Doctor’s health, GMC self-referral and fitness to practise

In general, self-referral is only considered necessary by the GMC in cases where a doctor’s health might impact on their fitness to practise.

We understand that practising medicine can be very stressful and can take a toll on a doctor’s physical and mental health. In most cases, poor, or adverse, health in doctors can be managed without the need for the GMC to become involved.

There are however times when a doctor’s adverse health is such that is might pose a fitness to practise risk and a doctor might need to consider a self-referral to the GMC. In general, self-referral is only considered necessary by the GMC in cases where a doctor’s health might impact on their fitness to practise.

What is adverse health?

The General Medical Council’s (GMC) Good medical practise explains that adverse health is:

“… a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment”. This includes both physical and mental health.”

GMC Fitness to Practise

According to the GMC, to practise safely, doctors must be competent in what they do. The GMC’s guidance goes on to say that “the public is entitled to expect that their doctor is fit to practise, and follows our principles of good practice described in Good medical practice.” In relation to a doctor’s health, the Good medical practice states:

“…doctors must contribute to and comply with systems to protect patients, respond to risks safely and protect patients and colleagues from any risk posed by their own health.”

When a doctor should consider a self-referral

A referral to the GMC is only necessary when a health condition … poses a risk to patients. The GMC goes on to explain that the following factors are relevant in deciding if a doctor’s health condition is something the GMC need to know about:

there are, or have been, serious concerns about the quality of clinical care provided, and the health condition may have been a contributory factor.
the nature of the health condition may affect conduct or the clinical care provide and

the doctor is not seeking or following treatment and advice, and/or
are not engaging with local support and steps put in place to manage any risks to patients.

the health condition has only recently been diagnosed, is not well controlled, and it’s too soon to know if risks to patients can be appropriately managed by you seeking and following treatment and advice, and/or engaging with local support and steps to manage risk.

It points out however that a referral does not need to be made about a health condition if:

there are not any concerns about a doctor’s conduct, and
there is no risk relating to the clinical care provided, and
a doctor is not working or likely to work. Or, if working, they are seeking and following treatment and advice, and taking steps to manage any potential risk to patients.

GMC Health Assessments

The GMC can refer a doctor to a health assessment if they are of the view that a doctor’s health may adversely affect their ability to practise safely.

In brief, two doctors will carry out an examination, assessing the doctor’s current health condition for their reports. Both examiners produce an independent report and do not usually discuss their findings with each other.

The reports cover:

a diagnosis using an internationally recognised classification system
whether you are fit to practise either generally, on a limited basis, or not at all
any recommendations about the management of your investigation.

Recommendations may include allocating a medical supervisor to report on a doctor’s progress, or attending a support group to deal with substance use disorder. If a doctor disagrees with the report, they can get their own report and submit it as evidence.

Health assessments can also include a psychiatric assessment or drug/alcohol screen if the concerns relate to mental health or addiction issues.

Self-referral – Approach with caution

Doctors are advised to seek legal advice prior to making a self-referral to the GMC. A self-referral made in error or unnecessarily can result in unnecessary stress and complication for doctors because the GMC open an investigation (“Provisional enquiries”) and this could take up to three months to complete.

In cases where a self-referral would be necessary, seeking legal advice at the earliest possible opportunity will assist doctors with responding to GMC enquiries, setting the most appropriate strategy and can often lead to a conclusion that does not require a full, and adversarial, fitness to practise hearing.

Kings View Chambers

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.

In upholding the appeal, Alan Bates, sitting as a Deputy Judge of the High Court, said:

Failure to assess witness credibility and reliability The panel did not sufficiently evaluate the general credibility and reliability of key witnesses, whose evidence was essential to the charges. It failed to consider factors such as contradictions between witnesses' accounts and whether their testimonies should be approached with caution. This omission undermined the panel's ability to justify its conclusions.
Lack of explanation for preferred evidence The panel failed to provide adequate reasons for preferring the complainants' evidence over the appellant nurse's and the paramedic's. Simply stating a preference for certain witnesses' accounts without detailed justification left the appellant without a clear understanding of why her evidence was rejected.
Errors in evidence evaluation The panel assessed each charge in isolation without considering broader patterns or contextual evidence. It failed to recognize that inaccuracies in one allegation (contradicted by CCTV) could cast doubt on the reliability of witnesses' accounts in other allegations, leading to flawed conclusions.
Improper handling of contextual evidence The panel neglected to evaluate the behaviour of the complainant nurses during the investigation, which was relevant to determining their credibility. Additionally, it overlooked the appellant nurse's claims that the allegations were fabricated to remove her from her managerial position.
Insufficient reasoning for findings The panel provided inadequate reasoning for its findings of misconduct. It did not fully explain how the evidence supported its conclusions, including why the NMC had met the burden of proof for each disputed allegation. This failure left the appellant with unsubstantiated conclusions, undermining the credibility of the process.

Lessons

This case highlights several critical considerations for fitness to practise tribunals. One key lesson is the importance of thoroughly evaluating the credibility and reliability of witnesses, particularly when their testimony is central to the charges. Without such assessments, the accuracy and fairness of the tribunal’s findings can be compromised. Witness accounts must be examined not only in isolation but also in a broader context, taking into account patterns and inconsistencies to achieve a holistic evaluation.

Additionally, tribunals must provide clear and rational reasoning for their decisions. Merely preferring one witness’s account over another without detailed explanations can lead to procedural unfairness. Ensuring transparency in decision-making fosters trust in the process and supports robust outcomes. Tribunals must also maintain procedural fairness by upholding the burden of proof on the prosecuting body. Accused parties should never feel pressured to disprove allegations, as fairness is crucial to preserving the system’s integrity.

Finally, the impact of procedural delays cannot be underestimated. Prolonged proceedings can cause undue harm to the accused, affecting their career and reputation. Timely resolutions are essential to upholding justice while minimizing unnecessary stress on all parties involved. By focusing on these principles, fitness-to-practise tribunals can enhance the fairness and effectiveness of their proceedings.

Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.