Policy responses and statements

Name of organisation:

General Medical Council

Name of policy document:

Proposed changes to the Indicative Sanctions Guidance for Fitness to Practise Panels - March 2008

Deadline for response:

9 May 2008

Background: The Indicative Sanctions Guidance was first published in 2001 for use by the Professional Conduct Committee following consultation with a number of interested parties including patient groups, the BMA, defence societies and the legal assessors. It is a living document, revised from time to time, most recently in April 2005 to take account of the reformed fitness to practise procedures.

The Indicative Sanctions Guidance provides a crucial link between 2 key regulatory roles of the GMC: setting out clearly what is expected of all registered doctors and taking action when those expectations have not been met. It provides an authoritative statement of the Council's approach to sanctions on registration. The medical and lay panellists who sit on the Panel are required to take account of the Guidance and refer to it in their determinations.

The Council of the GMC recently agreed to make a number of proposed changes to the current Indicative Sanctions Guidance.

COMMENTS ON
GENERAL MEDICAL COUNCIL
PROPOSED CHANGES TO THE INDICATIVE SANCTIONS GUIDANCE FOR FITNESS TO PRACTISE PANELS - MARCH 2008

The Royal College of Physicians of Edinburgh is pleased to respond to the GMC on Proposed changes to the Indicative Sanctions Guidance for Fitness to Practise Panels - March 2008.

General Comments:

1. We welcome this document and the guidance it provides.

2. Overall, the length and detail of the document achieve a reasonable compromise between clarity and comprehension. However, we advise the inclusion of a table summarising the sanction options available.

3. The emphasis on matters of sexual misconduct is understandable given the changes brought about by the internet, and the high media profile. However the detail on this topic seems disproportionate to the rather brief guidance on matters of poor clinical practice, research misconduct and personal health issues.

4. Guidance on sanctions inevitably involves some guidance on the conduct of panels. We would therefore welcome a statement that panellists must examine the facts before them dispassionately and deal with doctors honestly and fairly in the same way that they expect doctors to attend their patients. This is particularly important if the civil rather than the criminal standard of proof is to be applied.

Specific Points:

5. Paragraph 7 - Link to Good Medical Practice: The emphasis on Good Medical Practice as the basis for decisions, and the directive to panellists to refer to it, are welcome. However, obliging the panellists to explain how Good Medical Practice has been breached would enhance the clarity of the process and provide doctors with assurance that the links with Good Medical Practice are clear and precise.

6. Paragraph 25 - Mitigation: Mitigation is a difficult concept if sanction is not punishment. Further clarity on this point, and what evidence is acceptable for mitigation, would be appreciated.

7. Paragraph 63-64 - Illness: We realise that if a doctor is ill and fails to recover, continued suspension may be necessary to safeguard the public interest even if the circumstances which led to the original decision regarding impairment of fitness to practice were minor.

8. Paragraph 68 – 71 - Erasure: One example is given where erasure was applied with the reputation of the profession overriding the fortunes of the individual. In another example, erasure was not applied despite public demand because although there were clinical mistakes, the public was not endangered. These two examples are potentially confusing for panellists. The previous guidance that the purpose of sanction is to protect the public rather than punish the doctor (paragraph 17) could perhaps be re-stated here.

9. Paragraphs 110 – 115 - Immediate orders: With regard to immediate orders, the guidance points out the onus on employers to make contingency arrangements in the event that immediate suspension is applied. We would advise adding that this in no way prejudges the outcome of the panel and should not be seen as a negative act against the doctor.

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939

[14 May 2008]