1. Home
  2. Parties and representatives
  3. Guidance for tribunals
  4. Tribunal guidance for PA and AA hearings
  5. Guide for Associates tribunal hearings
  6. Step 2 - decision on what action to take if any
Associates tribunal hearings

Step 2: decision on what action to take, if any

Text alternative for this image can be found linked directly below.

Text alternative: step 2: decision on what action to take, if any

  1. At stage two of an associates tribunal (AT) review hearing, the AT will consider their finding on impairment and consider what action, if any, is needed to protect the public.

  2. At the final measure stage of a review hearing, the outcomes available to the AT will depend on their finding on impairment and the final measure in place at the time of the review hearing. 

  3. Where the AT has decided that the PA or AA’s fitness to practise does not remain impaired, the AT can:11
    • allow the current measure to expire, or 
    • revoke the current measure. 
  1. Where the PA or AA’s fitness to practise remains impaired, and the PA or AA’s registration is currently subject to conditions, the outcomes available to the AT are:12
    • take no further action - this allows the existing conditions to continue and end when they are due to expire 
    • revoke or vary any specific condition(s) imposed under a current final measure of conditions – the amended condition(s) will stay in place until the date the final measure is due to expire  
    • extend the current final measure of conditions from when it would otherwise expire for up to 12 months13 when doing so, the AT can revoke or vary any specific condition(s) imposed or impose new condition(s) 
    • revoke the current final measure of conditions and impose a final measure of suspension for up to 12 months,14 
    • revoke the current final measure of conditions and remove the PA or AA’s name from the register of PAs and AAs. 
  1. Where the AT has concluded that a breach of conditions demonstrates an increase in the level of current and ongoing risk the PA or AA poses to public protection, they should be mindful that the most proportionate outcome is likely to be a more restrictive measure. 

  2. Where the PA or AA’s fitness to practise remains impaired, and the PA or AA is currently suspended from the register, then the outcomes available to the AT are to:15
    • take no further action - this allows the current final measure of suspension to continue and end when it is due to expire 
    • extend the current final measure of suspension from when it would otherwise expire for up to 12 months 
    • revoke the current final measure of suspension and impose a final measure of conditions for up to 12 months,16 or 
    • revoke the current final measure of suspension and remove the PA or AA’s name from the register of PAs and AAs. 
  1. It is not open to an AT on review, including an AT considering both new and review matters, to find no impairment and issue a warning. If restrictive action is required to address the allegations, the AT should have made a finding of impairment. 

  2. Where the PA or AA’s fitness to practise remains impaired but the level of risk the PA or AA poses to public protection has decreased since the last assessment of risk, it may be proportionate for the AT to consider imposing a less restrictive final measure, or the same final measure for the same period or for a shorter period.  

  3. In cases where the AT is of the view that there has been no material change in the level of risk the PA or AA poses to public protection since the last assessment of risk, it may be proportionate to consider imposing the current final measure of conditions or suspension for a further period. 

  4. Where the level of current and ongoing risk the PA or AA poses to public protection has increased since the last assessment, it may be proportionate for the AT to consider imposing a more restrictive final measure or imposing the same final measure but for a longer period. However, if the AT is of the view that the increased risk can still be managed through the current final measure, it may be appropriate to consider extending the current final measure of conditions or suspension for a further period.

  5. When making their decision, the AT should always remind themselves of their earlier conclusions to ensure that they have been, and remain, consistent with previous findings and have regard to the level of current and ongoing risk to public protection posed by the PA or AA (low, medium, or high). Whether the risk the PA or AA poses to public protection has decreased, stayed the same or increased since the last assessment of risk will inform the decision on what final measure is required to protect the public.

  6. When deciding what final measure to impose, and for how long, the AT should consider: 
    • the initial final measure imposed and how that decision maker applied any relevant final measures bandings, along with the general guidance in Outcomes available to the AT  in Part C: Stage three - final measure of Section three: AT hearings to assist their understanding of that final measure
    • any subsequent decision on final measure if this is not the first review hearing
    • how the PA or AA has responded to the current final measure, and
    • what is the necessary and proportionate action to take at this stage to address the present level of current and ongoing risk to public protection. 
  1. In an early review, the AT should also consider the reasons why an early review was directed as this may impact on what is an appropriate final measure.  

  2. In all cases, the AT should consider when any new final measure will, or should, come into effect, having regard to how long is remaining on the current final measure.17 Where there has been an adjournment, the AT should note the effect that any extension of the current final measure has had on its expiry date. 

  3. The AT should also have regard to the general principle that where a PA or AA has been convicted of a serious criminal offence or offences, they should not be permitted to resume unrestricted practice until they have satisfactorily completed their sentence.18 Similarly, no PA or AA registered as a sex offender should be able to hold unrestricted registration. However, each case should be considered on its merits and decisions should be taken in the light of the individual circumstances of the case. 

  4. In most review hearings, the final measure stage will follow immediately after the AT has made its decision on impairment. Where there is a delay between the decision on impairment and consideration of what action, if any, is required in response, the AT 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 AT conducting an updated assessment of the current and ongoing risk to public protection posed by the PA or AA. 

  5. When conducting an updated assessment of risk, the AT 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 AT 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 PA or AA. They should do this with reference to the guidance in Stage one: 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 AT’s view on what final measure is a proportionate response. 

  6. The AT should give reasons as to why the selected outcome is appropriate and where a final measure is imposed, why it is sufficient to protect the public, and why a more restrictive final measure is not necessary. The decision should include a separate explanation as to the length of final measure and why it should last for a particular period, if relevant.  

  7. Where the tribunal’s decision is to impose a final measure that is lower, or higher, than that suggested by the guidance, the tribunal 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. 

Review hearings where there have also been new findings of fact

  1. When considering final measure, the AT should consider the most serious allegations found proved resulting in the finding of impairment and ensure that the final measure addresses those findings and the identified risks to public protection. 

Adjournments

  1. If it is not possible for the review hearing to conclude before the date that a final measure of conditions or suspension is due to expire, the AT may extend the current final measure so that it remains in effect during the period of any adjournment. This approach prevents a public protection gap from arising. 

  2. However, if the AT is not satisfied that extending the current final measure would sufficiently protect the public during the adjournment period, they should consider whether any interim measure should be imposed, extended, varied, revoked or revoked and replaced with a different interim measure instead.19 

Any final measure must be proportionate, transparent and fair

  1. For guidance on deciding what is a proportionate final measure to impose on review, the AT should refer to the section on Any final measure must be proportionate, transparent and fair  in Part C: Stage three - final measure of Section three: AT hearings. 

Outcomes available to the AT at the final measure stage of a review or a new and review hearing where the PA or AA’s fitness to practise does not remain impaired 

Take no further action – this allows the current final measure of conditions or suspension to continue and end when it is due to expire

  1. If the AT is of the view that the PA or AA no longer poses a current and ongoing risk to public protection requiring restrictive action in response and has made a finding that the PA or AA’s fitness to practise is not impaired, it may be proportionate to take no further action. The effect of this is that it will allow the current final measure to expire at the end of the final measure period. Whether this is proportionate will depend on the individual circumstances of the case and the reasons the current final measure was imposed. 

  2. In cases where the current final measure was imposed to maintain public confidence in the profession and/or maintain and promote professional standards, it will usually be more appropriate for the AT to allow the current final measure to expire. In these circumstances revoking the final measure immediately could risk undermining the earlier decision made by the previous AT that the final measure was needed for a certain length of time to specifically uphold and promote public confidence and/or maintain and promote professional standards. 

Revoke the final measure of conditions or suspension immediately  

  1. If the AT is of the view that the PA or AA no longer poses a current and ongoing risk to public protection requiring restrictive action in response, it may be proportionate to revoke the final measure immediately. Whether this is proportionate will depend on the individual circumstances of the case and the reasons the current final measure was imposed.

  2. In cases where the current final measure was imposed to maintain public confidence in the profession and/or to maintain and promote professional standards, it is unlikely to be appropriate to revoke the final measure immediately. In these circumstances revoking the final measure immediately could risk undermining the earlier decision made by the AT that the final measure was needed for a certain length of time to specifically uphold and promote public confidence and/or maintain and promote professional standards. 

Outcomes available to the AT at the final measure stage of a review or a new and review hearing where the PA or AA’s fitness to practise remains impaired 

Take no further action – this allows the current final measure of conditions or suspension to continue and end when it is due to expire

  1. If the AT is of the view that the level of current and ongoing risk to public protection requiring restrictive action in response has stayed the same, it may be proportionate to allow the current final measure to continue. The effect of this is that it will allow the current measure to expire at the end of its current period. Whether this is proportionate will depend on the individual circumstances of the case and the reasons the current measure was imposed. 

Revoke or vary any specific conditions imposed under a current final measure of conditions up until the date the current final measure is due to expire

  1.  Where the PA or AA’s fitness to practise remains impaired but the level of current and ongoing risk the PA or AA poses to public protection has decreased since the last assessment of risk, it may be proportionate for the AT to revoke specific conditions or consider varying the order and imposing less restrictive conditions up until the date the current final measure is due to expire. 

  2. Where the PA or AA’s fitness to practise remains impaired but the level of current and ongoing risk the PA or AA poses to public protection has increased, it may be proportionate for the AT to consider varying the order and imposing more restrictive conditions up until the date the current final measure is due to expire.

  3. Where the hearing is following a direction for an early review on the basis that the PA or AA has indicated that one or more of the conditions are not workable and/or will not be supported by a specific body, there may have been no material change to the level of risk the PA or AA poses to public protection. In these circumstances, the AT should carefully consider the reason for the previous conditions being imposed and not allow the review hearing to be used as a form of appeal against those conditions. 

  4. However, 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 PA or AA, consideration can be given to putting those in place instead. Where alternative conditions are not appropriate or proportionate, the AT does not need to vary the current final measure.  A lesser or greater final measure than that which is necessary to protect the public should not be imposed simply because certain conditions cannot be supported by a specific body.  

  5. For more information about conditions and to decide whether revoking or varying conditions is likely to be the proportionate response, the AT should also refer to the guidance in Outcomes available to the AT at the final measure stage in Part C: Stage three - final measure of Section three: AT hearings.  

  6. However, where the AT has concluded that a breach of conditions demonstrates an increase in the level of current and ongoing risk the PA or AA poses to public protection, they should be mindful that the most proportionate outcome is likely to be a more restrictive measure. 

    Where the current final measure is suspension, revoke the final measure and impose a final measure of conditions on the PA or AA’s registration for up to 12 months  
    OR 
    Where the current final measure is conditions, extend it from when it would otherwise expire for up to 12 months – when doing so, the AT can revoke or vary any specific condition(s) imposed or impose new condition(s) 

  7. Where the PA or AA is currently suspended and the AT has found that their fitness to practise remains impaired, but the level of current and ongoing risk the PA or AA poses to public protection has decreased since the last assessment of risk, it may be proportionate for the AT to consider revoking the current final measure of suspension and imposing a final measure of conditions for up to 12 months. 

  8. In cases where the PA or AA currently has a current final measure of conditions and the AT is of the view that there has been no material change in the level of current and ongoing risk the PA or AA poses to public protection since the last assessment of risk, it may be proportionate to consider extending the current final measure of conditions from the date it would expire for a further period of up to 12 months. 

  9. For more information about conditions and to decide whether conditions are likely to be the proportionate response and if so, how long they should be imposed for, the AT should also refer to the guidance in Outcomes available to the AT at the final measure stage in Part C: Stage three - final measure of Section three: AT hearings.  

  10. Where the AT has concluded that a breach of conditions has demonstrated an increase in the level of current and ongoing risk the PA or AA poses to public protection, they should be mindful that the most proportionate outcome is likely to be a more restrictive measure. 

    Where the current final measure is conditions, revoke the final measure and impose a final measure on the PA or AA’s registration of suspension for up to 12 months  
    OR  
    Where the current final measure is suspension, extend it from when it would otherwise expire for up to 12 months  

  11. Where the PA or AA has a current final measure of conditions, the AT has found that their fitness to practise remains impaired, and the level of current and ongoing risk the PA or AA poses to public protection has increased since the last assessment of risk, it may be proportionate for the AT to consider revoking the final measure of conditions and imposing a final measure of suspension for up to 12 months.  

  12. In deciding whether suspension is a proportionate response in cases where the AT has found the PA or AA has breached the current final measure of conditions, the AT must be mindful that where they have concluded that a breach of conditions has demonstrated an increase in the level of current and ongoing risk the PA or AA poses to public protection, the most proportionate outcome is likely to be a more restrictive measure. 

  13. In cases where the PA or AA currently has a final measure of suspension and the AT is of the view that there has been no material change in the level of current and ongoing risk the PA or AA poses to public protection since the last assessment of risk, it may be proportionate to consider extending the current final measure of suspension from when it would expire for a further period of up to 12 months. 

  14. For more information about suspension and to decide whether it is likely to be the proportionate response and if so, how long it should be imposed for, the AT should also refer to the guidance in Outcomes available to the AT at the final measure stage in Part C: Stage three - final measure of Section three: AT hearings. 

Removal from the register of PAs and AAs 

  1. Where the PA or AA has a current final measure of conditions, the AT has found that their fitness to practise remains impaired, and the level of current and ongoing risk the PA or AA poses to public protection has increased since the last assessment of risk, it may be proportionate for the AT to consider imposing a final measure of removal if they consider that conditions or suspension would not be sufficient to protect the public.  

  2. Where the PA or AA has a current final measure of suspension, the AT has found that their fitness to practise remains impaired, and the level of current and ongoing risk the PA or AA poses to public protection has increased since the last assessment of risk, it may be proportionate for the AT to consider imposing a final measure of removal.  

  3. For more information about removal and to decide whether it is likely to be the proportionate response, the AT should also refer to the guidance in Outcomes available to the AT at the final measure stage in Part C: Stage three - final measure of Section three: AT hearings.  

  4. In deciding whether removal is a proportionate response in cases where the AT has found the PA or AA has breached their current final measure of conditions, the AT must be mindful that where they have concluded that the breach demonstrated an increase in the level of current and ongoing risk the PA or AA poses to public protection, the most proportionate outcome is likely to be a more restrictive measure. 

Additional evidence that may be relevant to the decision on what outcome 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 AT’s decision on impairment, but can be considered at the final measure stage when deciding what outcome is proportionate: 
    • evidence about the impact that taking a specific type of action may have on patients or members of the public, or the PA or AA themselves, and/or 
    • references and testimonials about the PA or AA’s character. 
  1. For more information, the AT should refer to the guidance in Additional evidence that may be relevant to the decision on what final measure is proportionate in Part C: Stage three - final measure of Section three: AT hearings. 

The AT's determination

  1. The AT’s determination should show that the AT has considered their earlier conclusions at the impairment stage and had regard to the level of current and ongoing risk posed by the PA or AA (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 AT should give reasons as to why the selected outcome is appropriate and where a final measure is imposed, why it is sufficient to protect the public, and if relevant, why a more restrictive final measure is not necessary. The decision should include a separate explanation as to when the final measure will take effect and the length of final measure, if relevant. 

  3. Where the AT’s decision is to impose an outcome that departs from this guidance, the AT 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 final measure of conditions or suspension should also be clearly recorded and explained.  

Taking effect of directions and final measures

  1. A final measure of conditions or suspension imposed by an AT at a review hearing can take effect on the date that it is served on the PA or AA or on the expiry of the existing final.20 The AT may direct that a final measure of conditions or suspension takes effect immediately where it considers that there would be a risk to public protection if the measure did not do so.21 This is likely to be appropriate where the AT imposes a more restrictive final measure than the one currently in place. 

  2. The AT should give reasons for any decision made that a final measure should take effect immediately, with reference to any submissions made by the parties. In making their decision, the AT should also refer back to its earlier decision on what final measure is a proportionate response, and the reasons for it, to ensure that the decision reached is consistent. 

  3. Where the AT decides to impose a final measure of removal, the PA or AA’s entry in the register of PAs and AAs must be removed as soon as is reasonably practicable.22 This means the entry will be removed when notice of the decision is deemed served. Where the PA or AA is present and /or represented at the hearing this will be immediately. Otherwise, it will be when notice of the decision is deemed served under Rule 74(5). 

  4. If it is not possible for the review hearing to conclude before the date that a final measure of conditions or suspension is due to expire, the AT may extend the current final measure so that it remains in effect during the period of any adjournment.23 This approach prevents a public protection gap from arising. The AT will then need to consider the relevance of the new expiry date when they resume the hearing. 

Interim measures

  1. Interim measures are usually used to manage risk while a concern or allegation about a PA or AA’s behaviour, performance or the impact of a health condition goes through the fitness to practise process. In review cases where the GMC has alleged the PA or AA has breached a final measure of conditions, it is possible than an interim measure may be in place to manage any immediate risks arising from the alleged breach.  

  2. Where the AT makes a decision to adjourn a review hearing, it can also consider whether any interim measure should be imposed, extended, varied, revoked or revoked and replaced with a different interim measure to manage immediate risks where the AT is not satisfied that extending the current final measure in place would be sufficient to protect the public.24 

  3. Where an interim measure is in place at the time that a final measure of conditions or suspension is imposed, this should usually be revoked and any immediate risk to one or more parts of public protection should be managed by directing that the final measure of conditions or suspension takes effect immediately. The exception is where the interim measure relates to other concerns or allegations in the fitness to practise process that have not yet been determined. 

11 Article 14(2) or the Order.

12 Article 14(3) of the Order.

13 Article 13(2) of the Order.

14 Article 14(3)(c) of the Order. 

15 Article 14(3) of the Order.

16 Article 13(2) of the Order. 

17 Further information on when sanctions take effect can be found in the section Taking effect of directions and final measures.

18 CHRE v GDC and Fleischmann.

19 Article 11(1) of the Order and Rule 38(5).

20 Rule 72(7).

21 Rule 72(8).

22 Rule 72(9).

23 Article 14(3) of the Order. 

24 Article 11(1) of the Order and Rule 38(5).