Step 2a: decide whether there is a legal basis for considering impairment
The grounds for action
- An associates tribunal (AT) must be satisfied that there is a legal basis for considering whether a PA or AA’s fitness to practise is impaired, meaning that there is a current and ongoing risk to public protection. The table below explains the grounds for action that apply to taking regulatory action in respect of PA or AAs.
The following are the different grounds for action, along with their descriptions:
Inability to provide care to a sufficient standard (IPCSS)
This is about professional performance. It could be an act or omission and includes failing to act appropriately or being unable to provide care to the standard expected.
The performance will be a departure from the professional standards as set out in Good medical practice and will often be seen where there are clinical failings or incidents which give rise to a cumulative concern regarding the PA or AA’s fitness to practise. Taken together, the departures from the professional standards mean a PA or AA’s performance is unacceptably low. To amount to an inability to provide care to a sufficient standard, the acts or omissions will often form part of a wider pattern about the PA or AA’s professional skills, knowledge or experience.
While having a health condition does not of itself mean there is a departure from the professional standards, if it is not being appropriately managed then this may lead to a departure from the professional standards and/or may impact on a PA or AA’s ability to practise safely and provide care to a sufficient standard.
All PAs and AAs working in the UK must have the necessary knowledge of the English language in the areas of speaking, listening, reading and writing to provide a good standard of practice and care. This includes being able to effectively engage with patients and other healthcare professionals. If a PA or AA does not have the necessary English language knowledge to communicate effectively in all areas, they are unable to provide care to a sufficient standard.
A determination by a health or social care regulatory body or a conviction, caution or court sanction received in the UK, or from an equivalent overseas body, may, in certain circumstances, indicate an inability to provide care to a sufficient standard.
Misconduct
This is about behaviour. It could be an act or omission and includes failing to act appropriately or demonstrating behaviour that falls short of what can reasonably be expected.
To amount to misconduct, the behaviour will be a departure from the professional standards as set out in Good medical practice. This includes single clinical acts or omissions that are serious, or a limited number of clinical acts or omissions that taken together are serious.
While having a health condition does not of itself mean there is a departure from the professional standards, if it is not being appropriately managed then this may impact on a PA or AA’s behaviour, which, depending on the nature and seriousness of the behaviour in question, might constitute misconduct.
A determination by a health or social care regulatory body or a conviction, 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.
-
A finding of impairment can only be made by an AT where the facts found proved engage at least one of these grounds for action and the PA or AA is assessed to pose a current and ongoing risk to one or more of the three parts of public protection requiring restrictive action in response.
-
The GMC will state the grounds for action in the charges that are presented to the AT. Although the AT is not able to add or change any grounds for action, or add any additional allegations, they are able to amend the allegation provided it can be made without injustice to the PA or AA.6 Any amendment should have been made at stage one of the hearing.
-
If the AT is satisfied there is a legal basis for considering the PA or AA’s fitness to practise, they will need to decide whether the PA or AA poses any current and ongoing risk to public protection.
- The following questions should be used to inform the AT’s assessment of whether a PA or AA poses any current and ongoing risk to public protection, and if so, what level of risk (low, medium or high):
- Where on the spectrum of seriousness does the allegation lie?
- What is the impact of any relevant context known about the PA or AA and/or their working environment?
- How has the PA or AA responded to the allegation?
- The AT should answer these questions with reference to the facts found proved at the first stage of the hearing and any further relevant evidence considered at stage two of the hearing.
6 Rule 47(3).