What is remediation in fitness to practise?

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.