Key Facts

Fitness to practise is the mechanism by which the GMC ensures that doctors meet the standards expected of them. It protects patients while also providing a framework for support and rehabilitation of doctors whose practice falls below the required standard.

GMC Powers

• Investigate complaints from any source (patients, colleagues, employers, police)
• Require doctors to undergo health assessments or performance tests
• Impose interim orders (suspension or conditions) while investigation ongoing
• Refer to MPTS for tribunal hearing
• Outcomes: warnings, undertakings, conditions, suspension (up to 12 months), erasure

Grounds for FtP Investigation

• Misconduct: behaviour falling short of expected standards (dishonesty, sexual boundaries breach, discrimination)
• Deficient professional performance: persistent underperformance despite support
• Criminal conviction or caution: conviction relevant to fitness to practise
• Physical or mental health: condition impairing ability to practise safely
• Determination by another body: regulatory findings from abroad or other UK regulators

Related Processes

• Revalidation: 5-yearly process; doctors must demonstrate they meet standards through annual appraisal
• Responsible Officer: senior doctor in each designated body who makes recommendations about revalidation
• Local performance processes: handled by employer before/alongside GMC referral

When to Raise FtP Concerns

• You believe a colleague's behaviour or health puts patients at risk
• You have witnessed dishonesty, bullying, or discrimination
• You are aware of criminal behaviour relevant to practice
• You believe a colleague is impaired by substance misuse
• A colleague's clinical performance repeatedly falls below expected standards

Raising Concerns — GMC Guidance

1. Consider whether you can raise the concern locally first (clinical lead, medical director)
2. If local routes are ineffective or inappropriate, raise with GMC directly
3. You are protected from retaliation under whistleblowing legislation (Public Interest Disclosure Act 1998)
4. Focus on facts and patient safety, not personality conflicts
5. Document your concerns

Doctor in Difficulty

• May present with: complaints, errors, sickness absence, behavioural change, substance misuse, burnout
• Support available: occupational health, Practitioner Health Programme, NHS practitioner support
• Early intervention often prevents escalation to FtP proceedings
• GMC has health stream for doctors whose fitness to practise is impaired by health conditions

GMC FtP Process

1. Complaint/referral received by GMC
2. Triage: is FtP investigation warranted?
3. Investigation: gather evidence, interview parties
4. Case examiners: decide outcome (no action, warning, undertakings, referral to tribunal)
5. MPTS tribunal: formal hearing with panel (lay and medical members)
6. Determination: facts found, impairment assessed, sanction applied
7. Appeals: to High Court

Interim Orders

• GMC can impose interim orders before investigation concludes
• Interim conditions on practice or interim suspension
• Applied when necessary to protect patients, public interest, or doctor's own interests
• Reviewed regularly

Supporting Doctors Under Investigation

• Practitioner Health Programme: confidential mental health and addiction service for doctors
• BMA support services: counselling, legal advice
• Medical defence organisations: legal support
• Occupational health: workplace adjustments
• Peer support programmes

Prevention

• Annual appraisal and revalidation
• CPD requirements
• Reflective practice
• Clinical governance participation (audit, M&M, significant event analysis)
• Maintaining Good Medical Practice
• Seeking help early for health or performance concerns

Referral Criteria

• Immediate risk to patients: refer to GMC directly
• Local concerns: raise with clinical lead, medical director, responsible officer
• Whistleblowing: follow trust policy; protect under PIDA 1998
• Self-referral: doctors concerned about own health or practice should seek help early

• Approximately 8,000-10,000 complaints received by GMC annually
• Approximately 100-150 doctors erased from register per year
• Most complaints do not result in sanctions; many are resolved at investigation stage
• Health-related cases often have good outcomes with appropriate support and monitoring
• Impact on doctors under investigation is significant: anxiety, depression, suicide risk
• NHS Practitioner Health Programme provides essential support

GMC FtP Outcomes

Good Medical Practice — Four Domains