Reform of our fitness to practise Procedures Changes to the way we deal with cases at the end of an investigation

1. Reform of our fitness to practise Procedures Changes to the way we deal with cases at the end of an investigation

2. The role of the GMC • Our role is to protect, promote and maintain the health and safety of the public ensuring proper standards in medicine by: • keeping up-to-date registers of qualified doctors • fostering good medical practice • promoting high standards of medical education • dealing firmly and fairly with doctors whose fitness to practise is in doubt.

3. The role of the GMC • Our purpose is to ensure that doctors who practise are fit to do so. We are also concerned with public confidence but our primary purpose is patient protection. • Our concern is current and future fitness to practise and not discipline for past misconduct (See court decisions: Gupta v GMC, Raschid and Fatnaniv GMC, Cohen v GMC). • Mismatch between our purpose and what some complainants want – to ventilate their concerns in public or for doctor to be punished.

4. Our current procedures • We take a cautious approach to cooperation with doctors – only 2% of all fitness to practise cases concluded by cooperation. • The majority of cases are referred for a public hearing. • Hearings are mainly a mechanism to establish disputed facts but also may help to maintain public confidence – evidence tested and decision made in public. • Doctors and their representatives view a public hearing in itself as a form of punishment – stressful and may involve wide media reporting of unsubstantiated facts.

5. Why are we proposing changes? • Key drivers: • To focus on our core purpose of public protection. • To treat doctors fairly and proportionately. • To deal with cases efficiently – especially given increase in the number of complaints about doctors and the complexity of cases.

6. What changes are we proposing? • To introduce greater discussion of cases with doctors, including meetings at the end of the investigation stage, to encourage doctors to accept our proposed sanction. • To introduce a presumption of erasure for doctors who commit certain criminal convictions e.g. murder, rape. • To introduce automatic suspension for doctors who do not co-operate with our investigation.

7. Discussion with doctors • During or at the end of an investigation we will discuss our concerns with doctors in all cases – in some cases this will involve a meeting with the doctor. • We will disclose the allegations, any evidence we have to support it, and the sanction we consider to be appropriate. • The doctor and his legal representative will be given time to share any information we do not have, for example, any mitigating factors. • If the doctor accepts our proposed sanction, there will be no need to refer the case to a hearing.

8. Erasure for certain criminal convictions • At present, we presume that any offence that results in a custodial sentence should be referred to a public hearing. • We propose that conviction for certain offences is incompatible with registration as a doctor e.g. murder, rape. • In those cases, we would like to introduce a presumption of erasure. • Doctors will be able to make written representations. • Unless the representations raise issues that need to be considered by a panel, the doctor would be removed from the register without the need to refer the case for a public hearing.

9. Failure to comply with our investigation • Our guidance for doctors, Good Medical Practice, requires doctors to co-operate with any complaints procedure or formal inquiry into their treatment of a patient. • Sometimes a doctor’s repeated refusal to co-operate prevents us from proceeding with our investigation. • Where a doctor refuses to co-operate it is difficult for us to establish what risk they pose to patient safety. • In these cases, we propose to introduce automatic suspension to ensure that patients are protected.

10. Key issues: discussion/meetings with doctors • Should doctors be able to disclose information on a ‘without prejudice’ basis? • How can we facilitate meetings with doctors to support constructive dialogue? • How should we communicate the outcome of discussions with doctors to complainants?

11. Key issues: discussion/meetings with doctors • How do we maintain transparency and public confidence if the outcome is agreed with a doctor without a public hearing? • How do we maintain high standards of public protection in cases where the evidence is based on witness testimony? • Will signed statements of agreed facts address the risk of a doctor seeking restoration when evidence has deteriorated?

12. Key issues: serious convictions • Are some criminal convictions so serious they are incompatible with registration? • If so, what type of convictions? • Murder. • Blackmail. • Trafficking people for exploitation. • Rape or sexual assault against an adult or child. • Abuse of children: grooming, prostitution or pornography. • Any sexual activity with a child under 13 years old. • Other?

13. Key issues: suspension for non-compliance • Should doctors who refuse to engage with our investigation, where we have made every attempt to seek their engagement, be automatically suspended? • What types of non-compliance should trigger automatic suspension? Intended to deal with substantive non-compliance rather than difficult behaviour. • When will we seek to apply automatic suspension? Intended to provide a mechanism when all other efforts have failed.

14. How will the proposals impact on different groups? • We believe greater co-operation will have a positive overall impact for doctors and complainants. • In particular, vulnerable witnesses may not have the stress of giving evidence to a public hearing. • Doctors or complainants from different cultural backgrounds may react differently to a more consensual approach. • We are consulting with a diverse range of people and propose to monitor the outcome of any changes and assess any unintended consequences for particular groups.

15. Any questions?