GMC Health Cases

General Medical Council (GMC) Health Cases - Legal Advice for DoctorsThe General Medical Council (GMC) will investigate a doctors health status (both physical and mental health) in a number of circumstances. A whether a doctor’s fitness to practise is impaired by reason of ill health and/or whether a doctor is suitable to be (re)registered. The GMC will ask independent experts to see a doctor so to assess the doctor’s suitability to work, within restrictions (or undertakings), or at all.

Details of a doctor’s health are kept confidential and any references to ill-health will be heard in private. Even where a case is being heard in public, the panel will go into private session to explore the topic.

A doctor may be asked to undergo a psychiatric assessment or drug/alcohol screen, or to see a specialist physician, in order that the doctor’s physical and mental health can be assessed, and any dependencies or vulnerabilities to be identified. Where a doctor is found to be suffering from ill-health or a drug/alcohol dependency, a treatment plan may be recommended.

A doctor who has suffered from ill-health should compile their own action plan to return to work and an action plan to keep well. This can be discussed with their GP or health assessors.

The clinicians that the doctor is asked to see are referred to as Health Assessors or Health Examiners. These clinicians must abide by a code of conduct for health assessors: Standards for Health Examiners (GMC). An assessment should not be feared by a doctor going through the process.

A doctor who refuses to undergo a health assessment and adhere to a suitable and proportionate treatment plan may be at risk of being suspended from practice (by an Interim Orders Tribunal (IOT)) until the doctor complies with the recommendations of the clinicians and the requirements imposed by the GMC. [A doctor may appeal an IOT decision relating to health matters. By way of example, in the case of OTTO IJSSELMUIDEN v GENERAL MEDICAL COUNCIL [2018] EWHC 1199 (Admin), the appeal court declined to interfere with an interim order that had been imposed on a doctor who had declined to undergo a health assessment. The court made further observations that any ‘new evidence’ should first have been adduced at an IOT hearing. (April 2018)]

The GMC Interim Orders Tribunal may make it a condition of practice that the doctor remains abstinent from alcohol or drugs, or that the doctor complies with a programme of treatment or medication, if the doctor is to remain in practice. See, also, our Doctors and Misuse of Alcohol page, and our Doctors and Misuse of Drugs page.

Alternatively, the GMC may agree undertakings with the doctor (with is akin to a contract between the GMC for the doctor), which reduces the formality of the process. For an example of the wording of GMC undertakings, see our article on the subject: GMC Undertakings

GMC case examiners (a lay person and a doctor) make decisions about the appropriate response to health concerns raised about doctors. See the GMC’s  Guidance for Decision Makers in assessing health on the impact of conduct (2015)

For guidance on undertakings and conditions of practise in health cases, see the GMC’s publication: Information for Doctors who have Undertakings or Conditions that affect their Practice

Back to Health (Return to Work) Plans

Where a doctor has been unwell, such that their ill-health has impacted on their ability to practise, it would be sensible for them to devise a ‘Back to Health Plan’ or Return to Work Plan, as part of their personal assessment of their own needs. They should seek to identify permanent or temporary changes that will provide them with the optimum chance of returning to practice. Such considerations might include their making permanent changes in their personal life to improve their mental wellbeing, or to take steps to overcome a physical disability, or mitigate the risk of becoming unwell again in the future (putting in place a structured approach to recognising and minimising risk, and to reduce the amount of sick time that they need to take off).

On occasions, there may be some illnesses that require doctors to self-report when they are unwell, and to take time off to recover from an acute episode (whether a physical or psychological illness). In some instances, the plan will need to refer to specialist support or clinician involvement on an ongoing basis.

The GMC/MPTS will occasionally want to hear from a doctor about how they will manage their heath in the future, where their ill-health has had an impact on their conduct at work or in their private life, particularly it their conduct has brought the profession into disrepute or has put patients or other staff at risk of harm.

Additionally, it should be borne in mind that there are many protections in the workplace afforded to people who are unwell, including the provisions of the Equality Act. If an employer is unsympathetic, a carefully worded, polite and disarming letter might be enough to prompt them to become more supportive of their doctor employee. We have had a lot of experience of this letter writing approach working, over the years.

For further information, see our article on devising Stay Well Plans

GMC Health Cases - Case Law

Natural Justice Principles

In Crompton  v GMC [1981] 1 WLR 1435 it was held that it was contrary to the principles of natural justice for oothers to see psychiatric evidence that the doctor has not had disclosed to them.

Conditions Requiring Treatment

In Crompton v GMC (no.2) [1985] 1 WLR 885, it was held that tests or treatment imposed by way of conditions must be reasonable. A doctor did not have to comply with such conditions, if they did not wish to undergo such treatment or tests, but there was a risk that they would be suspended unless the refusal was considered to be reasonable. An application for a variation of unworkable conditions could also later be made. See also: Brocklebank v GMC [2003] UKPC – risk of recurrence of medical condition: the likelihood of recurrence needs to be considered. However, ‘The existence of an underlying condition capable of causing serious impairment if it should recur is sufficient to found jurisdiction‘.

Risk of Relapse

In Anjaneyulu v GMC [2001] UKPC 60 it was held that a committee could find continuing serious impairment by reason of a health condition, where the historical medical history made it likely that the doctor would relapse in the future, even if the health condition was currently in remission. (December 2001)

Seriousness of Conduct Aside from Health Condition

Not all health related misconduct need be dealt with by way of a formal health referral. Some misconduct is serious enough to be dealt with as a misconduct case: Crabbie v GMC [2002] 1 WLR 310 (September 2002) ; and Sreenath v GMC [2002] UKPC 56 (October 2002). In R (Rogers) v GMC [2004] EWHC 424 (Admin), where the professional conduct committee was dealing with a conviction case (12 offences of obtaining opiates by prescribing prescription drugs), the question of whether to erase the doctor from the register should be undertaken first, and if not erased, there might then be a referral to the health committee. These cases were decided prior to the current fitness to practise processes of the GMC. The GMC FTP process no longer has a separate health committee. All concerns are dealt with by the same tribunal, the Medical Practitioners Tribunal.

Doctors Defence Service represents doctors who are being investigated by the GMC. Our lawyers have advised and supported a large number of doctors who are/were suffering from mental ill-health, alcohol or drug dependencies, and physical health problems, where the GMC was/is involved. To discuss any matter concerning the GMC’s health assessment procedures, or the advice and support service we provide to doctors, call our team in strict confidence on: 0800 10 88 739