within the period listed and additional time is needed for the tribunal to reconvene and complete matters.
    
    
60. In medical practitioners tribunal (MPT) hearings, an adjournment may be required to allow for an assessment to be completed or for the parties to obtain further information or reports.

61. Where the outcome of an assessment is likely to be relevant to the fitness to practise process, the GMC will usually have directed an assessment, where appropriate, during the investigation stage. In the same way, the GMC will usually have sought information and reports which will enable the medical practitioners tribunal (MPT) to reach a full and fair decision.
    
    
62. However, in a small number of cases, issues relevant to the doctor’s performance, health and/or knowledge of English language arise for the first time during a hearing or further relevant information comes to light. When this happens, the medical practitioners tribunal may wish to consider whether to adjourn the hearing to allow an assessment to be undertaken, or for further information or reports to be provided.

63. The medical practitioners tribunal (MPT) should invite submissions from the parties in relation to whether adjourning a hearing to direct an assessment is appropriate. Submissions will assist the MPT in identifying:
• whether directing an assessment is proportionate
• the likelihood of the doctor complying, and 
• any additional actions that may need to be completed by the parties following the assessment and prior to the case reconvening. 

64. The decision whether to adjourn to direct an assessment is one for the medical practitioners tribunal (MPT) exercising its judgment. Having considered submissions, the MPT should set out its decision and reasons in a written determination.
    
    
65. The medical practitioners tribunal (MPT) should consider the following factors when deciding whether an assessment is required:
• the stage the hearing has reached
• the nature of the alleged impairment
• the nature of the assessment, and 
• the likelihood of the doctor complying with the assessment.

The stage the hearing has reached

66. The stage the hearing has reached is relevant to the medical practitioners tribunals (MPT’s) consideration of whether adjourning for an assessment is a proportionate response to issues that exist, or have arisen, in relation to the doctor’s performance, health and/or knowledge of English language.
    
    
67. If new allegations of impairment arise because of an assessment, the GMC will be required to particularise these allegations and formally disclose them to the doctor. If new allegations of impairment are referred to the MPTS for a hearing, the GMC may apply to join them to the ongoing allegations of impairment. The MPT will only be able to consider any new allegations if they are properly referred and joined.
    
    
68. If the medical practitioners tribunal (MPT) directs an assessment prior to deciding the facts and the assessment concerns an allegation of impairment which is already before the MPT to determine, it is possible that, at the reconvened hearing, one or other of the parties will apply for the particulars of allegation to be amended to reflect the outcome of the assessment.
    
    
69. If the assessment raises a new allegation of impairment which is not already before the medical practitioners tribunal (MPT) to decide, the GMC may make an application to join the new allegation and, if successful, the MPT may be asked to make findings of fact in relation to that new allegation as well, before considering impairment in relation to all the allegations where the facts have been found proven.
    
    
70. If the medical practitioners tribunal (MPT) directs an assessment following its finding of facts, and prior to deciding on impairment, it should be mindful that the facts stage is complete and cannot be re-opened. The MPT should consider the assessment(s) along with the other evidence presented at the impairment stage, when considering impairment in the category to which the facts found proven relate. Guidance on the facts and impairment stages of an MPT hearing can be found in Section 3: MPT hearings.

Nature of the alleged impairment

71. In practice, this factor means that the medical practitioners tribunal (MPT) should provide reasons for their direction in the context of the hearing and the nature of the allegation brought by the GMC.
    
    
72. MPTs should not direct an assessment without proper reason or justification. For example, if the allegation brought by the GMC relates to clinical misconduct, and there is no indication that there has been a pattern of poor care, the MPT should not direct a performance assessment to see whether the misconduct could amount to a deficient professional performance allegation.
    
    
73. The MPT should exercise caution when considering adjourning to direct an assessment that does not relate to the grounds of impairment under consideration. The MPT must be clear on the purpose of directing an assessment and how it will enable the tribunal to fulfil its regulatory function in a fair and proportionate way.
    
    
74. For example, if the allegation brought by the GMC relates to misconduct, the MPT should only direct an assessment of a doctor’s health or knowledge of English language where it is capable of helping them determine an issue in the case or is needed to inform the tribunal’s approach to ensuring the doctor has a fair hearing, such as by making adjustments. 

Nature of the assessment

Performance assessments

75. Deficient professional performance describes a standard of professional performance which is unacceptably low and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of the doctor's work. It is unacceptably low if there is evidence that it departs from the professional standards applicable to the level and specialty in which the doctor works.
    
    
76. A performance assessment is a mechanism for obtaining objective evidence of a doctor’s professional performance and may include tests of competence and/or other methods of assessment, as considered appropriate to the case.
    
    
77. In deciding whether it is appropriate to adjourn for a performance assessment to be carried out, the medical practitioners tribunal (MPT) will need to consider information about the doctor’s current working position or recent posts, the areas of concern, the grade of the doctor, whether the doctor is still working in the same specialty to which the allegation relates, and whether the doctor is currently in the UK or not.
    
    
78. The medical practitioners tribunal (MPT) should always consider whether there are any reasons that a performance assessment is not appropriate or necessary. These reasons may include, but are not limited to where:
• the doctor has already completed a GMC performance assessment and there is no reason to believe that the doctor’s performance has changed
• the clinical allegation reflects a single action or omission, or a number of actions or omissions, which do not amount to a pattern of poor or unacceptably low standards of professional performance
• the doctor has provided evidence of appropriate and effective remediation, and/or
• the doctor is a trainee doctor in Foundation Year 1 (FY1) who is provisionally registered. 

79. The MPT may also find it helpful to refer to the GMC’s guidance on Deciding how to approach evidence collection (Doctors). However, they should be mindful that this relates to directions at an investigation stage, and not all factors will be applicable to the tribunal’s consideration.

Health assessments

80. The impact of a doctor’s health condition which impacts on their ability to practise safely and effectively and raises a possibility of impairment can be assessed through a GMC health assessment. The assessment involves the doctor attending appointments with two health examiners appointed by the GMC. It may also be necessary for the doctor to undertake some form of medical testing, for example hair or blood analysis.
• It is possible that a concern about the impact of a health condition may arise at a hearing for the first time. For example:
• evidence emerges which indicates a health condition may impact on the doctor’s fitness to practise, for example, dependence on substances
• the doctor behaves in a manner that causes the medical practitioners tribunal to become concerned about the doctor’s health
• evidence emerges which calls into question the doctor’s ability to engage effectively with the proceedings, and/or
• the doctor presents evidence about personal context in relation to their health at the time of the events giving rise to the allegation and it is necessary to corroborate the evidence. 

82. Annex D contains information about the types of behaviour that may suggest that an individual is unwell. In addition, a perceived deterioration in, or lack of knowledge of, English language may be symptomatic of an undiagnosed health condition or the deterioration of a diagnosed health condition. Health concerns which may impact on a doctor’s communication skills include neurodegenerative disorders and acquired brain injuries from either a traumatic or non-traumatic event.
    
    
83. If information comes to the attention of the medical practitioners tribunal (MPT) that suggests a doctor might be unwell, the tribunal should consider the context in which the information has arisen, and whether it impacts on their ability to proceed to determine the issues in the case, before deciding that a health assessment is needed. For example, in a misconduct case, a doctor may put forward the impact of a specific health condition as an explanation for their behaviour. An adjournment in these circumstances would only be appropriate where the MPT considers the nature of the health condition can have a direct impact on their ability to determine the issues in the case.
    
    
84. The medical practitioners tribunal (MPT) should also be mindful of the need to ask appropriate questions of the doctor or, where appropriate, ask the parties to obtain relevant information from any healthcare practitioners treating the doctor, and place this before them to aid their consideration of whether it is necessary to direct a health assessment, or whether it would be possible to make any adjustments to support the doctor’s continued engagement in the proceedings. Adjustments might include increased breaks or shorter sitting days.
    
    
85. When deciding whether it is necessary to direct a health assessment, the medical practitioners tribunal (MPT) should remember that whilst certain behaviour can be related to the impact of a health condition, it can also be capable of arising generally in stressful and/or upsetting situations. In each case, the MPT will need to weigh up all the available evidence, including whether the behaviour, or combinations of behaviour, being exhibited by the doctor create a cause for concern about their health.
    
    
86. The presence of one or more of the factors below may suggest that a health assessment is required:
• a concern about the doctor’s health arises for the first time during the hearing and there is no existing objective evidence available about their health and how it might impact on the matters under consideration and/or their current fitness to practise and/or ability to participate effectively in the hearing
• the type and severity of the health condition reported is likely to affect the doctor’s fitness to practise either now or in the future, for example it has high rate of relapse or is likely to pose a risk to patients, or result in a lack of insight or cooperation on the part of the doctor
• the doctor is currently compulsorily detained under the Mental Health Act 1983 or has recently been detained and is now receiving treatment
• there are existing allegations about the doctor’s behaviour or performance which seem likely to be related to the impact of the doctor’s health condition, such as where it has led to their involvement in dishonest or criminal activity
• objective medical opinion raises concern about the doctor’s level of insight or compliance because of a health condition
• the doctor lacks insight into their health condition and / or has failed to seek appropriate treatment, and/or
• the doctor has failed to follow the advice of treating healthcare practitioners and/or occupational health departments or has ceased to engage with support. 

87. The presence of one or more of the factors below may suggest that a health assessment is not required:
• the doctor has already completed a GMC health assessment and there is no reason to believe that the impact of the doctor’s health condition has changed
• the type and severity of the health condition reported is unlikely to affect the doctor’s fitness to practise or pose a risk to patients either now or in the future
• there is no evidence to suggest that the doctor’s health condition is having, or is likely to have, an impact on their ability to participate effectively in the hearing
• there is no evidence that the doctor’s health condition has had a significant impact on their behaviour or performance to date, and/or
• there is evidence that the doctor has insight into their condition and is seeking or receiving appropriate treatment or support. 

88. The medical practitioners tribunal (MPT) may find it helpful to refer to the GMC’s guidance on Deciding how to approach evidence collection (Doctors). In doing so they should be mindful that this relates to directions at the investigation stage, and not all factors will be applicable to the tribunal’s consideration.
    
    
89. Before adjourning to direct a health assessment, the medical practitioners tribunal (MPT) should consider the purpose of the assessment and ask itself whether it would be more proportionate, and less likely to result in significant delay, to seek relevant information another way. For example, through permitting a short adjournment and issuing case management directions requiring further information or reports to be obtained from the doctor’s treating healthcare practitioners or others already involved in the doctor’s care. This will be particularly relevant in cases where any concerns or issues that have arisen during the hearing are not directly related to the ground of impairment under consideration by the MPT and/or where it appears to the tribunal that the doctor may reasonably have been able to obtain relevant evidence in advance of the hearing.
    
    
90. For example, if the allegation brought by the GMC relates to misconduct and information is needed about a doctor’s health to inform the medical practitioners tribunal’s approach to ensuring the doctor has a fair hearing, such as by making adjustments , it may be more proportionate for the tribunal to seek relevant information by making a direction for further information or reports.
    
    
91. When directing a health assessment, the medical practitioners tribunal may wish to consider whether they have any questions about the doctor’s health condition that it would assist them, when reconvening, for the health assessors to have addressed to inform the tribunal’s consideration of any issues still to be determined, such as facts or impairment, and/or the doctor’s ability to participate effectively in the hearing. Where appropriate, any such questions may be informed by hearing representations from the parties.

Knowledge of English language

92. A doctor’s fitness to practise may be found to be impaired because they do not have the necessary knowledge of English to practise medicine safely and effectively. A language assessment is a mechanism for obtaining objective evidence of a doctor’s knowledge of English language. It assesses a doctor’s ability in listening, reading, writing and speaking.
    
    
93. There may be situations where concerns about a doctor’s knowledge of English arise during a hearing. Matters which may give cause for concern about a doctor’s knowledge of English include:
• the doctor requesting or using an interpreter during a hearing
• a self-declaration by a doctor that suggests their knowledge of English may be limited, or
• where there is another good reason to believe the doctor has difficulty in communicating with, or understanding, others. 

94. The medical practitioners tribunal (MPT) should consider the context in which the concerns about the doctor’s knowledge of English have arisen, and whether they impact on the tribunal’s ability to proceed to determine the issues in the case, before deciding that an English language assessment is needed. For example, in a misconduct case a doctor may put forward communication issues as an explanation for their behaviour. An adjournment in these circumstances would only be appropriate where the MPT considers the nature of the communication concern can have a direct impact on their ability to determine the issues in the case or on the doctor’s ability to participate effectively in the proceedings.
    
    
95. The medical practitioners tribunal should be mindful of the need to ask appropriate questions of the doctor or, where appropriate, to issue case management directions to require the parties to obtain relevant information to aid their consideration of whether an English language assessment is necessary. They should also consider inviting comments from parties on whether it would be possible to make any adjustments, for example by using an interpreter, to support the doctor’s continued engagement in the proceedings.
    
    
96. When assessing information which relates to concerns about a doctor’s knowledge of English, the medical practitioners tribunal should consider whether there is any evidence to suggest the doctor has an underlying health condition. A perceived deterioration in, or apparent lack of knowledge of, English language may be symptomatic of an undiagnosed health condition or the deterioration of a diagnosed health condition. Health conditions which may impact on a doctor’s communication skills include neurodegenerative disorders and acquired brain injuries from either a traumatic or non-traumatic event.
    
    
97. Where the medical practitioners tribunal has good reason, based on specific evidence, to indicate that a health condition may be having an impact on the doctor’s ability to demonstrate their knowledge of English it should consider whether a health assessment may be appropriate. But before directing a health assessment, the tribunal should consider the guidance above.
    
    
98. If a health assessment is directed, the examiners can be asked to comment on whether any health condition is likely to impact on the doctor’s communication skills. In such cases, careful thought should be given to delaying a decision on whether it is necessary to direct a language assessment until further information is available about the doctor’s health.
    
    
99. It may be appropriate for the medical practitioners tribunal to consider directing a further English language assessment where a doctor has completed an English language assessment, has not met the GMC’s requirements, and at the hearing seeks to rely on alternative evidence about their knowledge of English relating to the period since they took the assessment. A further English language assessment may assist the tribunal when considering the issue of current impairment.
    
    
100. The medical practitioners tribunal may also find it helpful to refer to the GMC’s guidance on Deciding how to approach evidence collection (Doctors). In doing so they should be mindful that this relates to directions at the investigation stage, and not all factors will be applicable to the tribunal’s consideration.

The likelihood of the doctor complying with the assessment

101. If the medical practitioners tribunal (MPT) identifies issues, or receives submissions from the parties, in relation to concerns about the likelihood of a doctor complying with an assessment, it may be necessary to consider how to ensure that compliance is achieved. This can be done through issuing detailed directions, as well as identifying an earlier date for the MPT to reconvene (see below) to enable the tribunal to consider acting in the event of non-compliance.

102. The nature of the further information or reports required by the medical practitioners tribunal (MPT) may vary, and as such, so will the timescales for obtaining them. However, tribunals should apply the same principles in relation to assessments above, and consider: 
1. the stage the hearing has reached 
2. the nature of the alleged impairment 
3. the nature of the further information or reports to be sought, and 
4. the likelihood of the doctor complying with the direction for further information or reports. 

103. Where the medical practitioners tribunal receives information about an existing health condition or receives new information during the hearing that suggests a doctor might be unwell, they should be mindful of the need to ask appropriate questions of the doctor or, where appropriate, to issue case management directions to require the parties to obtain relevant information, for example from treating healthcare practitioners or others already involved in the doctor’s care, to aid their consideration of whether to adjourn for further information or reports. 
     
     
104. When adjourning for further information the medical practitioners tribunal may want to provide the parties with case management directions to provide such further information as it would assist the tribunal to see when the hearing reconvenes. If adjourning for reports, the MPT may wish to consider whether there are any specific questions that it would assist for the reports to address. These considerations will be particularly relevant when adjourning for further information or reports about a doctor’s health. Where appropriate, any such questions may be informed by hearing representations from the parties. 
     
     
105. When deciding whether an adjournment is necessary to obtain further information or reports about a doctor’s health condition, the medical practitioners tribunal (MPT) should remember that, whilst certain behaviours can be related to the impact of a health condition, they can also be capable of arising generally in stressful and/or upsetting situations. In each case, the MPT will need to weigh up all the available evidence, including whether the behaviour, or combinations of behaviour, being exhibited by the doctor create a cause for concern about their health. 
     
     
106. Annex D contains information about the types of behaviour that may suggest an individual is unwell. In addition, a perceived deterioration in, or apparent lack of knowledge of, English language may be symptomatic of an undiagnosed health condition or the deterioration of a diagnosed health condition. Health conditions which may impact on a doctor’s communication skills include neurodegenerative disorders and acquired brain injuries from either a traumatic or non-traumatic event. 

107. The medical practitioners tribunal (MPT) must provide reasons for its decision to direct an assessment, or direct further information or reports be provided, in a formal determination. Within the determination, they should explain the requirement for the assessment or further information or reports, giving clear reasons. When directing an assessment, the tribunal’s determination should also clearly set out the potential consequences of non-compliance.
     
     
108. The MPT may also wish to consider issuing case management directions, with specific timescales, in relation to the assessment, further information or reports. This will make it clear to each party what they must do and will assist the tribunal to determine the issue of compliance at the reconvened hearing.  

109. The medical practitioners tribunal (MPT) must ensure that every effort is made to reconvene as soon as possible to ensure that the matter is dealt with in a timely manner. In considering when to reconvene, the MPT must consider the time reasonably required for the type of assessment to be undertaken and for the parties to consider the implications of the assessment outcome, as well as the availability of those involved in the hearing. Further guidance about relevant considerations when determining dates to reconvene can be found in the guidance on Listing reconvening hearings.
     
     
110. In some cases, the MPT may hear submissions on, or themselves be concerned about, the likelihood of the doctor complying with a direction to undertake an assessment or provide information. In these cases, the MPT should use its discretion in deciding whether to set two dates to reconvene; one date for the substantive hearing and an earlier hearing date so that the tribunal can consider whether the doctor has complied and, if not, take appropriate action.
     
     
111. Where the doctor has complied, the GMC or the doctor may apply to the MPTS Case Management team to vacate the earlier date. Such applications must be made not less than 21 calendar days ahead of the earlier hearing date, to allow sufficient notice for tribunal members to be stood down. 

Nature of the assessment or information sought

Performance assessments

112. The assessment can take from six months in the case of a General Practitioner to 12 months and beyond in the case of a specific specialty. For specialist assessments, the timescales are dependent on the availability of the assessors, often dictated by their clinical commitments.
     
     
113. In addition to the time required for the assessment, the medical practitioners tribunal should consider the time required for the GMC to consider the assessment report when it is received, and for it to be disclosed to, and considered by, the doctor in preparation for the reconvened hearing.

Health assessments

114. Health assessments take between three to four months to complete, and the time can vary based on the doctor’s availability to attend appointments with the GMC health examiners and submit to any testing.
     
     
115. The medical practitioners tribunal (MPT) should also consider the time required for the GMC to consider the assessment reports, and for them to be disclosed to, and considered by, the doctor in preparation for the reconvened hearing.

English language assessments

116. Doctors must be provided with at least 30 days²⁵ in which to complete an assessment and provide their results to the GMC. The GMC will reimburse the doctor for one test conducted in that period. However, there is no limit on the number of tests that a doctor can take at their own expense during that time.
     
     
117. Within the timescales set, the doctor must provide the GMC with a copy of their test results from the assessment. The GMC will verify those results with the assessment provider. This verification process should take no more than one to two days.
     
     
118. Unlike performance and health assessments, significant additional time is not likely to be required by the parties to consider the results of an English language assessment. 

Further information or reports

119. The timescales associated with obtaining further information or reports will vary depending on the circumstances of the case. The medical practitioners tribunal (MPT) should seek to clarify the timescales required by inviting submissions from the parties. 

Days to set down 

120. The medical practitioners tribunal (MPT) should use its discretion when identifying how many days to set down for the reconvened hearing. If the MPT is minded to reconvene at an earlier hearing date to consider compliance, it is advisable to set down one to two days for this to allow sufficient time, should it be necessary.
     
     
121. If the MPT is reconvening to consider the outcome of the assessment and proceed with its consideration of the case, it will need to use its discretion in determining how many days are required. The MPT may be assisted by submissions from the parties and must ensure that the reconvened dates are accepted by the MPTS Case Management team before they are finalised.

Where the MPT adjourned for an assessment

122. When the MPT reconvenes, it will need to identify whether the doctor has complied with the assessment.
     
     
123. If the doctor has complied, the MPT may:
• proceed to consider the substantive case, or 
• refer the allegation to the Registrar for the Case Examiners to consider whether to offer undertakings to the doctor.

124. If the doctor has not complied with the assessment, the MPT must consider whether to make a finding of non-compliance. The MPT should refer to Part B of the Non-compliance guidance for medical practitioners tribunals for details of how to proceed.
     
     
125. Where the doctor’s non-compliance has prevented the MPT from being able to go on to determine the outstanding matters in the substantive hearing, that case will adjourn part heard. Consequently, the doctor’s non-compliance will have frustrated the regulatory process which means it is likely that protection of the public will only be adequately achieved by the MPT directing a non-compliance order of suspension.
     
     
126. Where the MPT imposes a non-compliance order, they should direct a review. This will be considered before a non-compliance review tribunal.
     
     
127. If the doctor later complies with the direction and, on review, a tribunal revokes the non-compliance order, a reconvened hearing will be scheduled so that the previously adjourned substantive hearing can resume and conclude.
     
     
128. Where the MPT makes no finding of non-compliance, it may continue with the substantive hearing, notwithstanding the lack of assessment. When continuing, the tribunal may want to consider whether a further adjournment is appropriate to enable the assessment to be carried out, or alternatively for further information or reports to be obtained.
     
     
129. When considering whether to further adjourn the substantive hearing, the MPT should consider submissions received from the parties. 

Where the MPT adjourned for further information or reports

130. When the MPT reconvenes, it will need to ascertain whether the GMC or doctor has obtained the further information or reports sought.
     
     
131. If the further information or reports have been obtained, the MPT should proceed to consider the case. This can include consideration of whether to adjourn for an assessment or whether another adjournment for further information or reports is necessary and proportionate.
     
     
132. Where the further information or reports relate to the doctor’s health, the MPT should be mindful of the need to ask appropriate questions to assist their consideration of the relevance and impact of the evidence obtained, and to aid in any assessment of whether a further adjournment may be appropriate, such as for a health assessment to be completed.
     
     
133. If the GMC or doctor has not obtained the further information or reports required, the MPT may want to consider:
• whether a further adjournment is appropriate, and
• in cases where a case management direction was made, whether to exercise its powers, including whether to draw an adverse inference in relation to the doctor’s failure to comply. To make this decision, the MPT should refer to the guidance on Failure to comply with Rules and/or case management directions. 

134. Interim orders will typically be considered by an IOT. However, an MPT may also impose or review an interim order.
     
     
135. A doctor may have interim restrictions in place at the point of the substantive hearing. Whilst these may relate to the same allegations that are before the MPT to determine, they may also arise from concerns relating to other grounds of impairment that are still being investigated.
     
     
136. Where the MPT intends to adjourn to direct an assessment or for further information or reports to be obtained and there is no existing interim order in place, the tribunal should consider whether it is necessary to impose an interim order, pending its further consideration of the matter.
     
     
137. Where the MPT intends to adjourn to direct an assessment or for further information or reports to be obtained in a case where the doctor already has interim restrictions, they should consider whether the existing interim order should be maintained, varied or revoked.
     
     
138. When considering an interim order, the MPT should hear submissions from the parties on whether an interim order is necessary or remains necessary. To decide the matter, the MPT should apply the guidance in Section 2: IOT hearings.