Restoration to the GMC Register
The GMC Restoration procedure is available to doctors where they have:
(A) accidentally failed to pay the annual registration fee or provide an up to date residential address, leading to a lapse of registration (called ‘administrative erasure’); or,
(B) been erased from the register due to professional misconduct, deficient performance, or ill-health, by way of the fitness to practise process; or,
(C) following Voluntary Erasure.
Administrative Erasure and Restoration
Where a doctor’s registration has lapsed due to history (A), above, the doctor may apply for Restoration in accordance with the Restoration Following Administrative Erasure Regulations 2004 recent amendments). The procedure is usually straightforward but can occasionally throw up problems because of the way a doctor has acted. Where there are doubts about a doctor’s probity or the accuracy of the reasons they have given for the lapse of registration, the GMC might choose to hold a detailed investigation. For that reason, doctors should be diligent about the way they complete their application forms and ensure they do so with probity.
Voluntary Erasure and Restoration
Where a doctor wishes to (C) apply for restoration following a Voluntary Erasure (VE), there is a specific Procedure to be followed: Restoration following Voluntary Erasure.
Substantive Issue Erasure (Strike Off) and Restoration
Where a doctor has been erased due to history (B), above, the doctor will be unable to apply for Restoration for a minimum period of five years from the date of the erasure order came into effect. The fitness to practise restoration legislation will apply to such cases.
The restoration application process is not a simple one and strong evidence of current fitness, remediation, updating and insight will be needed. Very few doctors are restored to the register and so any application needs to be made with great care and consideration, to get it right from the outset.
There will be a restoration hearing where the doctor must persuade the GMC that they are fit to practise again, despite the history of their case. The doctor should attend and give evidence.
The doctor’s past conduct will be scrutinised closely, and any lessons learned. While the process of restoration appears to be formulaic, each case turns on its own facts and bespoke preparation will be needed. Note that certain types of past conduct and convictions will make it less likely that a doctor will be successful. The GMC/MPTS must further the statutory overarching objective to protect patients, maintain standards and act in the public interest. The GMC/MPTS’s restoration guidance for tribunals states this:
“B49 Restoration is unlikely to meet the overarching objective if the doctor was
erased for conduct that was of an exceptionally serious nature such as being
convicted of the following types of criminal offence:
-
-
> murder,
-
> rape or sexual assault by penetration,
-
> sexual offences involving children or adults with a mental disorder impeding
choice. This could include the creation, possession or distribution of child
sex abuse materials, -
> offences involving human trafficking, slavery, servitude and forced or
compulsory labour, -
> extortion and blackmail.”
-
In short, there are certain criminal offences and past conduct that might be deemed to be fundamentally incompatible with the future practice of medicine. Nevertheless, there may be exceptional cases where restoration is justified because the doctor has taken concrete and worthy steps of remediation. The significant passage of time since erasure can also be something that can favour a doctor’s return to practice.
Proactive Steps A Doctor Might Take
A doctor will be assisted if they can go on a clinical attachment but these are not always possible to arrange and there may be fees involved in doing so. Also, the doctor will need to provide evidence of having maintained their competence. It might assist for a doctor to do PLAB training, even if they are unable to formally take PLABS, as it will show a commitment to demonstrate knowledge and skills. It would also assist the tribunal considering the case to see a personal development plan, setting out how the doctor is going to update their knowledge and skills moving forward. It is important for a doctor to reflect, too, on the reasons that they were erased. Showing insight and taking appropriate remediation is essential to achieving success.
A restoration will only be successful if the doctor can demonstrate that they are fit to practise. The onus is on them. Doctors often fail to appreciate that the responsibility is theirs, to show that they have overcome their past conduct and poor decision-making that lead to their erasure. An apology letter to others that they have let down might also assist their case, if they have acted unprofessionally, dishonestly, or harmed patients or others.
Restoration following erasure due to a period of ill-health will require a more specialised approach.
We often assist doctors to identify the aspects of behaviour that require detailed reflection and remediation. We can recommend courses and tutors to assist in some aspects of remediation.
See also the following case law on restoration:-
Case Law on Restoration to the GMC Register
See the seminal case of GMC v Chandra EWCA Civ 1898 (August 2018). This is considered to be a leading case on the principles relevant to restoration. The overarching principle is the main consideration when analysing whether a doctor is fit to practise as a doctor again. The case sets out matters that might be taken into consideration. In essence, the test is:
“having considered the circumstances which led to erasure and the extent of remediation and insight, is the doctor now fit to practise having regard to each of the three elements of the overarching objective.”
See also: The General Medical Council v Chandra (Rev 1) [2019] EWCA Civ 236 which is a qualification on the original judgment. (26 February 2019). Note that the first decision in the High Court was quashed.
Other Cases on Restoration to the GMC Register
In Banerjee v General Medical Council [2015] EWHC 2263 (Admin) – the High Court set out the powers of the tribunal when considering restoration (July 2015) at paragraphs 126 to 130:
-
-
- First, the panel has an inquisitorial function. It does not merely hold the ring; panel members can ask questions in an inquisitorial way.
- Second, despite what was said by both parties and the legal assessor during the “closed matters” discussion, the second panel was not bound by findings of first panel.
- Third, in reaching its decision on the second restoration application the panel had a very broad discretion.
- Fourth, the procedure on a restoration application differs from a misconduct hearing. It does not involve a separate fact-finding stage, and it does not entitle an applicant to an opening submission. There is no complaint about this.
- Fifth, while the panel’s discretion is a broad one, it has only two options as to its decision: it either allows the application or it refuses it. There is no half way house – it cannot allow the application subject to conditions.
-
In assessing whether the restoration hearing had been fair or not, the high court judge had regard to the case of Almeida v. Opportunity Equity Partners Ltd (The Cayman Islands ) [2006] UKPC 44 – The appeal court held that there was no unfairness and that the questioning undertaken by the tribunal was within proper bounds (October 2006).
In Banerjee v The General Medical Council [2017] EWCA Civ 78 – the Court of Appeal held that the restoration hearing (in which restoration was refused) had been fair. (February 2017)
More cases concerning GMC Restoration
Norton v. General Medical Council (GMC) [2002] UKPC 6 – para 15 reference to the change to five years period passing before a doctor can apply for restoration, following erasure (11 February 2002)
Raji v. General Medical Council (GMC) [2003] UKPC 24 – the privy council held that the determination of the issue of restoration should be determined separately from any suspension from making further applications for restoration, unless the parties agree otherwise, so as to ensure a fair and focussed opportunity to deal with each issue separately (19 March 2003).
Gosai v. General Medical Council (GMC) [2003] UKPC 31 – permanent suspension from making further applications for restoration was upheld. At para 23, the privy council held that ‘there is no basis for the assertion that suspension of the right to apply for restoration should be restricted to very clear cases, or should be regarded as exceptional’. (10 April 2003)
Sengupta v General Medical Council [2023] EWHC 1302 (Admin) the High Court set aside certain MPT findings, as was the tribunal’s suspension of her making further applications. A new hearing was directed. (31 May 2023)
We maintain an archive of restoration cases, accessible to our clients: Restoration Decisions
Doctors Defence Service can advise and represent doctors in relation to Restoration to the GMC Register. Our specialist lawyers can advise, in particular, on the GMC Restorations and Licensing Policy and on the steps a doctor might take in order to maximise their prospects of success of being restored to the register.
For information about how to apply for Restoration to the GMC Register, see the GMC’s Guidance on Restoration
An essential document to read is the tribunal’s guidance on whether to grant restoration or not: Guidance for doctors on restoration following disciplinary erasure
See also the guidance for tribunals: Guidance for medical practitioners tribunals on restoration following disciplinary erasure. This is the main document to focus on, when considering how a tribunal will assess the evidence of the applicant doctor.
See also the 2004 Rules relating to restoration: General Medical Council (Fitness to Practise) Rules Order of Council 2004
‘Appeals’ from Restoration Decisions (Refusals)
A doctor who is dissatisfied with a tribunal’s decision to decline restoration can bring proceedings by way of judicial review. There are strict time limits. A judicial review is narrower in scope than an appeal. There is no statutory right for a doctor to appeal.
GMC Power to Appeal a Restroration Decision
The GMC has a statutory power to lodge an appeal where a tribunal has granted a doctor restoration to the register, and the GMC is dissatisfied with the decision. See our Appeals page.
Doctors Defence Service – Legal Advice and Representation in Restoration Hearings, Appeals and Judicial Reviews
To discuss a potential Restoration Application or related matter, Doctors Defence Service legal team be contacted on 0800 10 88 739