Doctors can be issued with warnings under certain circumstances but, warnings can carry significant implications for a doctor’s careers.  What are your options?

GMC Warnings – what are they?

Before we consider the implications and how to respond to the threat of a GMC warning, we will briefly look at what they are and when the General Medical Council (GMC) considers them appropriate.

Warnings are one of the lowest levels of response available to the GMC following a fitness to practise investigation. They do not indicate that a doctor has impaired fitness to practise.  Instead they are meant to direct a doctor towards better practice in the future.

GMC guidance states that:

“A warning will be appropriate where the concerns indicate a significant departure from the principles set out in our guidance, Good medical practice, or if there is a significant cause for concern following assessment but a restriction on the doctor’s registration is not necessary.”

On the whole, warnings are considered at the Case Examiners stage of the GMC’s fitness to practise process.  Based on the evidence before Case Examiners, they might conclude that a referral to a fitness to practise hearing would be disproportionate because the fitness to practise threshold has not been reached.

If a case examiner considers that it may be appropriate to conclude the case with a warning, it will write to the doctor to seek their comments. The doctor has 28 days to provide such comments.

If both case examiners consider that a warning is appropriate and the doctor has not disputed the facts alleged or exercised their right to an oral hearing before the Investigation, the warning will be issued.  If the two case examiners do not agree, the case will be decided at a meeting of the Investigation Committee.

GMC Warnings – why does it matter?

First thing to say is that a warning does not prevent a doctor from holding a licence to practise and does not place any restrictions on their registration.

However, GMC research “has uncovered a good deal of evidence that suggests severe and long-term impacts are occurring for many doctors receiving warnings from the GMC. Many who received warnings report that their current and ongoing employment is adversely affected. Some have been unable to work again at all.”

GMC warnings are publicly visible on the GMC online register for two years, along with a summary of it issued it. After this, the warning will no longer be visible. However and more importantly, the GMC does retain a record of it and can disclose it to employers on request.

The same research referred to above found that:

“Employers react to warnings in a variety of ways.  In some cases warnings are ignored or even ridiculed. At the other extreme the receipt of a warning leads to the end of the employment relationship with the doctor in question.”

GMC warnings can therefore have a disproportionate impact on a doctor’s career and reputation.  In practice, a GMC warning might be a factor in career, career progression and/or the determinative factor in job applications.

GMC Warnings – How to deal and respond to them

Doctors are not obliged to accept a warning.  A warning cannot be issued where the facts alleged are disputed by the doctor.

As already mentioned, doctors have a right of reply before a warning is issued. Doctors have up to 28 days to respond to a request by the GMC which present the doctor with the opportunity to argue their case.  Since a doctor’s response could lead to a decision to close the investigation with no further action taken, careful thought and approach should be taken

It is strongly advisable that doctors seek expert legal advice because careful consideration should be given to the evidence and how this is presented in the response.  This is particularly important because Case Examiners (and the Investigating Committee) can make onward referrals to a fitness to practise hearing.

Secondly, a doctor can exercise their right to an oral hearing before the Investigation Committee.  This will provide the doctor with an opportunity to present evidence and arguments in person (or virtually via video link). Doctors have a right to be represented before the Investigation Committee.  It is again strongly advised that doctors seek expert legal advice and representation.

The Investigation Committee has the same powers as Case Examiners and common law has confirmed that the Registrar of the GMC does not have the power to overrule/review the Investigating Committee, where it imposes a warning.

It should be clear from the above that GMC warnings are significant notwithstanding the fact that they do not indicate that a doctor has impaired fitness to practise.  GMC warnings has the real potential to have a sever and adverse impact on a doctors reputation and therefore career. 

Kings View are expert medical defence barristers with over a decade’s experience in representing doctors facing GMC fitness to practise investigations and proceedings.  We offer doctors a free, no obligation case assessment.   

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.