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  6. Case type 1 sexual misconduct
Guidance introduction

Case type 1: sexual misconduct

  1. Sexual misconduct may take the form of uninvited or unwelcome behaviour of a sexual nature – or which can be reasonably interpreted as sexual – that offends, embarrasses, harms, humiliates or intimidates an individual. It encompasses elements of harassment and abuse, can be physical, verbal or visual. It can be carried out, and experienced by, anyone regardless of socioeconomic background or protected characteristics.

  2. Sexual misconduct may be sexually motivated, meaning it could be for the PA or AA’s gratification, but won’t always be. Where there is no clinical justification for touching a patient or member of the public (which includes a colleague) in a sexual way, or a way that could be perceived as sexual, then it will usually be appropriate to find sexual motivation. 

  3. Behaviour amounting to sexual misconduct can arise inside or outside a PA or AA’s working life. When sexual misconduct arises in a PA or AA’s working life, their behaviour may be directed towards patients, former patients, relatives of patients, or colleagues.3 

  4. Consensual and reciprocated4 sexual attraction and relationships between colleagues are not sexual misconduct. However, it is important that professional boundaries are maintained, and the undertaking, and/or end, of the relationship has no adverse impact on clinical practice or work environments.

  5. A relationship, or pursuit of a relationship, between colleagues may be inappropriate where there is an imbalance of power,5 or where training and career progression opportunities could be affected, and that is misused. The pursuit of a relationship with a colleague could also amount to sexual misconduct where the pursuit continues in the absence of clear reciprocation, even where there is no imbalance of power.

  6. Outside of a PA or AA’s working life, sexual misconduct may be directed at any member of the public, including the PA or AA’s partner or a family member. 

The professional standards PA or AAs are expected to meet

  1. PA and AAs work in close contact with others, including patients, relatives of patients and colleagues. In doing so, they must treat patients as individuals and recognise and respect their dignity and right to privacy,6 and treat colleagues with kindness, courtesy and respect.7 They must be aware of how their behaviour may influence others.8 

  2. Most individuals interacting with health services are likely to feel vulnerable to some extent and PA and AAs should not act in a way that exploits patients’ vulnerability or lack of medical knowledge. Some patients are at increased risk of harm due to having a specific vulnerability or because of their individual circumstances and it is important that a person’s full personal circumstances are considered in forming a picture of capacity or vulnerability. A person may have impaired capacity or be vulnerable for other reasons because of certain characteristics or a power imbalance.

  3. It is essential that PA and AAs make sure their conduct justifies their patients’ trust in them and the public’s trust in the profession,9 including by following the law.10 They should protect people who are at risk of harm and must consider the needs and welfare of adults, children and young people who may be vulnerable and offer them help if they think their rights are being abused or denied.11 

  4. PA and AAs must not act in a sexual way towards patients or use their professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them.12 Appropriate personal and professional boundaries are essential between PA and AAs and their patients, and between PA and AAs and their colleagues.13

  5. PA and AAs must not abuse, discriminate against, bully or harass anyone.14 They must not act in a sexual way towards patients or colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress.15 Acting ‘in a sexual way’ can include, but isn’t limited to, verbal or written comments, displaying or sharing images, as well as unwelcome physical contact. 

  6. If a PA or AA is told by a patient about a breach of sexual boundaries, or the PA or AA has other reasons to believe a colleague has, or may have, displayed sexual behaviour towards a patient, they must report those concerns to a person or organisation able to investigate them.16 If a colleague tells a PA or AA about, or a PA or AA becomes aware of inappropriate sexual behaviours within the workplace, they have a responsibility to take some action.17 

  7. All forms of sexual misconduct in medicine, including all forms of sexual harassment, are always unacceptable and can be criminal in nature.18 If a PA or AA suspects a colleague or patient has committed rape, sexual assault or other criminal activity they must report this in line with their workplace policy, or to a person who is in the position to act. If a PA or AA is in a formal leadership or management role they must make sure it is reported to the police and to any relevant regulatory body.19 

Seriousness

  1. Whilst a range of behaviour can be seen, the nature of the departure from the professional standards usually means these concerns or allegations fall at the higher end of the spectrum of seriousness. Even a single incident of sexual misconduct can have a significant harmful impact and pose a high level of risk to public protection.

Impact on public protection

In cases of sexual misconduct, the different parts of public protection might be engaged as follows:

Protecting, promoting and maintaining the health, safety and well-being of the public (patient safety)

Sexual misconduct can cause serious harm to the physical, emotional and/or psychological wellbeing of a patient or member of the public, including colleagues. This impact can be long lasting and may affect how a person accesses health services in the future. 

Where sexual misconduct is directed towards colleagues in addition to the harm it causes the individual(s) concerned, it may impact on patient safety as it can cause breakdowns in communication and/or in the collaborative working needed to deliver safe patient care. 

The nature of the behaviour means it often gives rise to a risk of repetition of similar behaviour towards the individual(s) concerned, and of the behaviour being directed at patients and other members of the public. 

Promoting and maintaining public confidence in the profession (public confidence) 

Patients must have confidence in PA or AAs to behave professionally towards them, especially during consultations and where a PA or AA needs to carry out an intimate examination. Sexual misconduct arising inside a PA or AA’s professional practice will result in a breakdown of trust and undermine public confidence. 

Sexual misconduct arising outside a PA or AA’s professional practice can undermine public confidence. This is particularly the case where sexual misconduct results in a criminal conviction and/or where a PA or AA has been required to register as a sex offender.  

The public having confidence in the profession is more important than the interests of an individual PA or AA. 

Promoting and maintaining professional standards and conduct (uphold professional standards) 

Sexual misconduct towards any individual will undermine the PA or AA’s integrity and amount to a significant breach of professional standards.

Decision on interim measure

  1. Where the concern or allegation relates to sexual misconduct towards patients or colleagues, or the PA or AA is under police investigation for a sexual criminal offence, the interim measure tribunal (IMT) should carefully consider the public interest, and the impact on public confidence if the PA or AA were to continue working unrestricted pending resolution of the fitness to practise process.

  2. More detail about when an interim measure is likely to be appropriate in a sexual misconduct case can be found in the specific case types section in Section 2: IMT hearings. 

Decision on impairment

  1. Most allegations relating to sexual misconduct have a starting point of a high level of seriousness and therefore fall at the higher end of the spectrum of seriousness. This means the starting point for assessing current and ongoing risk to public protection will usually be high.

  2. Where this is the case, evidence of relevant context known about the PA or AA and/or their working environment and evidence of insight and remediation that decrease risk will usually have less impact because sexual misconduct allegations falling at the higher end of the spectrum of seriousness can be more difficult to remediate. 

  3. In such cases the associates tribunals (AT’s) decision on risk should reflect this and a conclusion that the PA or AA poses a current and ongoing risk to public protection may be needed even in cases where the PA or AA has shown insight and taken steps to try and remediate. Where the AT concludes that the PA or AA poses a current and ongoing risk, this will result in them finding that the PA or AA’s fitness to practise is impaired. 

  4. The level of risk associated with a sexual misconduct allegation will generally be medium or high.

  5. Where a sexual misconduct allegation leads to a finding of impairment, it may engage one or more of the three parts of public protection. Whilst the AT must consider the individual circumstances of the case, it will be unusual for a proven allegation of sexual misconduct not to undermine public confidence in the profession.

Decision on whether a warning is required

  1. On the rare and exceptional occasion where the specific type of behaviour amounting to sexual misconduct is found to have just fallen short of a finding that the PA or AA’s fitness to practise is impaired, and there are no other proven allegations that require restrictive action to be taken, a warning will usually be appropriate to maintain public confidence in the profession and uphold professional standards.

Decision on final measure

  1. The proportionate final measure in response to an allegation of sexual misconduct will depend on the extent of the PA or AA’s behaviour and the impact it’s assessed to have on each of the three parts of public protection. 

  2. Because the level of current and ongoing risk to public protection will generally be medium or high, this will require consideration of suspension or removal. In cases where sexual misconduct is found to be sexually motivated, the inherent seriousness is likely to be high and make any outcome short of removal inappropriate. 

  3. When deciding on final measure, the AT should have regard to the final measures banding for sexual misconduct cases in Part C of Section 3: AT hearings.
Lower level of risk to public protection Medium level of risk to public protection Higher level of risk to public protection
Suspension up to 6 months Suspension 6 to 12 months Suspension 12 months to Removal
  1. In sexual misconduct cases, evidence about the impact of a specific type of final measure and references and testimonials will have limited, if any, relevance to the AT’s decision about what final measure is appropriate. 

  2. For sexual misconduct cases involving a criminal conviction or caution, or where the PA or AA is registered as a sex offender, the AT should also refer to the specific case type section Criminal convictions, cautions, court sanctions and determinations. Where there is more than one type of proven allegation, the AT should impose the final measure that addresses the most serious findings.

3 Colleagues include anyone a PA or AA works with, whether or not they are medical professionals.

4 Reciprocated means to share the same feelings as someone else, or to behave in the same way as someone else.

5 A power imbalance is a common feature in sexual misconduct. Higher risk factors for consensual relationships between colleagues might include situations with large differences in power levels, for example hierarchically across, and within, specialities and grades. There is also a specific power imbalance between PA or AAs and students in higher education that can place additional pressure on the student not to challenge unwanted sexual behaviours and actions. It can be incredibly difficult to challenge the PA or AA that they are reliant upon to provide learning opportunities and recommendations.

6 Good medical practice, paragraph 16.

7 Good medical practice, paragraph 48.

8 Good medical practice, paragraph 53.

9 Good medical practice, paragraph 81.

10 Good medical practice, paragraph 4.

11 Good medical practice, paragraph 41.

12 Good medical practice, paragraph 86. The detailed guidance Maintaining personal and professional boundaries explains how PA or AAs can put this principle into practice.

13 Maintaining personal and professional boundaries, paragraph 3.

14 Good medical practice, paragraph 56.

15 Good medical practice, paragraphs 57 and 86.

16 Maintaining personal and professional boundaries, paragraph 25.

17 Examples of action can be found in Maintaining personal and professional boundaries, paragraph 36.

18 Maintaining personal and professional boundaries, paragraph 20.

19 Maintaining personal and professional boundaries, paragraph 21.