In general, self-referral is only considered necessary by the GMC in cases where a doctor’s health might impact on their fitness to practise. 

We understand that practising medicine can be very stressful and can take a toll on a doctor’s physical and mental health.  In most cases, poor, or adverse, health in doctors can be managed without the need for the GMC to become involved.

There are however times when a doctor’s adverse health is such that is might pose a fitness to practise risk and a doctor might need to consider a self-referral to the GMC. In general, self-referral is only considered necessary by the GMC in cases where a doctor’s health might impact on their fitness to practise. 

What is adverse health?

The General Medical Council’s (GMC) Good medical practise explains that adverse health is:

“… a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment”.  This includes both physical and mental health.”

GMC Fitness to Practise

According to the GMC, to practise safely, doctors must be competent in what they do.  The GMC’s guidance goes on to say that “the public is entitled to expect that their doctor is fit to practise, and follows our principles of good practice described in Good medical practice.”  In relation to a doctor’s health, the Good medical practice states:

 “…doctors must contribute to and comply with systems to protect patients, respond to risks safely and protect patients and colleagues from any risk posed by their own health.”

When a doctor should consider a self-referral

A referral to the GMC is only necessary when a health condition … poses a risk to patients.  The GMC goes on to explain that the following factors are relevant in deciding if a doctor’s health condition is something the GMC need to know about:

• there are, or have been, serious concerns about the quality of clinical care provided, and the health condition may have been a contributory factor.
• the nature of the health condition may affect conduct or the clinical care provide and
• the doctor is not seeking or following treatment and advice, and/or
• are not engaging with local support and steps put in place to manage any risks to patients.
• the health condition has only recently been diagnosed, is not well controlled, and it’s too soon to know if risks to patients can be appropriately managed by you seeking and following treatment and advice, and/or engaging with local support and steps to manage risk.

It points out however that a referral does not need to be made about a health condition if:

• there are not any concerns about a doctor’s conduct, and
• there is no risk relating to the clinical care provided, and
• a doctor is not working or likely to work. Or, if working, they are seeking and following treatment and advice, and taking steps to manage any potential risk to patients.

GMC Health Assessments

The GMC can refer a doctor to a health assessment if they are of the view that a doctor’s health may adversely affect their ability to practise safely.

In brief, two doctors will carry out an examination, assessing the doctor’s current health condition for their reports. Both examiners produce an independent report and do not usually discuss their findings with each other.

The reports cover:

• a diagnosis using an internationally recognised classification system
• whether you are fit to practise either generally, on a limited basis, or not at all
• any recommendations about the management of your investigation.

Recommendations may include allocating a medical supervisor to report on a doctor’s progress, or attending a support group to deal with substance use disorder.  If a doctor disagrees with the report, they can get their own report and submit it as evidence.

Health assessments can also include a psychiatric assessment or drug/alcohol screen if the concerns relate to mental health or addiction issues.

Self-referral – Approach with caution

Doctors are advised to seek legal advice prior to making a self-referral to the GMC.  A self-referral made in error or unnecessarily can result in unnecessary stress and complication for doctors because the GMC open an investigation (“Provisional enquiries”) and this could take up to three months to complete.

In cases where a self-referral would be necessary, seeking legal advice at the earliest possible opportunity will assist doctors with responding to GMC enquiries, setting the most appropriate strategy and can often lead to a conclusion that does not require a full, and adversarial, fitness to practise hearing.