If the General Medical Council’s (GMC) receives complaints or evidence that a doctor’s fitness to practise may be impaired as a result of a physical or mental health issue (also referred to as “adverse health”), it has the power to direct the doctor to undertake a health assessment.
We look at GMC health assessments, what doctors can expect from these assessments, and the role and significance of legal representation during a GMC fitness to practice investigation.
What is adverse health?
The 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
Simply put, to practise safely, doctors must be competent in what they do and follow the principles of good practice described in Good medical practice. The Good medical practice states that:
“…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.”
If a doctor’s health concern calls in to question their fitness to practice, the GMC can direct them to undertake a health assessment.
GMC Health Assessments – An Overview
Under GMC rules, the GMC can direct a doctor to undergo a health assessment under the following circumstances:
- after an allegation has been referred for consideration by a case examiner as part of a fitness to practise investigation;
- after an allegation has been referred to a MPT tribunal as part of a fitness to practise investigation
- where undertakings have been agreed with the case examiners
- where undertakings have been agreed by a MPT tribunal
- following receipt of an application for restoration following erasure by a MPT tribunal or due to administrative erasure
The factors which may indicate the need for a health assessment, include:
- whether there is a possible health problem
- what type of health problem it may be
- whether the health problem has or is likely to affect the doctor’s fitness to practise
- whether the health problem is being managed locally
- whether the doctor is compliant with treatment
In the majority of cases, doctors can manage health related issues and, in general, as long as a doctor can show they are engaging with treatment, there should be no need for the GMC to formally intervene.
You may also be interested in: “Doctors, adverse health and fitness to practise”
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GMC Health Assessments – The Process
The GMC will select two doctors to carry out an examination of a doctor’s physical or mental health, or both. If it needs a more detailed examination, the GMC may refer a doctor to a specialist.
It is also worth noting that if a doctor’s health condition relates to drugs or alcohol use, they will usually be asked to provide a testing sample as part of their investigation.
After the assessment, both examiners will produce an independent report, which means they do not usually discuss their findings with each other.
The reports will cover, amongst other things:
- a diagnosis
- 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.
When the GMC received the health assessment reports, two “senior decision makers” (one medical and one nonmedical) will decide how to progress your investigation. The GMC explains:
“They’ll consider all the evidence gathered during the investigation, not just the contents of the health assessment report.”
They can decide to:
- conclude the case with no further action
- refer to the Medical Practitioners Tribunal Service for a hearing
- agree undertakings with you
- issue a warning (except where the issue relates solely to a doctor’s health)
Can I refuse to take a health assessment?
Doctor’s can refuse to comply with a GMC direction to undertake a health assessment. However, careful consideration should be given to this, and it is highly advisable that doctor’s seek legal advice. Doctors who refuse to take a health assessment are likely to have their case referred directly to a Medical Practitioners Tribunal.
Why legal representation and advice might be necessary
As mentioned, in the majority of cases, doctors can manage health related issues and, as long as a doctor can show they are engaging with treatment, the need for intervention by the GMC is significantly reduced.
However, this is not always the case and, in some cases, doctors will face the possibility of GMC sanctions including erasure. It is always advisable for doctors to comply with GMC directions and to engage with the GMC throughout the duration of a fitness to practise investigation.
GMC Health Assessments – The Process
The GMC will select two doctors to carry out an examination of a doctor’s physical or mental health or both. If it needs a more detailed examination, the GMC may refer a doctor to a specialist.
It is also worth noting that if a doctor’s health condition relates to drugs or alcohol use, they will usually be asked to provide a testing sample as part of their investigation.
After the assessment, both examiners will produce an independent report which means they do not usually discuss their findings with each other.
The reports will cover, amongst other things:
- a diagnosis
- 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.
When the GMC received the health assessment reports, two “senior decision makers” (one medical and one nonmedical) will decide how to progress your investigation. The GMC explains:
“They’ll consider all the evidence gathered during the investigation, not just the contents of the health assessment report.”
They can decide to:
- conclude the case with no further action
- refer to the Medical Practitioners Tribunal Service for a hearing
- agree undertakings with you
- issue a warning (except where the issue relates solely to a doctor’s health)
Can I refuse to take a health assessment?
Doctor’s can refuse to comply with a GMC direction to undertake a health assessment. However, careful consideration should be given to this, and it is highly advisable that doctor’s seek legal advice. Doctors who refuse to take a health assessment are likely to have their case referred directly to a Medical Practitioners Tribunal.
Why legal representation and advice might be necessary
As mentioned, in the majority of cases, doctors can manage health related issues and, as long as a doctor can show they are engaging with treatment, the need for intervention by the GMC is significantly reduced.
However, this is not always the case and, in some cases, doctors will face the possibility of GMC sanctions including erasure. It is always advisable for doctors to comply with GMC directions and to engage with the GMC throughout the duration of a fitness to practise investigation.
In relation to GMC health assessments, there are a number of consideration for doctors where legal advice and representation will greatly assist:
- Before directing a health assessment, the GMC will consider evidence from the doctor to show that their fitness to practise is not impaired as a result of adverse. The GMC said, for example, it would look at “copies of recent or up-to-date health reports – such as from occupational health, your GP or treating physician”. This information and evidence might satisfy the GMC that “the type and severity of the health problem reported is unlikely to affect the doctor’s fitness to practise or pose a risk to patients either now or in the”
- Doctors have the right to submit their own medical reports and assessments. These are often most when the doctor disputes the conclusion of GMC appointed doctors, their conclusions and recommendations.
- A relevant factor is evidence of a doctor’s insight into their condition. GMC guidance makes clear that evidence of such insight “may suggest that a health assessment is not needed and that local management is appropriate”.
Legal advice and representation can greatly assist doctors under GMC investigation – providing advice and guidance on evidence, how and when to engage with the GMC during an investigation and, if required, representing doctors before tribunals and contested hearings.
Legal advice and representation can greatly assist doctors under GMC investigation – providing advice and guidance on evidence, how and when to engage with the GMC during an investigation and, if required, representing doctors before tribunals and contested hearings.
When things go wrong, we are here when you need us
Kings View Chambers has over 30 years’ combined experience representing heath and care professionals at all levels. We are a leading fitness to practise defence chambers that have a proud record of consistently achieving excellent outcomes for our clients.
We are proud to be rated excellent by our clients. As public access barristers, you can instruct us directly without having the additional expense of hiring a solicitor.
It is a well-established fact that healthcare professionals who seek legal advice and representation at an early stage in any fitness to practise process, generally, receive better outcomes and lesser sanctions, if any. We can advise on the right strategy to take and represent you before a fitness to practise hearing.
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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.
