One of the most important steps to protect your medical licence is avoiding what the GMC considers to be the very worst offences.
The 10 most serious offences from the perspective of the General Medical Council (GMC) are:
- dishonesty in role as doctor (eg falsifying clinical records)
- dishonesty to obtain / keep employment (eg falsifying references or qualifications)
- clinical issues / poor patient care (eg failure to diagnose, problems with paperwork, consent)
- inappropriate relations (eg with patients, colleagues)
- patterns of offending (eg demonstrating consistent behaviour)
- prescribing issues (eg theft and forgery)
- lying and covering up (eg failing to admit allegations at hearing)
- misconduct in personal life (eg criminal, sexual, violence, drink driving, fraud, social media)
- lack of remorse (eg failing to apologise and express suitable regret)
- failing to demonstrate remediation (eg failing to undergo process to change behaviour)
To understand why certain offences are deemed more serious than others requires an understanding of what the GMC’s role is – and isn’t.
Public protection versus protecting the medical profession
The GMC previously made clear that it did not exist “to protect the medical profession – their interests are protected by others. Our job is to protect patients.”
The language may have softened somewhat in the last few years – with an increasing emphasis now placed on the role of the GMC in helping to support doctors.
But if you find yourself under investigation, you may quickly find that the GMC is far less concerned about protecting doctors than you first thought – it’s two main concerns are patient safety and maintaining public confidence in the profession as a whole.
Perhaps the most obvious risk to patient safety is poor clinical competence – and this can certainly lead to the imposition of the most serious sanctions, particularly if a pattern of offending can be established.
However, the GMC uses a broader interpretation of patient safety that also includes:
- dishonesty (eg falsifying UK visa, qualifications, CVs and references to obtain employment)
- administrative (eg failing to arrange personal indemnity insurance)
- issues in personal life (eg violent, drunken or sexual misconduct)
Public Confidence in Profession
In addition to the idea of ‘impairment’, there is another main thread of the need for the GMC to maintain public confidence in the profession as a whole. A large part of the MPTS decision process will be about maintaining this very high level of public confidence in doctors as a profession – and so cases where your misconduct could be seen as harming confidence in the medical profession as a whole are much more likely to result in the imposition of sanctions.
This list is the product of years of experience representing doctors at MPTS tribunals, with additional data from the GMC’s own publications.
Protecting your Licence
The GMC has emphasised in recent years that it is less interested in punishing doctors for one-off clinical mistakes that do not form part of a pattern of behaviour.
If the MPTS tribunal finds that your fitness to practise has been impaired or that you risk bringing the profession into disrepute, the future of your medical licence will depend to a large extent on whether or not they feel you can be successfully rehabilitated – or whether on balance they believe you will likely continue to engage in the behaviour in question.
To this end it is important that you can demonstrate:
- one-off transgression, rather than repeated patterns of behaviour
- short-term issue, rather than issues over a prolonged period
- insight into what specific guidance your behaviour breached
- remorse for the detrimental consequences of your actions on others
- that you have made a good faith attempt at remediation (eg engaging with training, mentors, etc)
In some cases, the alleged impairment falls neatly into a single category – for instance adverse physical health or a conviction for a serious crime. In other cases the alleged impairment could be argued variously as negligence, misconduct or deficient professional performance, depending on factors such as the number and seriousness of the relevant offences. If your livelihood is on the line and you are defending a complex case like this you would be well advised to seek the advice of an experienced medical lawyer familiar with the relevant case law.
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.