1. Home
  2. Parties and representatives
  3. Guidance for tribunals
  4. Tribunal guidance for PA and AA hearings
  5. Interim measures tribunal hearings
  6. Step 1a assess the risk arising from the information referred
Interim measures tribunal hearings

Step 1a: assess the risk arising from the information referred

full text alternative for this image can be found using link 'Text alternative: step 1a assess the risk arising from the information referred'

Text alternative: step 1a assess the risk arising from the information referred

Assess the risk arising from the matter referred

  1. To assess the risk arising from the matter referred the tribunal should consider: 
    • the seriousness of the concern or allegation 
    • the likelihood of repetition, and 
    • the weight of the information available. 

The seriousness of the concern or allegation

  1. When deciding if there is a risk arising from the information referred, the seriousness of the concern or allegation will need to be considered. This involves having regard to the nature of the concern or allegation, the extent of any departure from the professional standards and/or the impact of the PA or AA’s health condition on their ability to practise safely and provide care to a sufficient standard. It also means looking at any specific factors that may increase seriousness.

  2. Concerns or allegations about a PA or AA’s fitness to practise can fall on a spectrum of seriousness. Certain types of behaviour or poor performance represent such a significant departure from the professional standards expected that they have a starting point of a high level of seriousness. This is usually because the departure from the professional standards amounts to an abuse of, or interference with an individual’s dignity, and/or breaches the fundamental tenets of the profession to act with honesty, integrity and uphold the law.

  3. The following factors may be seen in any type of case and where present, will aggravate seriousness and increase where on the spectrum of seriousness the concern or allegation lies:
    • the behaviour or poor performance was persistent or repeated
    • relevant fitness to practise history
    • the behaviour was directed towards, or the poor performance involved interaction with, a person with impaired capacity or a person with a particular vulnerability
    • premeditated behaviour
    • predatory behaviour
    • abuse of professional position
    • a reckless disregard for patient safety or professional standards
    • undermining a system designed to protect the public
    • undermining collaborate working
    • putting their own interests before those of patients, and/or
    • an attempt to hide and/or avoid taking responsibility for behaviour or poor performance.
  1. The guidance in the Introduction section should be referred to, to support the tribunal to reach a view on seriousness.

  2. Once this has been done, the tribunal’s view on seriousness should be used to inform their decision on whether one or more parts of the test for imposing an interim measure is met. Concerns or allegations which fall at the higher end of the spectrum of seriousness will usually present one or more risks that require an interim measure to be imposed.

  3. A PA or AA’s failure to comply with a direction to undergo an assessment of their performance, health or knowledge of the English language, or a significant delay in their compliance with an assessment without a reasonable explanation, is not in itself a factor to consider when reaching a view on the seriousness of the concern or allegation. However, a failure or delay can be relevant to the tribunal’s decision on whether the concern or allegation presents a real and immediate risk to protection of the public, the public interest, or the interests of the PA or AA.

The likelihood of repetition

  1. When deciding if there is a risk arising from the information referred, the likelihood of repetition will need to be considered. 

  2. The following may be relevant to the tribunal’s assessment of the likelihood of repetition: 
    • the number of incidents or departures from the professional standards giving rise to the concern or allegation 
    • the nature of the PA or AA’s health condition and whether any impact it is having on the PA or AA is being managed 
    • the recency of the circumstances giving rise to the concern or allegation, 
    • any relevant fitness to practise history, and/or 
    • the PA or AA’s response to the concern or allegation and whether they have shown insight and taken steps to remediate. 

The weight of the information available

  1. The weight of the information available is relevant to the tribunal’s assessment of risk. When assessing risk, an interim measure tribunal (IMT) must remember that it is not making findings of fact, resolving disputes of fact, or deciding whether the PA or AA’s fitness to practise is impaired.

  2. At an IMT hearing, in addition to the information referred by the GMC, the PA or AA can provide documentary evidence for consideration. The IMT may admit any evidence it considers fair and relevant to the issue of whether an interim measure is necessary. However, oral evidence must not be given at an IMT hearing unless the IMT considers that oral evidence is necessary to enable it to reach a decision.

  3. As a referral to an IMT hearing can be made by the GMC at any point after an investigation has been opened, the extent of the information available to the tribunal may vary considerably. 

  4. In all cases, the weight to attach to the information available is a matter for the tribunal’s judgment. However, when assessing the risk associated with the concern or allegation, the tribunal may consider it is appropriate to give greater weight to objective evidence that’s available, such as the outcome of an assessment of the PA or AA’s performance, health or knowledge of English, or to an expert report. 

  5. When a PA or AA is going through criminal proceedings, the level of weight attached to the information available should reflect both the stage of the criminal process the matter is at and the seriousness of the underlying behaviour or performance. This means greater weight should usually be given to a certificate of conviction than to a charge, and similarly greater weight may be given to a charge than an arrest.

  6. Tribunals should be mindful that there are differences between the charging system in England, Wales and Northern Ireland compared to Scotland. In England and Wales, the Crown Prosecution Service (CPS) authorise the police to charge the suspect, with the Public Prosecution Service (PPS) undertaking this role in Northern Ireland. However, in Scotland, the police can charge an individual and then send their report to the Crown Office and Procurator Fiscal Service (COPFS) who will then decide whether to prosecute or ask the police to obtain more evidence. 

  7. This means a charge in Scotland potentially carries less weight than a charge in England, Wales and Northern Ireland because the decision on whether to prosecute takes place after the individual is charged. In these cases, the tribunal should enquire as to the present status of the charge; whether it has been approved by the COPFS or remains with the police.

  8. However, the considerations as to whether an interim measure is necessary are the same in all criminal cases and the tribunal must consider the individual features of the case and the particular facts and seriousness of the criminal charges.

  9. Where there is evidence of insight, the nature, quality and timing will be relevant to how much weight the tribunal attaches to it. And remedial steps that have been completed will usually carry greater weight than actions started by a PA or AA that have not yet concluded. However, evidence of insight and remediation will usually have a greater impact in cases where the concern or allegation falls at the lower end or mid-range of the spectrum of seriousness. 

Assessing risk where it is alleged a PA or AA has breached conditional registration imposed by an AT

  1. Where a referral has been made to an interim measure tribunal (IMT) on the basis the GMC considers there is evidence to suggest a PA or AA has breached conditions currently imposed on their registration following an associates tribunals (AT) hearing, the tribunal will first need to decide whether they are satisfied, on the balance of probabilities, that a breach has in fact occurred.  

  2. Some, or all, of the following factors are relevant to assessing the seriousness of a breach of conditional registration and any associated risk: 
    • if the breach is a one-off or a repeated occurrence 
    • whether patient safety has been compromised, and it places patients at risk of harm 
    • if there appears to have been a wilful disregard of the conditions imposed on the PA or AA’s registration, and/or 
    • whether the PA or AA accepts a breach has occurred, the reasons for it and the level of insight shown about the impact and likely consequences.