The GMC has issued new guidance for decision makers in determining how to assess the overall risk to public protection (including patient safety, public confidence and upholding professional standards) posed by a doctor in relation to allegations of impaired fitness to practise in a clinical setting during the Covid-19 pandemic.

Key to the new GMC guidance is consideration of “the specific circumstances which arose” that led to the allegations of impaired fitness to practise for doctors saying:

“This guidance provides support to decision makers on how to take into account the circumstances which have arisen as a result of the Covid-19 pandemic and how they impacted on the systems in which a doctor was working and on how they delivered care.”

Approach

The new guidance confirms the age-old principle that each case must be determined on its individual merits.

The specific circumstances the guidance states must be considered are:

• the availability and distribution of resources to provide healthcare and the change in healthcare provision due to social distancing guidance
• the uncertainty and rapidly evolving evidence-base about a novel disease and effective care and treatment
• the disproportionate impact of disease and mortality rates for individuals from black and minority ethnic groups (BME) 
• access and availability of personal protective equipment (PPE)
• staff shortages due to Covid-19 infection or self-isolation requirements
• ways of working outside of normal routine and practice and requirements to work in unfamiliar roles, teams and/or environments at short notice
• changing and sometimes conflicting guidance and protocols, often produced and communicated quickly
• wearing PPE for extended periods of time can create discomfort and impede communication with patients and colleagues
• the effectiveness of existing clinical governance processes creating unexpected challenges for leaders and managers.

Fitness to practise impaired?

Under the new guidance “when considering allegations about a doctor in a clinical setting” allegations could result in impairment:

• being unlikely to raise a question of impaired fitness to practise 
• being unlikely to raise a question of impaired fitness to practise but involving possible failings where there is an opportunity for reflection and improvement
• being unlikely to raise a question of impaired fitness to practise because, while on the face of it serious, information gathered indicated that the doctor’s actions and/or conduct were reasonable in the circumstances of the pandemic; or 
• being likely to raise a question of impaired fitness to practise having taken the circumstances of the pandemic into account.

The GMC fitness to practise during Covid19 guidance also deals with:

1. Allegations in a clinical setting during the pandemic that are unlikely to raise a question of impaired fitness to practise 
2. Allegations in a clinical setting during the pandemic that are unlikely to raise a question of impaired fitness to practise but there are matters that a doctor should reflect on
3. Allegations unlikely to raise a question of impaired fitness to practise because, even though on the face it serious, information gathered indicated that the doctor’s actions and/or conduct were reasonable in the circumstances of the pandemic
4. Allegations in a clinical setting during the pandemic that are likely to raise a question of impaired fitness to practise after having taken the circumstances of the pandemic into account 

On the final point (likely to raise a question of impaired fitness to practise), the guidance states:

• acted in a reckless manner which presented a serious risk to patient safety during the pandemic  
• knew or suspected that they had Covid-19 that they could pass on to a patient and continued to work without consulting a suitably qualified colleague
• refused to wear PPE and treated a patient when the dangers of this were known, where they knew that PPE was available and accessible, and no reasonable justification has been identified
• based decisions on access to or prioritisation of treatment purely on the patient’s protected characteristics where there was no reasonable justification for their decision 
• infringed the patient’s autonomy by failing to obtain their consent to their treatment or care, or that of their legal proxy, where it was possible to do so
• failed to take reasonable steps in planning for a change in a patient’s capacity to make decisions about their care where there was no reasonable justification for their decision.