MPTS Interim Orders Tribunal Review Hearings

Interim Orders Tribunals (IOT) decide if a doctor’s practice should be restricted while an investigation takes place, and orders must be reviewed six monthly.

Interim Orders Tribunals – A Brief Overview

General Medical Council (GMC) investigations can take many months and even years to complete.  At any point during the investigation, the GMC and/or its Investigation Committee can refer a case to the Interim Orders Tribunals (IOT).   

It is important to note that an IOT does not make findings of fact or determine the allegations against the doctor. Its scope is to decide if a doctor’s practice should be restricted while an investigation takes place. 

In doing so, the IOT must be satisfied that: 

1. in all the circumstances there may be impairment of the doctor’s fitness to practise which poses a real risk to members of the public, or may adversely affect the public interest or the interests of the practitioner; and
2. after balancing the interests of the doctor and the interests of the public, an interim order is necessary to guard against such risk, the appropriate order should be made.

In reaching a decision whether to impose an interim order, an IOT will consider:

1. The seriousness of risk to members of the public if the doctor continues to hold unrestricted registration. In assessing this risk, the IOT should consider the seriousness of the allegations, the weight of the information, including information about the likelihood of a further incident or incidents occurring during the relevant period.
2. Whether public confidence in the medical profession is likely to be seriously damaged if the doctor continues to hold unrestricted registration during the relevant period.
3. Whether it is in the doctor’s interests to hold unrestricted registration. For example, the doctor may clearly lack insight and need to be protected from him or herself.

The IOT may impose either:

• No Order; or
• Suspension Order; or
• Conditions of Practice Order

Review of Interim Orders

Where it imposes an interim order, an IOT must specify the length of the order. The maximum period for which an initial order may be imposed is 18 months (unless extended by the High Court).

In most cases, IOT orders must be reviewed every six months, and thereafter every six months.  The exceptions to the six-month rule are:

1. Where an order for interim conditions has been replaced with an order for interim suspension.
2. Where an order for interim suspension has been replaced with an order for interim conditions.
3. Where the High Court has extended an order beyond the period initially set.

Unless the IOT hearing is held on paper (see below), a doctor is entitled to attend the hearing and have a right to be legally represented.

We will consider the importance of legal representation later, but sufficient to say at this stage that doctors must think carefully before deciding not to attend a review hearing.  IOT hearings can proceed in the doctor’s absence.  Where this is the case, doctors face the increased prospect of worse outcomes.  Doctors can opt to send legal representation to represent them at an IOT.

Request of early review

Following a first or subsequent review of an order, the doctor may request an early review. If three months have elapsed since the date of the immediately preceding review, then the order shall be reviewed as soon as practicable after receipt of a request for an early review. An order may also be reviewed at any time when new evidence relevant to the order becomes available, which may affect the order in place.

Review on the papers

GMC rules allow cases to be reviewed “on the papers” as an alternative to holding a hearing.  ‘On the papers’ means the review of a case by a tribunal or tribunal chair without the attendance of parties (i.e. the doctor and the GMC). 

Reviews on the papers take place when the parties are in agreement as to the outcome. The Chair or Tribunal has the power to maintain, vary or revoke an interim order in line with the agreed submissions made by the parties. The Chair can also determine that a hearing should take place to consider the case. 

Why Legal Advice and Representation is Important 

• GMC Rules – Like with all GMC proceedings, there are strict statutory rules and procedures governing IOT hearings. Expert legal advice and representation will help doctors navigate these to avoid technical pitfalls and mistakes.  Doctors must bear in mind that most IOT hearings will have a legally qualified chair who is part of the tribunal and advises on points of law. Some cases may have a legal assessor who advises the tribunal on points of law, but plays no part in decision making.
• Evidence – Apart from statutory rules, fitness to practise lawyers understand the relevance of evidence, what to present but importantly also how to challenge evidence from the GMC. Both the GMC Presenting Officer and the doctor or their representative may make submissions and adduce documentary evidence. Those submissions are limited to whether, given the circumstances of the case, it is necessary to impose/maintain an order either imposing interim conditions or interim suspension on the doctor’s registration.
• Hearing or review “on the papers” – Doctors will need to carefully consider their approach, whether to attend a hearing or agree to a review “on the papers”. Doctors should seek legal advice if faced with these choices because the wrong approach may result in a worse outcome for the doctor.
• Legally qualified chairs – Most hearings will have a legally qualified chair who is part of the tribunal and advises on points of law. Some cases may have a legal assessor who advises the tribunal on points of law, but plays no part in decision making.
• Appeals – Failing to seek legal advice is more than likely to lead to worse outcomes. Interim order appeals will be costly and take a long time to resolve.  Agreeing a robust and clear strategy with expert legal advice will place the doctor in a much better position and minimise the need for costly appeals.
• Burden of Interim Orders – Ultimately, restrictions on a doctor’s practice might have an adverse impact on their employment, income and/or reputation. It is therefore important that a doctor seeks legal advice at the earliest opportunity. 

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.