What is remediation in fitness to practise?
In broad terms, remediation refers to rectifying or correcting a certain behaviour that has generated fitness to practise concerns. More specifically, in the context of fitness to practise, remediation is where a doctor addresses concerns about their conduct, behaviour or health.
Remediation is where a doctor addresses concerns about their conduct, behaviour or health. Why it is important and what remediation looks like in practice?
What is remediation?
In broad terms, remediation refers to rectifying or correcting a certain behaviour that has generated fitness to practise concerns. More specifically, in the context of fitness to practise, remediation is where a doctor addresses concerns about their conduct, behaviour or health.
The Medical Practitioners Tribunal Service’s (MPTS) “Sanctions guidance for medical practitioners tribunal members and the GMC decision makers” defines remediation as:
Remediation is where a doctor addresses concerns about their knowledge, skills, conduct or behaviour.
Remediation is only possible through reflection to gain insight and from this to demonstrate remediation.
It is important to remember that impairment can be found for range of circumstances which are not limited to clinical errors or misconduct. It can also include, amongst other things, adverse health and/or language proficiency.
Why it is important
Doctors must be fit to practise. When doctors’ fitness to practise is found to be impaired, the General Medical Council (GMC) requires doctors to take steps to address their fitness to practise shortcomings.
Genuine and demonstrable remediation is vitally important for good outcomes for doctors. Through many years of advising and representing doctors, there are many cases that clearly show the importance and significance of demonstrable remediation in achieving positive outcomes for doctors. Please visit our website to read about these cases and the successful outcomes for doctors.
The GMC and MPTS attach considerable weight to demonstrable remediation. For example, the MPTS “Sanctions guidance for medical practitioners tribunal members and the GMC decision makers” states:
To find that a doctor’s fitness to practise is impaired, the tribunal will have taken account of the doctor’s level of insight and any remediation, and therefore these mitigating factors are unlikely on their own to justify a tribunal taking no action.
It further states on the question of mitigating and aggravating factors to consider when deciding on a sanction:
Evidence that the doctor understands the problem and has insight, and of their attempts to address or remediate it. This could include the doctor admitting facts relating to the case, apologising to the patient, making efforts to prevent behaviour recurring, or correcting deficiencies in performance or knowledge of English.
Irremediable concerns
Certain fitness to practise concerns are deemed so serious that, according to the GMC, they are irremediable.
The GMC guidance states that irremediable concerns are “serious or persistent” actions “that, despite steps subsequently taken, action is needed to maintain public confidence. This might include where a doctor knew, or ought to have known, they were causing harm to patients, and should have taken steps earlier to prevent this.”
Please contact us for a free, no obligation assessment of your case.
Demonstrating insight without accepting impairment
Doctors must carefully consider their approach to this. Case law, in the case of Yussuff v General Medical Council, found that a doctor may be able to demonstrate insight without accepting the original findings, however, things are far from simple in this regard. It is highly advisable that you seek expert legal advice in the first instant to discuss your case and the best possible approach to addressing the concerns.
Examples of remediation
The correct remediation will depend on the individual circumstances of each case. However, some common examples include:
- Training courses and learning – Probity and ethics courses in cases of dishonesty, professional boundaries courses in cases involving sexual impropriety or language proficiency training in cases involving language concerns.
- 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.
Often remediation will require a number or combination of some of these. Kings View can advise doctors on the best remediation strategy for their individual circumstances.
Remediate or contest?
In certain cases, a doctor might chose to contest the allegations made against them instead of seeking to remediate which is often a long and expensive process. In these cases, the doctor should seek legal advice.
How long does remediation take?
Remediation is often a long process. It is important that remediation is genuine and demonstrable to ensure good outcomes for doctors facing fitness to practise investigations and other issues. In many cases, remediation steps can take many months to fully achieve.
Kings View are rated excellent and have successfully represented many doctors. We can advise doctors on the best remediation strategy for their individual circumstances.
Is legal representation the answer?
It is widely accepted and proven that legal representation makes a real difference to the outcome of investigations and results in lesser sanctions for doctors.
What is also unquestionably clear is that GMC investigations and MPTS hearings are complex, daunting, prolonged and legalistic leaving doctors stressed and anxious. Where legal advice and representation can have the biggest impact on this, is helping doctors understand the process, what to expect and how to engage with the GMC during an investigation and hearing.
Research has shown that registrant’s engagement and legal representation can impact on decisions about seriousness, and that the lack of legal representation has been identified as being associated with more severe sanctions outcomes in fitness to practise cases, stating:
“Legal representation was seen as important by participants because legal advice could support and guide registrants through the FtP process, which is complex and legalistic. Legal advice was seen as important in aiding registrants to understand regulators’ expectations, especially in terms of the need for registrants to demonstrate insight and perhaps to show evidence of remediation activities. Lack of legal representation was, therefore, seen to potentially have an impact in terms of the seriousness of the outcome for registrants who are perhaps unaware of how to present their case to best effect.”
A compassionate approach to legal representation
The right legal advice and representation is not just about the legalities and technicalities of a case. Our barristers fully understand the stress and anxiety that doctors experience during prolonged GMC investigations.
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 never lose sight of the human aspects of FtP investigations and hearings. We will always give an open and honest assessment of cases, but we will marry that with an approach that also supports health and care professionals through the duration of a case.
“I was not optimistic about the case, I felt that it is a lost case that we couldn’t do much about and especially just before the start of the trial I lost my confidence and was very nervous. Mr McCaffrey was there to prove me wrong. He turned everything around in a victorious , panegyric manner. I was stunned.” – CL
Catherine is professional, empathic and very knowledgeable. She provided all the necessary assistance throughout the long thorough investigation. – AR
A colleague recommended me to Catherine. She was very experienced , professional, empathetic , non-judgemental and listened to me. – Mel
I found myself consumed with dark thoughts, isolated and afraid. Stephen worked with me and slowly but surely formulated a plan not to just to fight my case and win, but to build me back up bit by bit so as to prepare me to face external scrutiny and present with confidence to panels where this was necessary. – FJ
What you can Expect when Instructing Kings View
All clients are entitled to an initial, no obligation and free telephone consultation about their case. During this consultation, we will outline the stages and next steps, including indicative timeframes and fixed price quotations for preparation and representation and confirmed in writing at each and every stage.
We understand that timescales are entirely dependent on the stage you are at in proceedings, what work needs to be done and dictated by internal investigations or hearing dates. We always meet those timescales however should more time be needed, then we will apply for such on your behalf and with your permission.
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.
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