Guidance introduction

Case type 8: criminal convictions, cautions, court sanctions and determinations by other health or social care regulatory bodies

A conviction or caution, or court sanction received in the UK or from an equivalent overseas body, can indicate misconduct where it relates to a PA or AA’s behaviour. In certain circumstances, it may indicate an inability to provide care to a sufficient standard. Very rarely, a PA or AA will be convicted of a criminal offence relating to their clinical practice. For example, conducting a clinical procedure without proper consent, or where a PA or AA’s intentional or reckless practice, results in a conviction for assault. Exceptionally, in the case of a patient death, a PA or AA could be convicted of gross negligence manslaughter or culpable homicide.
A conviction may result in a custodial or non-custodial sentence. A custodial sentence is a period of imprisonment and can be immediate or suspended. It is given for the most serious types of criminal offences. A non-custodial sentence includes discharges, fines and community orders.
Discharges are given for the least serious types of offences and do not impose a punishment beyond having a criminal record. Fines are a form of financial penalty given for low-level types of offences, such as some motoring offences. Community orders are given to address the cause of offending in cases that are not serious enough to require a custodial sentence and can be made of different components, such as drugs rehabilitation, attendance on courses and unpaid work.
A conditional or absolute discharge may not be considered as a conviction for the purposes of our fitness to practise processes, but the PA or AA’s underlying behaviour may still amount to a concern.
A bind over is a civil promise to keep the peace. It’s not a criminal conviction in and of itself, although an individual may be bound over by a criminal court on being convicted of an offence. Again, the PA or AA’s behaviour resulting in the bind over may still amount to a concern and need to be considered.
Cautions are a formal warning issued by the police to an individual who admits to committing a criminal offence. They are usually only given in response to low-level, first time, offences – for example low value theft, disorderly conduct, or possession of cannabis – and can only be issued with the acceptance of the offender.
Convictions and cautions can be the result of a wide range of behaviour arising inside or outside a PA or AA’s working life. Minor motoring offences arising in a PA or AA’s private life, such as speeding, traffic light offences, not wearing a seatbelt and talking on a mobile phone will not usually amount to a fitness to practise concern.
A court sanction is a penalty imposed by a judge on a party who has not complied with a relevant court rule, direction or order. It can be imposed because of conduct arising in civil or criminal litigation. Court sanctions include dismissing a civil claim, imposing a fine and imprisonment, for example for contempt of court.
A determination by a health or social care regulatory body can indicate misconduct where it relates to a PA or AA’s behaviour.
A determination by a health or social care regulatory body, may, in certain circumstances, indicate an inability to provide care to a sufficient standard.
A determination can be the result of a wide range of behaviour arising inside or outside a PA or AA’s working life.

The professional standards PA and AAs are expected to meet

Good PA and AAs act with honesty and integrity and ensure their conduct justifies their patients’ trust in them and the public’s trust in their profession.⁸⁶
PA and AAs must tell the GMC without delay if, anywhere in the world: they have been charged with or found guilty of a criminal offence; they have accepted a caution from a prosecuting authority; they have been criticised by an official inquiry, including by a coroner at an inquest; another professional body has made a finding against their registration as a result of fitness to practise procedures.⁸⁷

Seriousness

A wide range of behaviour and/or poor performance can be seen in cases where the PA or AA is the subject of a conviction, caution, court sanction or determination.
A conviction or caution for a minor criminal offence resulting in a discharge or fine will usually fall at the lower end of the spectrum of seriousness.
Very rarely, a PA or AA will be convicted for a criminal offence relating to their clinical practice. For example, conducting a clinical procedure without proper consent, or where a PA or AA’s intentional or reckless practice results in a conviction for assault. Exceptionally, in the case of a patient death, a PA or AA could be convicted of gross negligence manslaughter⁸⁸ or culpable homicide.⁸⁹ Also very rarely, a PA or AA might receive a criminal conviction for encouraging or assisting suicide.
Where this is the case, these matters will usually fall at the higher end of the spectrum of seriousness, along with cases in which the PA or AA received a criminal conviction or other court sanction resulting in a custodial sentence.
In a determination case, where the regulatory body ordered the suspension or erasure / removal of the PA or AA from the relevant register, this will usually fall at the higher end of the spectrum of seriousness.

Impact on public protection

In cases of criminal convictions, cautions, court sanctions and determinations by other health or social care regulatory bodies, 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)

Behaviour or poor performance that has led to a conviction, caution, court sanction or determination may impact on the physical, emotional and/or psychological wellbeing of a patient or member of the public. This impact can be long lasting and may impact on how a person accesses health services in the future.

Where the behaviour resulting in a conviction, caution, court sanction or determination is towards colleagues, in addition to any impact on them, the behaviour may also impact on patient safety by causing breakdowns in communication and/or in the collaborative working needed to deliver safe patient care.

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

Patients and members of the public must have confidence in PA and AAs to behave professionally, act with honesty and integrity and act within the law. A conviction, caution, court sanction or determination resulting from behaviour arising inside a PA or AA’s working life may result in a breakdown of trust and undermine public confidence.

A conviction, caution or court sanction relating to a matter arising outside a PA or AA’s working life can also undermine public confidence. This is particularly the case where it has led to a custodial sentence and / or where a PA or AA has been required to register on the sex offenders register.

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

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

PA and AAs are expected to act in accordance with the law and comply with their professional guidance.

A conviction, caution or determination will usually amount to a significant breach of the professional standards.

Decision on interim measure

Where the concern or allegation relates to criminal behaviour in the workplace or otherwise arising from the PA or AA’s professional practice, or the PA or AA is under police investigation, 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.
Similarly, where the concern or allegation relates to a determination case where the regulatory body ordered the suspension or erasure/removal of the PA or AA from the relevant register, the 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. Depending on the underlying reason for the determination, patient safety may also be a key consideration.
More detail about when an interim measure is likely to be appropriate in these types of cases can be found in the specific case types section in Section 2: IMT hearings.

Decision on impairment

Where the allegation relates to a conviction, caution, court sanction or determination that 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.
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 may have less impact because allegations falling at the higher end of the spectrum of seriousness can be more difficult to remediate. In such cases the associates tribunals (AT’s) decision on risk should reflect this and a conclusion 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.
While the courts distinguish between degrees of seriousness, any conviction for child sex abuse materials will mean the PA or AA presents a current and ongoing risk to public confidence in the profession, requiring a finding of impairment.
The level of risk associated with an allegation relating to a conviction, court sanction or determination will often be medium or high.
Where an allegation about a conviction, caution, court sanction or determination 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 relating to a conviction, caution, court sanction or determination not to undermine public confidence in the profession.

Decision on whether a warning is required

Certain types of convictions, court sanctions and determinations will usually fall at the higher end of the spectrum of seriousness, and so a conclusion that the PA or AA poses a current and ongoing risk to public protection will often have been made.
However, for other types of conviction, caution, court sanction and determination cases, where the circumstances of the case just fell 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 may be appropriate to maintain public confidence in the profession and uphold professional standards.

Decision on final measure

The proportionate final measure in response to an allegation relating to a conviction, caution, court sanction or determination 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.
Where the level of current and ongoing risk to public protection is medium or high, this will require consideration of suspension or removal.
While the courts distinguish between degrees of seriousness, any conviction for child sex abuse materials will undermine public confidence in the professions. The only proportionate action in these cases will usually be removal and any departure from this will need to be carefully explained.
In a very exceptional case where the level of current and ongoing risk to public protection is assessed to be so low that conditions are being considered as the proportionate restrictive action to impose on a PA or AA who is registered as a sex offender, consideration should be given to including conditions that stipulate no contact with any patients or any category of patients. Consideration should also be given to imposing a condition requiring the PA or AA to undergo an assessment, for example by a clinical psychologist, to evaluate the risk they pose to patients before they may be permitted to resume certain forms of practice.
When deciding on final measure, the associates tribunal (AT) should consider the final measures banding for conviction, caution, court sanction and determination 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
Conditions up to 12 months to Suspension up to 3 months	Suspension 6 to 12 months	Suspension 12 months to Removal

In conviction, court sanction and determination cases falling at the higher end of the spectrum of seriousness, evidence about the impact of a specific type of restrictive action and references and testimonials, will have limited, if any, relevance to the AT’s decision about what final measure is appropriate.
When considering the length of a final measure, the tribunal should bear in mind that where a PA or AA has been convicted of a serious criminal offence resulting in an immediate or suspended custodial sentence, the impact on public protection means they should not be permitted to hold unrestricted practice until they have completed their sentence. Similarly, no PA or AA registered as a sex offender should be able to hold unrestricted registration.
For convictions, cautions or determinations relating to sexual misconduct, dishonesty, violent or abusive behaviour, discrimination or clinical concerns, reference should also be made to the guidance and bandings set out in the relevant specific case type section. Where there is more than one type of proven allegation, the AT should impose the final measure that addresses the most serious findings.

Move to section one: procedural matters relating to tribunal hearings

⁸⁶Good medical practice, The duties of medical professionals registered with the GMC and paragraph 81.

⁸⁷Good medical practice, paragraph 99.

⁸⁸In England, Wales and Northern Ireland.

⁸⁹In Scotland.

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