Conditions or Undertakings – A brief overview

The General Medical Council (GMC) or Medical Practitioners Tribunal Service (MPTS) can:

• Agree a doctor’s undertakings (GMC)
• Imposing conditions on a doctor’s registration (MPTS)
• Imposing interim conditions on a doctor’s registration (MPTS)

Undertakings are agreed between the doctor and the GMC, either at the end of an investigation or at a tribunal hearing run by the Medical Practitioners Tribunal Service (MPTS).

Undertakings are offered, in certain cases normally associated with competence of health, where there is evidence that a doctor’s fitness to practise is impaired  but, undertakings are sufficient to protect patients, the public, and address the concerns about the doctor.  The GMC will not agree undertakings where it thinks there is a realistic chance that a medical practitioners tribunal hearing might erase the doctor from the register.

Undertakings might:

• stop a doctor doing certain things (practise or behaviour)
• commit a doctor to only working while supervised
• commit a doctor to retrain
• commit a doctor to being monitored as to their health

Conditions of Practice are imposed on a doctor’s practice by a Medical Practitioners Tribunal and an Interim Orders Tribunal (IOT).  These conditions set out the limits within which the doctor may practise including:

• restrictions on the doctor’s practice
• restrictions to the doctor’s behaviour

• commitments to practise under clinical supervision

• commitments to undergo retraining

Breaches of Conditions or Undertakings

When, following a decision to impose undertakings or conditions on a doctor’s practice, these restrictions will be monitored and reviewed by the GMC’s Case Review team. 

Under GMC Rules (10), the GMC may decide to refer a case to a medical practitioners tribunal if they receive information that any of the following circumstances have occurred:

1. a doctor has not, within the period of 28 days from the date of the letter (or such further period as the Registrar may allow), agreed to comply with the undertakings proposed;
2. a doctor has failed to observe an undertaking they have agreed to comply with; or
3. a doctor’s health or performance has deteriorated, or otherwise gives rise to further concern regarding his fitness to practise.
   

The individual circumstances of every case will be a factor in the GMC’s consideration.  The GMC’s guidance states: 

“A decision on whether to refer to a medical practitioners tribunal will depend on the extent of the breach or the significance of the deterioration in the doctor’s health or performance. As a starting point, the investigation stage test should be considered to determine whether the doctor’s fitness to practise is still impaired. If the decision maker is of the view that the doctor’s fitness to practise may no longer be impaired, he should refer the case to case examiners for a decision before going on to look at whether further steps (if any) need to be taken.”

In particular, the GMC will consider: 

1. The seriousness of the breach;
2. The significance of any deterioration in the doctor’s health or performance and the evidence that supports that assessment;
3. Patient protection. Any decision to continue monitoring of existing undertakings or to amend undertakings needs to be sufficiently robust to ensure patient protection.

As a consequence, minor breaches will not generally lead to a referral to a tribunal, whereas persistent breaches are likely to result in a referral.

Right of Appeal

It should be clear that doctors should take undertakings and conditions seriously.  Before looking at rights of appeal, it is worth saying at this point that doctors who feel aggrieved should seek legal advice before agreeing to undertakings. 

A doctor is entitled to appeal to the High Court or Court of Session (in Scotland) against any decision of a medical practitioners tribunal and the determination will not take effect until either the appeal period (28 days) expires, or any such appeal is determined. Where an immediate order is made, any such order takes immediate effect and continues until such time as any appeal is determined. 

Conditions and undertakings can severely restrict practice and can cause reputational damage.  Doctors should take legal advice at an early stage as a means to avoid conditions and undertakings in the first instance.  Where conditions or undertakings are imposed, the right of appeal exists, but doctors must seek legal advice.

Legal Advice

With over 30 years combined experience, Kings View Chambers have established itself as one of the best when it comes to fitness to practise defence.  We fully understand that fitness to practise defence is not merely about processes and procedures.  We also understand that we are working with people who are anxious and worried about what investigations might mean for them, their professions and the reputations. 

We are proud to be rated ‘excellent’ by our clients.  Our commitment to client care is genuine in both seeking the very best outcomes for our clients, but also ensuring we do what we can to support them through the process. 

Contact us today for a no obligation and free telephone consultation about your case in the knowledge that you are speaking to one of the best in the business.