Doctor’s must manage adverse health or face the prospect of a GMC fitness to practise investigation. I consider what doctors should know and what action might be necessary to avoid an investigation and sanction.
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: The meaning of fitness to practise
Simply put, to practise safely, doctors must be competent in what they do and follow the principles of good practice described in Good medical practice. The Good medical practice states that:
“…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.
Action by the GMC
GMP puts it this way:
“Serious or persistent failures to follow this guidance will put your registration at risk”. In the context of adverse health, action by the GMC is likely where it deems a doctor’s health is compromising patient safety or poses a risk to public confidence in the profession.
The GMC does not need to be involved merely because a doctor is unwell, even if the health condition is serious. However, a doctor’s fitness to practise is brought into question if:
- the doctor is working or likely to work and:
- there are, or have been, serious concerns about the clinical care the doctor has provided, and the health condition may have been a contributory factor.
- the nature of the condition may affect the doctor’s conduct or the clinical care they provide and they are not seeking and / or following treatment and advice,
- and / or are not engaging with local support and steps put in place to manage any risks to patients. This suggests the doctor may lack insight into any risk, or potential risks, their health condition poses.
- the health condition has only recently been diagnosed, is not well controlled and it is too soon to know if risks to patients can be appropriately managed by the doctor seeking and following treatment and advice and / or engaging with local support and steps to manage risk.
If the GMC decide to open an investigation, a doctor will be notified in the usual way. A fitness to practise investigation will months (up to 9 according to the GMC) to complete. It is vitally important for a doctor to seek legal advice if notified of a GMC fitness to practise investigation.
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.
Interim Orders and Undertakings
A doctor, under investigation by the GMC relating to adverse health, might be offered undertakings. Before agreeing to these, doctors should seek legal advice.
Doctors might also face Interim Orders, particularly if they do not comply with GMC direction to undergo an assessment or there is evidence that they are not adhering to treatment plans.
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.
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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.