The GMC's disciplinary procedures vary according to the type of case. There are up to four stages in the process.
Where a case is referred directly to the GMC, a member of staff (a "caseworker") will be assigned to the investigation, and will be responsible for gathering all the necessary information. This will involve taking a written account of the complaint from the person who is complaining (the "complainant"), getting hold of any relevant medical records or reports, and obtaining details of any concerns that have been raised - and any action that has been taken - at a local level (e.g. by the employers of the doctor in question). It will also be necessary, at this stage, for the caseworker to obtain information from the doctor about whom the complaint has been made. He or she will be provided with details of the allegation, and asked for comments. The complainant will then be given the opportunity to respond to any comments the doctor makes.
Cases that are referred to the GMC by a local disciplinary body (e.g. following a hospital's internal review) may bypass this stage, because all the work involved in it will already have been accomplished.
If, after putting together all the relevant information, it is decided that the case needs to be considered further, it will be referred on to the next stage: screening.
When a case is submitted for screening, it is assessed by one or more members of the Council (who are known as "screeners"). The screeners' first responsibility is to decide whether the case should be pursued. A medical member of the Council always reviews a case first, and can refer it on without further ado. However, if the medical member advises that the case should not be pursued, the GMC's procedures demand that a lay member of the Council has to review it, too. This means that a case that has been accepted for screening by the GMC will never be rejected without being assessed by at least one medical member of the Council and at least one lay member. Even when a complaint is not pursued by the GMC, the doctor is informed that a complaint has been made, and the details are kept on file for three years so that, if similar concerns are raised about the same doctor, the original complaint can be reconsidered.
The screeners' second responsibility is to decide, where a case is to be pursued, which of the GMC's procedures would be most appropriate for further action. The screeners have to decide whether a case relates to conduct, performance, or health.
The most serious cases are categorised as being to do with conduct. This may be because a doctor is accused of deliberately behaving in an inappropriate manner, but it may also be because he or she has not only failed to live up to proper standards, but has blatantly ignored them. It is easy to see how a question of substandard performance becomes a question of improper conduct if it appears that a doctor, for one reason or another, "should have known better" (a good example would be when a doctor has not taken seriously the concerns of colleagues about the level of his or her performance).
When complaints are judged to relate to performance or health, they are referred straight to the relevant part of stage four (final hearings). When a complaint is judged to fall into the category of conduct, it will be referred to one or other of the steps in stage three (preliminary proceedings).
Preliminary Proceedings Committee (PPC): Where a doctor is accused of serious professional misconduct, he or she will receive formal notice of the particular allegations from the GMC. The doctor then has a further chance to comment. The next step is for the case to be considered by the GMC's Preliminary Proceedings Committee (PPC). This is a panel of medical and lay members which meets in private, to discuss the case. Once they have reviewed the evidence, they have several options open to them:
They can decide that the case should not be pursued. This can be without any action being taken (if they conclude that the case is unfounded). Alternatively, if the PPC believe that there is a case to answer, but it is not serious enough to demand further proceedings, they can conclude the case by issuing formal advice to the doctor about his or her future conduct (a sort of "written warning"). They can refer the case to stage four private hearings (Performance or Health proceedings - see below). They can refer the case to a full, public, stage four hearing (Professional Conduct Committee - see below). Cases can only be listed for this kind of public hearing by the PPC, whose job it is to decide whether the allegations against a doctor are strong enough and serious enough to demand detailed consideration in public. In addition to this step, the PPC also have the power to refer the case to the Interim Orders Committee, if they believe that there is an urgent need to restrict the doctor's practice (see below). Interim Orders Committee (IOC): This stage is reserved for the most serious of all cases, where it is believed that the doctor about whom a complaint has been made poses a real and immediate risk to the public. In such cases, a doctor's right to practise may be restricted or suspended while full hearings are carried out. Such orders are a temporary measure, and will always be followed by further investigation.
The final sanction available to the GMC in the investigation of a case is a full hearing. Such hearings usually take one of three forms:
The GMC's Professional Conduct Committee (PCC) is made up of Council members. Its inquiries are the GMC's highest level of hearing. Proceedings are held in public, with full legal representation available to all of the participants. Much like in a criminal case, where proceedings are pursued by the Crown and not by the victim of an alleged crime, cases that are referred to the PCC are brought by the GMC against the doctor. This means that, though a case will almost inevitably involve a doctor's patients as witnesses, the case is not between doctor and patient.
The GMC's solicitors will prepare the case by taking witness statements, obtaining expert reports, and collecting any other information that will support the case against the doctor. The doctor's legal representatives will put together a defence to the allegations in a similar way.
The hearings are conducted in front of a panel of members of the PCC (normally seven, including two lay members). There will be one or more charges against the doctor which the GMC's lawyers are required to prove. The doctor's lawyers will present evidence to refute the allegations and/or to explain the doctor's conduct ("mitigation"). Witnesses are called by both sides, and answer questions from the GMC's lawyers, the doctor's lawyers, and the panel themselves.
When the PCC has heard all the relevant evidence, the panel will come to a decision about whether any of the charges against the doctor has been proved and, if so, what disciplinary action is to be taken. This can take one of several forms:
The least severe penalty is to "admonish" the doctor (i.e. to give him or her a public, verbal warning about his or her conduct) The doctor's right to practise may be made subject to conditions (e.g. the doctor might be banned from working on a certain type of case, or made to work under supervision). These restrictions can be imposed for a period of up to three years. If the PCC decide to do this, they will usually hold another hearing before the period of conditional registration is due to end. At this second hearing, they will consider whether to continue the conditions, change them or remove them altogether. If they find that the doctor has not met the conditions, he or she may face more serious sanctions, such as those given below. The doctor may be suspended from medical practice for up to a year. The doctor may have his or her right to practise permanently removed. He or she will be removed ("struck off") from the GMC's register, and not allowed to work in medicine again (either for the NHS or privately) If a doctor receives any of the last three penalties listed above, he or she has the right to appeal against the decision.
Cases that are considered in this category are those that relate to concerns about a doctor's performance which, though significant, are not so extreme as to demand consideration by the conduct committees. The GMC asks the doctor in question to undergo an assessment of skills and knowledge, and can compel him or her to undergo such assessment, if they do not cooperate. The doctor is given the opportunity to comment on the assessment panel's findings.
The assessment panel can then recommend one of three things:
In these circumstances, his or her case will be considered by the Committee on Professional Performance (CPP). The CPP panel is made up of a number of GMC members (normally seven, including two lay members). Although the CPP's hearings are not open to the public, they are like a smaller-scale version of the PCC's proceedings (see above). This means that witnesses are called, and the Committee will hear from complainants and medical experts, as well as the doctor whose performance is under question. At the end of the hearing, the CPP has the right to suspend a doctor's registration (for a period of up to a year) or to impose limits on his or her right to practise. At the end of a period of suspension, or when conditions are due to be removed, the CPP will reconsider the case. They will then decide, on the basis of the evidence, whether they can close the case or whether further action is needed. Although the hearings themselves are in private, the CPP publishes findings of seriously deficient performance.
If the screeners (or the PPC) suspect that a doctor is unable to perform his or her duties properly due to ill health, the case will be referred to the health committee. This process is very similar to the performance committee's work: Firstly, an initial assessment is carried out, to see whether there are grounds for concern. Secondly, an attempt is generally made to resolve the problem in consultation with the doctor, which may include voluntary restrictions placed on his or her workload (for example, unsupervised practice may be ruled out). Finally, if the doctor does not cooperate with the GMC's assessment, if he or she refuses to accept the GMC's recommendations, if he or she does not follow the GMC's recommendations, or if his or her health deteriorates further, the doctor can be referred to the Health Committee. In the same way as the CPP, the Health Committee holds hearings in private, and has the power to suspend a doctor, or impose restrictions on his or her practice.