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  5. Guide for Associates tribunal hearings
  6. General introduction
Associates tribunal hearings

General introduction

  1. The role of an associates tribunal (AT) is to protect the public by ensuring that where a PA or AA is not currently fit to practise, appropriate restrictions are put in place, or the PA or AA is removed from the register of PAs and AAs.

  2. 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 AT must act in a way that:
    • protects, promotes and maintains the health, safety and well-being 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.
  3. An AT hearing has three distinct stages:
    • stage one: the AT reaches a decision on the facts.
    • stage two: the AT decides if the PA or AA’s fitness to practise is impaired.
    • stage three: the AT decides what regulatory action, if any, is required.
  4. At stage one, the AT will consider evidence provided by both parties (the GMC and PA or AA) to decide whether the allegations presented by the GMC are proved. To reach a decision the AT will apply the civil standard of proof. This means the AT must decide whether, on the balance of probabilities, the GMC is able to prove it is more likely than not that the matters occurred as alleged. If the AT finds some, or all, of the facts are proved, they will go on to consider the PA or AA’s fitness to practise. Further information about the approach taken to stage one of the hearing can be found in Part A of this section of the guidance Step one: Make findings of fact.

  5. At stage two, to decide if a PA or AA is fit to practise, the AT must assess whether that PA or AA poses any current and ongoing risk to one or more of the three parts of public protection. This assessment must be made with reference to the facts found proved at the first stage of the hearing and any further relevant evidence presented to the AT.

  6. An AT can only assess whether a PA or AA is fit to practise where there is a legal basis for doing so. There are two grounds for taking regulatory action for PAs and AAs. These are:
    • inability to provide care to a sufficient standard, or
    • misconduct1
  7. Where there is a legal basis for considering a PA or AA’s fitness to practise, to assess whether that PA or AA poses any current and ongoing risk to public protection, an AT will consider:
    • the seriousness of the facts found proved
    • any relevant context known about the PA or AA and/or their working environment, and
    • how the PA or AA has responded to the allegation(s).
  8. The AT will only make a finding of impairment where a decision is reached that the PA or AA poses a current and ongoing risk to one or more of the three parts of public protection requiring restrictive action in response. Further information about the approach taken to deciding impairment can be found in Part B of this section of the guidance Step two: Make a decision on impairment.

  9. At stage three, the AT will consider their conclusion on impairment, and decide what regulatory action, if any, is needed to protect the public.

  10. Where the AT has decided that the PA or AA’s fitness to practise is impaired, they will then go on to consider what restrictive action is required in response. This is known as a final measure. Further information about the approach to deciding what final measure is a proportionate response can be found in Part C of this section of the guidance Step three: Decide on final measure.

  11. Where the AT has decided that the PA or AA’s fitness to practise is not impaired, but they have found that the PA or AA has significantly departed from the professional standards, the AT can decide to issue the PA or AA with a warning. This is a formal way of indicating that the PA or AA’s behaviour or performance significantly departed from the professional standards and should not be repeated. Further information about the approach to warnings can be found in Part D of this section of the guidance Decide if a warning is required.

  12. The process that the AT should follow to decide an allegation of impaired fitness to practise and what regulatory action to take, if any, are illustrated in the diagram that follows.

1 Part 1 (2)(a) of the Anaesthesia and Physician Associate Order 2024 (AAPA Order 2024) (the Order).