Medical Practitioners Tribunal Research Articles

What are the precise reasons for the disparity in referrals to fitness to practise between international and UK medical graduates?

To discover the precise reasons for referring a doctor to the Medical Practitioners Tribunal Service, and whether there are any disparities between referrals of international medical graduates and UK graduates. Further to consider whether understanding the precise reasons would provide insight into the nature of referrals. We collected and analysed the data from the Medical Practitioners Tribunal Service website over a period of 12 months. There were 228 cases of which 142 (62%) were international medical graduates and 86 (38%) were UK graduates. More international medical graduates were referred for professional misconduct, poor performance and lack of adequate English language. The common reasons for professional misconduct were providing sub-optimal care, sexual misconduct and dishonest behaviour. More UK graduates were referred following convictions due to offences related to alcohol intake and financial dishonesty. There is paucity of good quality information to identify the exact reasons for the disparity. More international medical graduates were referred to the Medical Practitioners Tribunal Service than UK graduates. There was disparity in the nature of the referrals and we hope our findings will inform employers and the regulatory bodies to understand that comprehensive induction, inclusion, mentoring and adjustments are needed to support international medical graduates to mitigate the risks of failure and help them to meet the required professional standards.

Extreme medical misconduct: 49 UK-registered doctors involved in child pornography, dealt with by the General Medical Council 2012-2020.

Between 1 June 2012 and 31 December 2020, there were 49 cases considered by the Medical Practitioners Tribunal Service where a doctor's misconduct involved child pornography. The determinations concerning these cases provided the data for analysis. In 47/49 (96%) the regulatory outcome was erasure from the GMC's Medical Register, ending the doctor's career. 12 doctors had been imprisoned for 1 to 20 years, and 19 given suspended prison sentences. In 33/49 (67%) cases the indecent images of children included one or more video recordings. Some of these were of children (including very young infants) being raped, sometimes for prolonged periods, the video recordings sometimes indicating that the child could be seen to be in extreme pain. The high proportion of erasures reflected the gravity of these cases, coupled with the fundamental incompatibility of sexual misconduct involving children with a career in medicine.

The Concept of Dishonesty in British Medical Discipline

The Concept of Dishonesty in British Medical Discipline

From the Editor

THE LAST FEW YEARS HAVE DEMONSTRATED that the medical community, medical regulators in particular, responded to the chaos of the Covid pandemic in remarkably creative and mostly effective ways. Adoption of the IMLC, expansion of the scope of telehealth, and emergency licensure were ways many jurisdictions used to facilitate adequate access to care during this time.In “How COVID-19 Emergency Practitioner Licensure Impacted Access to Care: Perceptions of Local and National Stakeholders”, Ann M. Nguyen et al reflect on just this in New Jersey.Historically, CME activity was tracked with paper certificates. Painful. Based on a pilot program, the Accreditation Council for Continuing Medical Education (ACCME®) launched a new Program and Activity Reporting System (PARS) in late 2021. In “Regulators Collaborate to Digitize CME for America’s Doctors” Graham T. McMahon and Humayun J. Chaudhry discuss how this change eases the paper burden for physicians.Prompted by the recent US Supreme Court Dobbs v. Jackson Women’s Health decision, David A. Johnson presents “An Historical Perspective on Medical Boards, Disciplinary Actions, and Abortion”. Until Roe v. Wade (1973) medical license revocation by boards frequently stemmed from criminal cases involving abortion. Change is hard. Will history repeat itself in the wake of Dobbs? Are large numbers of such cases once again headed to state medical boards?We broaden our perspectives and consider changes by studying how others conduct medical regulation. Cathal T. Gallagher and David H. Reissner review a series of recent appeals of decisions rendered by the Medical Practitioners Tribunal Service (MPTS) in “The Concept of Dishonesty in British Medical Discipline”.Resistance is a normal and natural response to change. But without change, we would lose the ability to move forward and lose opportunities for growth and progress that would improve our lives as well as the lives of our patients.

Responding to Good Medical Practice Consultation 2022

Responding to Good Medical Practice Consultation 2022

Cross-sectional exploration of the impact of the Dr Bawa-Garba case on doctors’ professional behaviours and attitudes towards the regulator

ObjectiveThis paper examines the impact on doctors’ attitudes towards the General Medical Council (GMC) and on professional behaviours (reflective practice and raising concerns) following the Dr Bawa-Garba case.DesignA cross-sectional survey...

A review of fitness to practise referrals and investigations of ophthalmologists by the General Medical Council in the United Kingdom.

The General Medical Council (GMC) is a public body which regulates doctors in the United Kingdom (UK). One of its main roles is to investigate any concerns raised regarding a doctor. We aimed to study the current trends in referrals of ophthalmologists to the GMC. A request was made to the GMC under the Freedom of Information Act 2000 for all complaints of ophthalmologists received by the GMC between 2007 and 2019, their outcomes and types of allegations. We have also calculated the annual incidences of suspension and erasure. There were 1032 complaints received by the GMC against ophthalmologists in 2007-2019. No actions were taken in 569 cases (55%). GMC investigations were carried out in 347 cases (34%). Sixty cases were referred to the Medical Practitioners Tribunal Service tribunal (6%), some of which cases resulted in suspension (28, 3%) and erasure (11, 1%). The commonest allegation types were Clinical Care, Knowledge, Skills and Performance, Maintaining Trust, Communication, Partnership and Teamwork and Probity. Annual incidences of complaints and serious outcomes between 2009 and 2017 were 30.54 (range 18.7-42.4) and 1.1 (range 0.8-2.0) per 1000 ophthalmologists respectively. There is an overall increase in the number of complaints to the GMC for ophthalmologists from 2007 to 2015 but since then there has been a gradual reduction. The annual incidences of complaints and serious outcomes have remained stable.

Note on Medical Practitioners Tribunal Service

Note on Medical Practitioners Tribunal Service

Permission without Direction: Gross Negligence Manslaughter and Erasure following Bawa-Garba.

This article explores when a doctor convicted of gross negligence manslaughter would be erased from the medical register. The General Medical Council (GMC) sanctions guidance avoids directing the Medical Practitioners Tribunal (MPT) about erasure following gross negligence manslaughter and rulings at the High Court and Court of Appeal argue against any presumption of erasure after a doctor is convicted of gross negligence manslaughter. The Court of Appeal in Bawa-Garba ruled that the sanctions guidance should not be taken to guide the MPT towards erasure after "serious harm to others either deliberately or through incompetence", but merely permits erasure in those circumstances. This approach is consistent with the rest of the sanctions guidance which allows the MPT wide discretion and defends that MPT's case-by- case approach. This promotes decision-making behind closed doors, diminishes the Sanctions Guidance, and makes it difficult to predict when a doctor will be erased after gross negligence manslaughter.

A focused mapping review and synthesis of a priori risk factors associated with medical misconduct

BackgroundMedical misconduct is an international problem. It is judged according to whether a doctor has endangered the health of the public. Little is known about the risk factors associated with...

The Medical Practitioners Tribunal Service: Modernising fitness to practise adjudication.

The Medical Practitioners Tribunal Service: Modernising fitness to practise adjudication.

Government approves plan to allow fitness to practise panels to recoup costs from doctors

The government has approved plans to allow the Medical Practitioners Tribunal Service (MPTS) to recoup costs from doctors. The Department of Health for England has published its report on the responses to its consultation on changes to how the General Medical Council and the Professional Standards Authority work.1 As part of the response the government said that it had approved plans that would allow the MPTS to recoup costs from doctors who had failed to follow its rules or who demonstrated unreasonable behaviour.2 The MPTS will also become a statutory committee of the …

Impairment and sanction in Medical Practitioners Tribunal Service fitness to practise proceedings.

The principal aims of this research were to assess whether, when imposing sanctions, the aggravating and mitigating circumstances considered by the General Medical Council are first considered when determining impairment of fitness to practise and to determine whether the circumstances described by the General Medical Council in their Indicative Sanctions Guidance as warranting erasure from the Medical Register will lead to that outcome. The consideration of specific aggravating circumstances or points of mitigation when determining impairment of fitness to practise was compared to their subsequent consideration by the General Medical Council when deciding on the severity of sanction to be applied. Additionally, the proportion of cases that highlighted aggravating circumstances the General Medical Council deemed sufficiently serious to warrant erasure and the actions taken were monitored. One hundred forty-six cases heard by the General Medical Council between 1 October 2011 and 30 September 2012 met with the inclusion criteria. Fisher's exact test was used to detect a variation from the expected distribution of data. Three of the four aggravating/mitigating circumstances were more likely to be considered when determining sanction having first been factored into the consideration of impairment. There was a statistically significant correlation between both a risk of harm and dishonesty as aggravating factors and the sanction of erasure from the Medical Register. In general, the General Medical Council consider relevant factors at all stages of their deliberations into practitioner misconduct, as required by the determinations in the cases of Cohen, Zygmunt and Azzam; and subsequently follow the guidance within their Indicative Sanctions Guidance document when determining which sanction to apply.

Secret guidance for fitness to practise panels is withdrawn

Secret guidance issued to interim fitness to practise panels has been withdrawn after permission was granted to challenge it in court. A doctors’ defence organisation argued that adverse decisions may have been reached on the basis of erroneous instructions in the guidance. It added that doctors’ defence teams would not have been able to correct these instructions because the guidance was kept secret from them. The Medical Practitioners Tribunal Service, which hears fitness to practise cases brought by the General Medical Council, withdrew the guidance after the Medical Protection Society won permission for an urgent High Court hearing to challenge it. The guidance was included in a document distributed by the tribunal service titled “Circular 34/13.” The circular was issued on 17 December 2013, but doctors and their defence bodies became aware of it only when it was discovered …

GMC seeks to recoup costs from doctors who delay fitness to practise hearings

The GMC’s Medical Practitioners Tribunal Service (MPTS) is seeking the power to charge costs to doctors and their representatives if they unreasonably delay fitness to practise hearings. The MPTS is hoping for changes to the Medical Act that would allow fitness to practise panels to charge either the …

GMC introduces new rules to speed up fitness to practise hearings

The General Medical Council has introduced 15 new rules to speed up hearings of doctors’ fitness to practise at its Medical Practitioners Tribunal Service (MPTS). Thirteen of the rules take effect immediately. One of these is that doctors will not be told in cases where complaints against them have been closed at triage, except those cases concerning vexatious complaints and …