General Medical Council (GMC) Restoration

GMC Restoration is available to doctors who have:

1. been administratively erased;
2. been erased due to a fitness to practise issue; or
3. voluntarily erased.

Erasure due to impaired fitness to practise

The GMC is unlikely to consider restoration applications until at least 5 years have elapsed from the date of the disciplinary erasure, and applications for restoration following a disciplinary erasure will be referred to the MPTS.

The burden of proof lies with the doctor applying for restoration, which means the onus is on the doctor to persuade a Medical Practitioners Tribunal (MPT) of their current fitness to practise.  A restoration application following erasure due to impaired fitness to practise is not a simple process and detailed supporting documentary evidence, demonstrating current fitness to practise, will be needed.  At the MPT hearing, the doctor will usually be required to give oral evidence and can expect to be questioned by the GMC and the MPT.

Many doctors underestimate the complexity of a restoration application, which means few doctors are successful.

The GMC stipulates that a MPT will consider a “number of factors”, including:

• the circumstances that led to erasure, including the reasons given by the previous tribunal for the decision to direct erasure;

• whether a doctor has demonstrated insight into the matters that led to erasure and taken responsibility for their actions;
• whether a doctor has remediated the previous findings about their behaviour, skills, performance or health and if there is a risk of repetition;
• what a doctor has done since their name was erased from the register; and
• the steps you have taken to keep your medical knowledge and skills up to date.

A MPT could order a doctor to undertake a performance assessment, or health assessment, to assist them with their decision.

Insight and Remediation

Substantial weight is attached to insight and remediation. 

A restoration application following erasure due to impaired fitness to practise needs to be approached with great care and consideration as to the right approach.  Doctors seeking restoration under these circumstances have sufficient time to prepare their case and evidence. 

Doctors should seek expert legal advice at the earliest possible opportunity when considering a restoration application because setting the correct strategy from the outset is crucial to good outcomes.  This is particularly the case for insight and remediation because remediation is often a long process. 

See also: What is remediation?

Kings View can advise doctors on the best remediation strategy for their individual circumstances.  Common examples include: 

• Training courses and learning – Insight Works Training has designed unique and practical courses focusing on impairment, reflection, insight, and remediation at highly competitive prices.
• Reflective accounts – are written statements reflecting on the circumstances of each case to demonstrate that a doctor has gained sufficient insight.
• Supervision – this might be appropriate in cases involving lack of clinical competence or performance.
• Apologising – can be the simplest example of insight and remediation. (Is apologising an admission of guilt?)
• Professional help – Seeking support and help from professional services such as the AA for alcohol abuse issues and/or other professionals for behavioural issues.

Typically, remediation will require a number or combination of some of these.

Medical knowledge and skills

The issue of evidence of maintaining “medical knowledge and skills” needs careful planning and consideration.  The evidence of maintaining “medical knowledge and skills” will largely depend on the circumstances of each case.  It is highly advisable that doctors seek expert legal advice on the most appropriate course of action when considering a restoration application.  A number of things could be considered:

1. Strong and clear evidence of remediation and insight
2. A personal development plan showing how you will, or have, maintained your medical knowledge and skills
3. PLAB training notwithstanding the fact that you might not take the exam
4. In some cases, clinical attachments could be appropriate

Ultimately, the burden of proof rests on the doctor making the restoration application to convince the MPTS that they are fitness to practise.  If you are considering an application for restoration, contact Kings View Chambers at the earliest opportunity for GMC fitness to practise advice, guidance and representation.

Due to an administration error and lapse (“administrative erasure”)

This could happen when a doctor failed to pay the annual registration fee or provide an up-to-date residential address.  Restoration to the GMC register under these circumstances is normally straightforward.  Under exceptional circumstances, restoration due to administrative erasure could result in a formal investigation where, for example, the error was caused by an allegation of deception or another form of misconduct.

Voluntary erasure

A doctor can apply for voluntary erasure at anytime during their registration, including at anytime during a fitness to practise investigation.  The GMC has an adopted process for considering applications for voluntary erasure during a fitness to practise investigation.

Doctors, who have had an application for voluntary erasure approved, can apply to re-join the register.  The process is set out in The General Medical Council (Voluntary Erasure and Restoration following Voluntary Erasure) Regulations Order of Council 2004.

Restoration decisions are referred to GMC case examiners (one lay and one medical) and the accompanying GMC guidance states that granting restoration:

“will be appropriate if the case examiners are satisfied, based on reliable evidence, that the doctor is fit to practise without restriction. Restoration should normally be granted if the concerns are not serious enough to raise an issue of impaired fitness to practise or are not capable of proof to the civil standard.”

The alternative to granting the application is refusal or a referral to the MPTS.

Doctors considering applying for restoration following a voluntary erasure should seek legal advice to discuss the individual circumstances that lead to the voluntary erasure and the best way to approach the restoration application.

The standards set by the General Medical Council expected of registered doctors apply equally to medical students.  A finding of impaired fitness to practise could have lasting and significant implications for medical students.

We also act for, and represent, medical students facing competency, conduct and other fitness to practise proceedings.