Associates tribunal hearings

Step 3: make a decision on final measure

Text alternative: step 3: make a decision on final measure

Decision on final measure

At stage three of an associates tribunal (AT) hearing, the AT will consider what regulatory action, if any, is needed to protect the public.
Where the AT has decided that the PA or AA’s fitness to practise is impaired at stage two of the hearing, it will need to go on to consider what is a proportionate regulatory response to protect the public.
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 wellbeing 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.

At the final measure stage, the outcomes available to the AT are to:

take no action
impose conditions on the PA or AA’s registration for up to 12 months
suspend the PA or AA’s registration for up to 12 months, or
remove the PA or AA’s name from the register of PAs and AAs.

When making their decision, the AT should always remind themselves of their earlier conclusions at the facts and impairment stages to ensure that they have been, and remain, consistent with previous findings and have regard to the level of current and ongoing risk to one or more of the three parts of public protection posed by the PA or AA (low, medium, or high).
In most hearings, the final measures stage will follow immediately after the AT has made its decision on impairment. But sometimes, in the event of a split listing or an adjournment, there is a time lapse prior to the AT’s consideration of final measure. Where a time lapse occurs, 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.
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 Part B Step 2: make a decision on 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.
For some types of cases, final measures bandings are available. The AT should be mindful that these provide a guide, and there may be evidence relevant to the individual circumstances of the case that indicates the appropriate action should be lower or higher than that indicated by the bandings. This can include whether the type of final measure should be less or more restrictive, or where conditions or suspension are imposed, that the length should be longer or shorter than that stated.
The AT will always need to record reasons for their decision on final measure. Where the AT’s decision departs from the principles in this part of the guidance, which includes the final measures bandings, the AT must carefully explain how this is justified, given the specific circumstances of the case. They must also explain how the decision relates to any submissions made by the parties.

Any final measure must be proportionate, transparent and fair

A good decision about a PA or AA’s fitness to practise should protect the public, be proportionate, be transparent and be fair. In the context of deciding what final measure, if any, is required to address the level of current and ongoing risk to public protection posed by a PA or AA (low, medium or high), being proportionate means:

When deciding what is required but no more than necessary to achieve public protection, approaching the question by considering if the least restrictive action is appropriate, and not making a final decision until the options immediately above and below the action the AT is minded to take, have also been assessed.
When considering the impact on those affected by the decision, the interests of individual patients and members of the public may include the impact that taking a specific type of action is likely to have on the delivery of health services in a particular speciality or within a defined geographical location. However, whilst there may be a public interest in facilitating a PA or AA’s return to safe practice, the decision on what final measure is required needs to reflect the level of current and ongoing risk to one or more of the three parts of public protection that has been identified, and which takes into account the seriousness of the allegations, and must be consistent with the GMC and MPTS’ legal role to protect the public.
The interests of the PA or AA will include the impact on their career. This means when deciding what final measure is required, it may be appropriate to consider any increased impact a specific outcome would have on an individual PA or AA compared to others, considering their specific circumstances. However, case law is clear that the need to protect the public always outweighs the interests of any individual medical professional. And while restrictive action is not put in place to punish or discipline a PA or AA, a final measure may have a punitive effect yet still remain necessary.

When reaching a view on what is a proportionate final measure, the AT must demonstrate they have considered any submissions made by the parties.
Final measures are published on the PA or AA’s entry on the register of PAs and AAs and disclosed in line with the GMC’s Publication and Disclosure Policy.

Outcomes available to the AT at the final measure stage

Taking no action

Where a PA or AA’s fitness to practise is impaired, it will usually be necessary for the AT to restrict the PA or AA’s registration to achieve public protection. But there may be exceptional circumstances to justify an AT taking no action. Exceptional circumstances are unusual, special, or uncommon, so such cases are likely to be very rare.
When making their decision on impairment, the AT will already have taken into account any relevant context and the PA or AA’s response to the allegation. Therefore, the presence of relevant context and insight and remediation are unlikely on their own to justify an AT taking no action.
Where an AT decides to take no action, its determination must fully and clearly explain:

what the exceptional circumstances are,
why the circumstances are exceptional, and
how the exceptional circumstances justify taking no action.

Conditions

Conditions are suitable for those cases where the PA or AA’s behaviour, performance, or the impact that a health condition is having on their ability to practise safely and effectively, is currently incompatible with unrestricted registration. This means the current and ongoing risk to public protection posed by the PA or AA needs to be managed by restricting their registration for a period of time, with the aim they should be able to safely return to unrestricted practice in the future.
Where a final measure of conditions is imposed on a PA or AA’s registration, the AT must specify the period for which it is to remain in force, up to a maximum of 12 months.⁹

What are conditions?

Conditions restrict a PA or AA’s ability to practise and/or require them to do something. The purpose of putting in place a final measure of conditions is to provide a PA or AA with time to address identified failings to demonstrate they are fit to practise on an unrestricted basis, whilst ensuring that the current and ongoing risk posed to public protection is being adequately managed.
Where conditions are put in place, they should be appropriate, workable, and measurable.

Appropriate

To be appropriate, conditions must address the specific findings about the current and ongoing risk to public protection posed by the PA or AA.

Workable

To be workable, conditions must be capable of producing the desired result of addressing the specific findings about the current and ongoing risk to public protection posed by the PA or AA.
Conditions are likely to be workable where:

the PA or AA has shown insight
time is needed for the PA or AA to take steps to address the findings (remediate), for example through retraining, study, supervision and/or seeking medical treatment
the PA or AA is willing to remediate, and
the AT is satisfied the PA or AA will comply with them.

When deciding whether remediation is possible, the AT should carefully consider any objective evidence that is available to them. This may include the outcome of assessments, or other independent evidence of the PA or AA’s performance, health, or knowledge of the English language.
Sometimes evidence is provided that a PA or AA’s employer, or another relevant body, will not support certain conditions if they were to be put in place, which means that a specific condition(s) is not workable in that environment. 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.
However, where alternative conditions are not appropriate or proportionate, the conditions considered necessary to protect the public in a timely way should be imposed, despite the fact they may not be supported by the PA or AA’s current employer or relevant body. A lesser or greater final measure than that which is necessary to protect the public should not be imposed simply because certain conditions may not be supported by a specific body.

Measurable

A condition must be described in specific terms to make it measurable. Conditions must be measurable so that the PA or AA can be clear about what is required of them. Having measurable conditions also means that when an assessment of whether the PA or AA poses any current and ongoing risk to public protection is next made to reach a view on impairment, the extent to which the PA or AA has complied with the conditions, and the question of whether the conditions have had the desired result, can be considered.

When are conditions likely to be proportionate?

Conditions may be proportionate in cases where the PA or AA has shown a degree of insight into the allegation and some, or all, of the following factors are present:

the PA or AA has demonstrated they are willing and/or able to remediate
identifiable areas of the PA or AA’s practice need prohibiting, monitoring, or retraining
the PA or AA has demonstrated they are willing to be open and honest with patients and others they work with if things go wrong
the PA or AA will not put patients at harm, either directly or indirectly, by having conditions on their registration.

A PA or AA may have demonstrated they are willing and able to remediate where they’ve provided evidence that they’re committed to improving their knowledge and skills and keeping them up to date throughout their working life, improving the quality of their work and seeking and responding to feedback. They may not have demonstrated they are willing and/or able to remediate where there is evidence there have been previous unsuccessful attempts to remediate, or where there is evidence the PA or AA has been unwilling to engage.
Conditions are unlikely to be a proportionate response in cases where the nature of the allegations about the PA or AA’s behaviour fall at the higher end of the spectrum of seriousness and/or suggest an underlying problem with their attitude.

Imposing conditions on a PA or AA’s registration

When imposing conditions, as well as giving reasons for the need for this type of restrictive action, the objectives of the conditions should be clearly set out, so they are measurable.
Conditions should be drawn from the suite of conditions detailed in the conditions bank Imposing conditions on a PA or AA’s registration. The wording of conditions in the bank should be retained unless, unusually, it is necessary to amend or add to them, considering the individual circumstances of the case.
The AT will need to decide the appropriate length of time that conditions should be put in place for, up to the maximum of 12 months. The following factors will be relevant:

the assessment of the level of current and ongoing risk to public protection posed by the PA or AA (low, medium, or high)
the reasons for assessing conditions as being the proportionate response
the amount of time the PA or AA is likely to need to remediate, complete treatment for and/or recover from a health condition that is having, or is likely to have, an impact on their ability to practise safely and effectively, and/or
the amount of time the parties will reasonably need to prepare for a review of whether the PA or AA continues to pose a current and ongoing risk to public protection requiring restrictive action in response, meaning their fitness to practise remains impaired, or is safe to return to unrestricted practice.

Where a condition has been imposed that requires a PA or AA to complete an assessment of their performance, health or knowledge of English language, the time needed to complete the assessment should be accounted for.¹⁰
Any time spent under an interim measure of conditions or suspension is unlikely to be relevant to deciding the appropriate length of conditions. This is because the type of action and the length of time conditions are put in place for both need to adequately address the finding of impairment based on the decision that the PA or AA poses a current and ongoing risk to public protection requiring restrictive action in response.
Interim measures serve a very different purpose to final measures; when imposing an interim measure, an interim measures tribunal (IMT) makes no findings of fact and the test for considering whether to impose an interim measure is entirely different from the criteria that applies when considering what, if any, is an appropriate final measure to impose on a PA or AA’s registration following a finding of impairment.
To take into account previous time spent under an interim measure before any decision to impose a final measure of conditions is made, would likely leave a public protection gap, as reducing the length of time that any conditions are put in place for would not wholly reflect the assessment of the level of current and ongoing risk to public protection that has now been made by the AT.
The question of whether the PA or AA can safely return to unrestricted practice will need to be considered before a period of conditions concludes and so a review should be directed.
Where an interim measure is in place at the time that a final measure of conditions is imposed, this should usually be revoked. 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.
The AT’s decision to impose a final measure of conditions will take effect when notice of the decision is deemed served on the PA or AA.¹¹ An AT may direct that a final measure of conditions takes effect immediately where it considers that there would be a risk to public protection if the measure did not take effect immediately.¹²

Suspension

Suspension is for those cases where the PA or AA’s behaviour, performance, or the impact that a health condition is having on their ability to practise safely and effectively, is currently incompatible with unrestricted registration. This means the current and ongoing risk to public protection posed by the PA or AA needs to be managed by restricting their registration for a period, with the aim they should be able to safely return to unrestricted practice in the future.
Where suspension is imposed on a PA or AA’s registration, the AT must specify the period for which it is to remain in force, up to a maximum of 12 months.¹³

What is suspension?

Suspension restricts a PA or AA’s registration and prevents them from practising during the period it is in effect. The purpose of suspending a PA or AA’s registration is to protect the public by removing them from practice to manage the current and ongoing risk they pose to public protection.
Restrictive action of suspension is intended to address the level of current and ongoing risk to public protection and is not intended to be punitive. However, as it prevents a PA or AA from working and earning a living within that profession, it can have this effect. Suspension can also have a deterrent effect and be used to send a signal to the individual PA or AA, the profession and public about what is regarded as behaviour unbefitting a registered PA or AA.

When is suspension likely to be proportionate?

Suspension may be proportionate in cases where some, or all, of the following factors are present:

conditions are not appropriate, measurable and/or workable
the level of current and ongoing risk to public protection is such that it cannot be safely managed with conditions and suspension is necessary to stop the PA or AA from working and putting patients at risk while they gain insight into any deficiencies and remediate, or undergo medical treatment, and/or
the level of current and ongoing risk to public protection is such that, although patient safety is not an issue, suspension is needed to maintain public confidence in the profession and/or maintain professional standards

Imposing suspension on a PA or AA’s registration

The AT will need to decide the appropriate length of time that suspension should be put in place for, up to the maximum of 12 months. The following factors will be relevant:

the assessment of the level of current and ongoing risk to public protection posed by the PA or AA
the reasons for assessing suspension as being the proportionate response
the amount of time the PA or AA is likely to need to remediate, complete treatment for and/or recover from a health condition that is having, or is likely to have, an impact on their ability to practise safely and effectively, and/or
the amount of time the parties will reasonably need to prepare for any review of whether the PA or AA continues to pose a current and ongoing risk to public protection requiring restrictive action in response or is safe to return to unrestricted practice.

A short suspension may be appropriate in cases where: the PA or AA’s behaviour fell at the higher end of the spectrum of seriousness; there was evidence of relevant context and/or evidence of insight and remediation that decreased the level of current and ongoing risk to public protection such that there are no outstanding patient safety considerations; and suspension is being imposed on public confidence grounds and/or to maintain professional standards. It might also be appropriate in relation to a very small number of clinical cases where a PA or AA’s performance was such that although unlikely to recur, the nature of the allegation was so serious as to undermine the public’s trust in the profession.
Where a PA or AA is suspended because of findings in relation to insufficient knowledge of English, a short suspension is unlikely to be suitable in the first instance because they will need sufficient time to improve their language skills, take an English language assessment and for the parties to consider the results.
Any time spent under an interim measure of conditions or suspension is unlikely to be relevant to deciding the appropriate length of a suspension. This is because the type of action and the length of time it’s put in place for both need to adequately address the decision that the PA or AA poses a current and ongoing risk to public protection requiring restrictive action in response.
Interim measures serve a very different purpose to final measures; when imposing an interim measure an IMT makes no findings of fact and the test for considering whether to impose an interim measure is entirely different from the criteria that applies when considering what, if any, is an appropriate final measure to impose following a finding of impairment. To take into account previous time spent under an interim measure before any decision to impose a suspension is made would likely leave a public protection gap, as reducing the length of time that suspension is put in place for would not wholly reflect the assessment of the level of current and ongoing risk that has now been made.
However, time spent under an interim measure of suspension may be relevant when determining the proportionate period of suspension to be imposed purely on the grounds of public confidence. In many of these cases, given the different purposes of interim measures and final measures, a previous interim measure of suspension is unlikely to have a significant impact. Nevertheless, it must still be considered.
The question of whether the PA or AA can safely return to unrestricted practice will need to be considered before a period of suspension concludes and so a review should be directed. The exception to this is where a short suspension (usually three months or less) has been imposed on public confidence grounds and/or to maintain professional standards.
Where an interim measure is in place at the time that suspension is imposed, this should usually be revoked. 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.
The AT’s decision to impose a final measure of suspension will take effect when notice of the decision is deemed served on the PA or AA.¹⁴ The AT may direct that a final measure of suspension takes effect immediately where it considers that there would be a risk to public protection if the measure did not take effect immediately.¹⁵

Removal from the register of PAs and AAs

Removal is action available for those cases where a PA or AA’s behaviour, performance, or the impact that a health condition is having on their ability to practise safely and effectively, is incompatible with continued registration at this point in time. It means the level of current and ongoing risk the PA or AA poses to public protection is so significant that they should not be allowed to practise.

What is removal?

Removal takes away a PA or AA’s registration which means they are no longer entitled to practise in the UK at all, or anywhere else where they are required to hold GMC registration. It is used to protect the public in the most serious cases. It also has a deterrent effect as it sends a signal to the individual PA or AA, the profession and public about what is regarded as behaviour unbefitting a registered PA or AA.

When will removal be the only proportionate response?

Removal may be the proportionate response where:

conditions are not appropriate, measurable and/or workable and suspension is not sufficient to protect the public
the PA or AA’s behaviour or performance is such that it caused serious harm, and the risk of harm recurring cannot be mitigated sufficiently through putting conditions or suspension in place
the PA or AA has shown a persistent lack of insight into the seriousness of the allegation about their behaviour or performance and the potential or actual consequences, and/or
the seriousness of the facts found proven and/or impact of any relevant context that increased the current and ongoing risk to public protection mean the effect of the PA or AA continuing to hold registration is such that it will undermine public confidence in the profession.

Removing a PA or AA from the register of PAs and AAs

Following a final measure removal decision, the PA or AA’s entry in the register of PAs and AAs will be removed as soon as reasonably practicable.¹⁶ Where an interim measure is in place at the time that removal is imposed, this should be revoked at the time at which the final measure of removal has taken effect (this will be on service of notice, where the PA or AA is either not present nor represented, or immediately, where the PA or AA is either present or represented).

Final measures bandings for specific case types

At the impairment stage, the associates tribunal (AT) will have assessed the current and ongoing risk to one or more of the three parts of public protection arising from all the facts found proved. Sometimes those facts and the finding of impairment will relate to a range of allegations. Where this is the case, the AT should consider, where available, the final measures bandings for all the specific case types relating to the proven allegations.
When assessing the level of current and ongoing risk to public protection, the AT will have considered 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 responded to the allegation. The level of risk (low, medium, high) identified by the AT should be used to inform where within the final measures bandings the case falls.
Below are the final measures bandings for some case types commonly seen at hearing.¹⁷

Case type	Lower level of risk to public protection	Medium level of risk to public protection	Higher level of risk to public protection
Sexual misconduct	Suspension up to 6 months	Suspension 6 to 12 months	Suspension 12 months to Removal
Dishonesty	Suspension up to 3 months	Suspension 3 to 9 months	Suspension 9 months to Removal
Violent or abusive behaviour	Suspension up to 3 months	Suspension 3 to 12 months	Suspension 12 months to Removal
Discrimination	Conditions up to 12 months to Suspension 3 months	Suspension 3 to 9 months	Suspension 9 months to Removal
Clinical concerns	Conditions 12 months (with review directed)	Conditions 12 months (with review directed) to Suspension 6 months	Suspension 6 months to Removal
Impact of a health condition	Conditions 6 to 12 months	Conditions 12 months (with review directed) to Suspension	Suspension
Insufficient knowledge of English language	Conditions up to 6 months	Conditions 6 to12 months	Suspension
Convictions, cautions, misconduct arising from breach of court sanctions and determinations by other regulatory bodies	Conditions up to 12 months to Suspension up to 3 months	Suspension 6 to 12 months	Suspension 12 months to Removal

In all cases, once the AT has identified the level of banding, they will need to decide the appropriate length of final measure to impose within that range provided they are satisfied it is the most proportionate type of action considering the individual circumstances of the case. The following factors will be relevant to deciding the appropriate length of time that conditions or suspension should be put in place for:

the reasons for assessing conditions or suspension as being the proportionate response
the amount of time the PA or AA is likely to need to remediate, complete treatment for and/or recover from a health condition that is having, or likely to have, an impact on their ability to practise safely and effectively
where a condition has been imposed that requires a PA or AA to complete an assessment of their performance, health or knowledge of the English language, the time needed to complete the assessment, and/or
the amount of time the parties will reasonably need to prepare for a review of whether the PA or AA continues to pose a current and ongoing risk to public protection requiring restrictive action in response or is safe to return to unrestricted practice.

Once the AT has applied the bandings to reach a provisional view on what final measure is appropriate, before finalising their decision they must consider if there is any additional evidence that may be relevant to deciding what final measure is proportionate. They should also remind themselves of their decision on how the case engaged one or more of the three parts of public protection with reference to their decision on impairment and the general guidance and specific case types section in the Introduction.
Where the type of case is not covered by the final measures bandings, the AT should apply the general guidance on Outcomes available to the AT at the final measure stage.

Additional evidence that may be relevant to the decision on what final measure is proportionate

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 this stage when deciding what final measure 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.

Where the AT considers it is appropriate to take such evidence into account, they must explain the weight given to it and the impact this has had on their decision on final measure. This will include justifying any departure from a final measures banding, if one is available for the specific case type.

Evidence about the impact of a specific type of action

The following should inform the AT’s consideration of whether evidence about the impact of a specific type of action is relevant to the decision on what final measure to impose:

the extent to which the information provided can be corroborated or verified, and
what is known about the PA or AA’s future career plans and prospects.

Evidence about the impact a specific type of action will have on patients and members of the public will usually only be relevant where is it likely the PA or AA will stay working in their area of specialty or the same geographical area.
Where the AT concludes that the impact a specific type of action will have is relevant to their decision on final measure, the weight to be given to it is a matter for their judgment, having regard to their earlier assessment of the current and ongoing risk to public protection posed by the PA or AA. But in most cases, particularly those where the allegation fell at the higher end of the spectrum of seriousness, this type of evidence may have limited, if any, impact because it will be outweighed by the need to protect the public.

References and testimonials

References and testimonials may support the PA or AA and/or provide a view on their character. The following should inform the AT’s consideration of whether any references or testimonials are relevant to the decision on what final measure to impose:

whether the reference or testimonial is relevant to the specific findings about the PA or AA’s fitness to practise – to be relevant, the person providing the reference or testimonial needs to be fully aware of the circumstances of the allegation(s)
the extent to which the views expressed in the reference or testimonial are supported by other available evidence
how long the author has known the PA or AA and the relationship between them
how recently the author has had experience of the PA or AA’s behaviour or performance at work, and
whether there is any evidence that the author has a conflict of interest in providing the reference or testimonial.

Whilst greater emphasis can usually be placed on testimonials that have been verified,¹⁸the question of how much weight to be given to evidence provided in references and testimonials is a matter for the AT’s judgment, having regard to their earlier assessment of the level of current and ongoing risk to public protection posed by the PA or AA. But in most cases, particularly in those where the allegation fell at the higher end of the spectrum of seriousness and the level of current and ongoing risk to public protection remained high, this type of evidence may have limited, if any, impact because the need to protect the public will outweigh any relevant evidence about the PA or AA’s character.
An adverse inference should not be drawn in cases where references and testimonials are not presented by the PA or AA. This is because there may be a range of reasons why they are not available, including, but not limited to:

a variation in the quantity, quality and spread of references and testimonials between cases does not necessarily relate to the PA or AA’s character
there may be cultural reasons for not requesting references and testimonials - for example some PA or AAs may be less likely to discuss the fact they are under investigation with colleagues because of the significant reputational consequences for their family and networks in their communities, and/or
those who qualified outside of the UK and have just started working in the UK may find it more difficult to obtain them, as may individuals who have recently changed employer or are working on a locum basis.

The AT’s determination on final measure

The associates tribunals (AT’s) determination should show that the AT has considered their earlier conclusions at the facts and impairment stages 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.
The AT should give reasons as to why the selected final measure 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.
Where the AT’s decision is to impose a final measure that is lower, or higher, than that suggested by this guidance and any relevant final measures bandings, 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.
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 final measures and interim measures following final measure

A final measure of conditions or suspension imposed by an AT will take effect on the date that it is served on the PA or AA by the Regulator.¹⁹ An AT may direct that a final measure of conditions or suspension takes effect and/or immediately where it considers that there would be a risk to public protection if the measure did not do so.²⁰ Following a final measure removal decision, the PA or AA’s entry in the register of PAs and AAs will be removed on service of notice, where the PA or AA is either not present nor represented, or immediately, where the PA or AA is either present or represented.

Interim measures

Interim measures are 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.
Where an interim measure is in place at the time that a final measure of conditions or suspension is imposed at the conclusion of the fitness to practise process, 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.

⁹Article 13(1) and (2) of the Order.

¹⁰ Usually nine months for performance assessments and three months for health and English language assessments.

¹¹Rule 53(1).

¹² Rule 53(2).

¹³Article 13(2) of the Order.

¹⁴Rule 53(1).

¹⁵ Rule 53(2).

¹⁶ Article 9(1)(b) of the Order.

¹⁷ A final measure of conditions can only be imposed for up to a maximum of 12 months. Where the final measures bandings indicate that a review should be directed, this is because there is likely to be a current and ongoing risk to justify a final measure of conditions being imposed for longer than 12 months, the bandings below indicate that a review of conditions should be directed.

¹⁸ The GMC will confirm whether testimonials have been verified. This involves checking they are authentic, and the authors are aware of the circumstances of the allegation(s) about the PA or AA’s fitness to practise. Verification may have been completed by the GMC or the PA or AA’s legal representative.

¹⁹Rule 53(1).

²⁰ Rule 53(2).

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