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Scrutinising final fitness to practise decisions

Recent Court judgments

Law - Appeal - Gavel Since our last newsletter, the High Court has given its judgment in the second General Medical Council (GMC) Appeal where the Authority exercised its discretion to join as an interested party. This was in the case of Dr Nwachuku. Whilst the issues that arose between the parties about interpreting the new legislation had been addressed by the Jagjivan determination, we attended the hearing to assist the Court. This was an appeal by the GMC against the determination by the Medical Practitioners Tribunal (MPTS) on 19 January 2017. The GMC appealed the MPTS decisions on the grounds that they were not sufficient to protect the public. The MPTS had neither found Dr Nwachuku’s fitness to practise impaired by reason of his misconduct, nor imposed a more serious sanction, issuing only a warning instead. 

Dishonesty and the seriousness with which it should be considered

The registrant was a hospital doctor making the transition into General Practice. He carried out three locum night shifts at a hospital over Friday, Saturday and Sunday nights, without obtaining the approval of his supervisor in the GP programme. He had been asked by a senior colleague not to leave the hospital without conducting an adequate handover. However, Dr Nwachuku left two hours early from his Sunday night to Monday morning shift, did not conduct a handover and left the hospital without adequate cover. He then went to work as a GP without resting. He subsequently submitted a claim form for the locum shifts which indicated he had remained at work on that Monday morning until 08:30, when he had in fact left at 06:00. It was alleged that this was dishonest.
 
We were pleased to note that the Court referred to a number of the principles established in dishonesty cases and the seriousness with which dishonest acts ought to be regarded. We rely on these principles when we bring our own appeals for final fitness to practise panel decisions which we consider are insufficient to protect the public. This included reference to two of the Authority’s own successful appeals (in both Uppal and Ghaffar, our overriding concern and one of the main grounds for our appeal was that the Panel had not treated dishonesty seriously enough as the Panels in both these cases had found the registrants not impaired). The Court concluded that the decision of the MPTS was insufficient and the case has been remitted for a new hearing.

Cases waiting to be heard by the Court

We are currently waiting for four cases to be heard by the High Court. We have appealed these cases because we consider the final fitness to practise panel decisions were insufficient to protect the public. The Authority is also an interested party in one further GMC appeal which is listed for hearing. 

NEW - Fitness to Practise learning points digest

Learning digest 
We recently distributed to the regulators our first Learning points digest. We identify learning points as part of our scrutiny of the regulators’ final fitness to practise panel decisions and feed them directly back to the regulators. However, we thought it would be useful to bring some of the key points together in one document.
 
The aim of the digest is to summarise learning points to help improve regulators’ processes and procedures and eventually incorporate them into their determinations. Each digest will focus on a theme we have identified as part of our scrutiny of final fitness to practise panel decisions. The first digest concentrated on the quality and level of detail in determinations. It included relevant case law and examples of what makes a good determination. In summary, determinations should clearly set out:
  • what the registrant has done and what is being alleged
  • what evidence the panel considered
  • why allegations were found proved/not proved and the reasons for this
  • the panel’s judgment on misconduct/impairment of fitness to practise with reasons
  • why the sanction was imposed and how it protects the public
  • whether a review hearing is necessary and, if so, what sort of evidence might assist a reviewing panel.

Performance reviews

Time for a change – consultation on reviewing our Standards of Good Regulation

We are currently analysing responses to our consultation on our Standards of Good Regulation. We received 29 responses from a number of sources, including regulators and the representative bodies of the different professions. During the consultation, we held meetings with the regulators and others to discuss the key questions we raised in the paper. These meetings were extremely valuable and helped us gain a greater understanding of some of the issues and have assisted us in refining our thinking. 
 
An initial paper will go to our Board in November with a full report in January.  We will then develop our proposed approach with a view to a further consultation in early 2018. We envisage that the new Standards could be in place for the 2019 round of performance reviews.

Performance reviews published

Since our last newsletter, we have published three more performance review reports. We carry out our performance reviews as part of our oversight of the nine health and care statutory regulators. We measure the regulators’ performance against our 24 Standards of Good Regulation to ensure that they are protecting the public, upholding professional standards, and maintaining confidence in the professions they regulate. Recent reports are for:

We have just published our performance review schedule for the 2017/18 review cycle. The first deadline for sharing experience is for the HCPC and is 22 December 2017.