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30-675: One of the recommendations in the fifth report of The Shipman Inquiry , which was published in December 2004, was for the adjudication stage of fitness to practise procedures to be undertaken by a body that is independent of the General Medical Council (GMC). In 2007 the UK Government released a white paper on The Regulation of Health Professionals. In late 2010 the Department of Health consulted on plans to create

60-533: A body that was separate from the health regulators, to adjudicate on fitness to practise matters. On 2 December 2010, the government announced that they had decided not to proceed with an Office of the Health Professions Adjudicator (OHPA). In July 2011, the GMC approved proposals to separate its presentation of fitness to practise cases from their adjudication. The adjudication would become

90-485: A doctor is fit to be restored to the medical register. They may arise from an application following a disciplinary erasure, an administrative erasure or a voluntary erasure The Shipman Inquiry The Shipman Inquiry was the report produced by a British governmental investigation into the activities of general practitioner and serial killer Harold Shipman . Shipman was arrested in September 1998 and

120-402: A maximum of 18 months. The GMC must apply to one of the higher civil courts if they believe it must be extended beyond 18 months. Any order should be proportionate to the perceived risk and it should be no longer than necessary for the investigation and/or MPTS hearing to complete. If an order is imposed on a doctor then it must be reviewed at 6 monthly intervals. A review can take place on

150-431: A number of recommendations for the reform of various British systems. It called for coroners to be better trained and underlined that better controls on the use of schedule 2, 3 and 4 drugs by doctors and pharmacists were needed. It also recommended that fundamental changes be implemented in the way that doctors are overseen. Specifically, it said, the General Medical Council "was an organisation designed to look after

180-455: A period of one year. If the MPT decide that fitness to practise is not impaired they will consider whether a Warning ought to be issued. If the MPT decide that fitness to practise is impaired they will consider what Sanction should be imposed on a doctor. Where a doctor has been suspended or their registration has been subject to conditions at a fitness to practise hearing it usually follows that

210-480: Is in issue or there are other reasons in the public interest warranting privacy. It is also possible that a hearing can take place 'on the papers'. This is where an MPT is not attended by the doctor or any representatives but the case is considered by reviewing the evidence on the papers only. Unless there are any preliminary matters, the first stage of the hearing is whether a doctor's fitness to practise remains impaired. The GMC will set out their position and then

240-506: Is necessary and it should follow the sanction will be revoked. It may not be revoked immediately because it may have a short time remaining and they may feel it ought to continue to its expiry. The Tribunal do however have a discretion and submissions can be made as to the period of revocation. If the Tribunal determine that a doctor's fitness to practise remains impaired the next stage is to consider if any sanction should be imposed. Here

270-589: The 15 deaths Shipman was convicted of, it concluded that Shipman had killed 250 patients, starting in 1971 while he was working in Pontefract General Infirmary. Though the majority of his victims were elderly, there was a strong suspicion that he had killed one patient aged four. The report rejected claims by a prisoner, John Harkin, who knew Shipman while he was in Preston prison, that Shipman had confessed to 508 deaths. The report made

300-551: The 2004 Rules, although there is no statutory definition of what constitutes 'impairment'. The MPT's frequently refer to Dame Janet Smith in the fifth Shipman Report, as adopted by the High Court in CHRE v NMC and Paula Grant [2011] EWCH 297 Admin. In particular, the Tribunal consider whether the findings of fact show that a doctor's fitness to practise is impaired in the sense that a doctor The MPTS maintain decisions publicly for

330-757: The EU. In October of the following year, the first doctors from the EU were disciplined following inadequate performances in tests that the MPTS itself had requested. David Pearl became the first Chair of the Medical Practitioners Tribunal Service on 11 June 2012, after being appointed through an independent process in February of that year. Caroline Swift succeeded him as chair in August 2016. There two main types of hearing constituted by

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360-469: The IOT is an interim process. For example, if the allegation is that a doctor's health is causing practise difficulties, the GMC may seek a condition limiting hours of work while they investigate. The restrictions may be imposed if it is found that it is necessary to protect the public, protect a doctor or their health or it is in the public interest to do so because proper standards of behaviour or confidence in

390-554: The MPTS: interim orders tribunals and medical practitioners tribunals. Medical Practitioners Tribunals can be further divided into new fitness to practise hearings, review hearings, restoration hearings, and non-compliance hearings. Upon the GMC commencing an investigating they may at any stage make a referral to the Interim Orders Tribunal ("IOT") to restrict a doctor's practise and registration. As its name suggests

420-458: The Tribunal must consider what sanction if any is appropriate and they have to be considered in order of increasing severity. At the sanctions stage of the hearing both the GMC and the doctor can make, submissions, adduce evidence and address the MPT on what they consider is the appropriate sanction decision. At the end of each stage the MPT will announce its decision giving reasons for its conclusions. A restoration hearing will determine whether

450-400: The Tribunal will list a review hearing to reconsider the sanction and safe resumption of practise. The review hearing is not another opportunity to challenge or test the facts in relation to the allegation, the review Tribunal will review the findings of the fitness to practise tribunal or any previous review tribunal. Review Hearings are usually heard in public except where a doctor's health

480-492: The allegations. There are occasions where these issues alone take a day or more to deal with. The first stage is the facts stage, in the ordinary run of cases the GMC will go first, setting out the allegations, calling their witnesses who will be sworn in and confirm their statements. Assuming the doctor is in attendance they will then be cross-examined by the doctor with the purpose of testing their evidence and as required disputing facts, highlighting weaknesses or putting to them

510-462: The case will conclude. A doctor may elect not to provide evidence but may risk an adverse inference being draw from the omission. If no facts are found proved the hearing ends. If some or all of the facts in the allegation/s are found proved the MPT will move to consider whether a doctor's fitness to practise is impaired which is Stage 2 of the hearing process. This is referenced in Rule 17(2)(k) of

540-406: The doctor their position. In terms of evidence a doctor may include certificates of courses they have attended, statements from colleagues, written reflections, PDPs and witness statements which address the concerns following from the fitness to practise hearing or previous review hearing. If the Tribunal determine fitness to practise is no longer impaired they will decide that no further sanction

570-426: The doctor's version of events. If at the end of the GMC's case the evidence is such that the allegations appear unprovable a doctor can make an application to discontinue the case under Rule 17(2)(g). If the case does proceed a doctor can adduce relevant evidence and any witnesses in support of their defence. They will likely be cross-examined by the GMC's representative. If the facts in the allegation are not proven

600-413: The final form of the allegations will have been sent to the doctor by the GMC. The hearing will take place before a Tribunal of three members comprising a legal qualified chair, a medically qualified member and a lay member. A clerk will record the hearing and assist with arrangements. If there are any preliminary issues, they are dealt with first. For example, any legal arguments or final amendments to

630-604: The future". Its findings would be made public, though it would be held in private. It was to be chaired by Lord Laming of Tewin . It began work on 10 March and was to produce a report by September 2000. Many families of the victims along with certain sections of the British media called for a Judicial Review in the High Court . It found in their favour and recommended that the inquiry be held in public. The Secretary of State for Health agreed, and in September 2000 announced that

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660-568: The inquiry commenced shortly after he was found guilty of 15 murders in January 2000. It released its findings in various stages, with its sixth and final report being released on 27 January 2005 – by which time Shipman had died by suicide in prison. It was chaired by Dame Janet Smith DBE . While Shipman was convicted of 15 murders, the inquiry in July 2002 established that he had killed at least 284 people, and may have killed as many as 300, although

690-605: The inquiry would be held under the terms of the Tribunals of Inquiry (Evidence) Act 1921. This was then ratified by both Houses of Parliament in January 2001. Lord Laming was replaced by Smith. Dr Aneez Esmail was medical adviser to the inquiry. Smith initially hoped to finish her inquiries by "Spring of 2003". The inquiry was held in the Town Hall in Manchester with proceedings relayed by closed-circuit television to

720-401: The likely sanction is one of the more serious ones beyond an undertaking or a warning that they can impose. Before the hearing directions will be given either directly by the MPTS or at case management hearings. The purpose of these hearings is to ensure that all preparations are made for the substantive hearing. The hearing itself will be listed with at least 28 day's notice to the doctor and

750-488: The papers where there is agreement between the doctor and the GMC. The MPTS publish decisions they take when an interim order is granted. It is published on the MPTS website and the GMC Register but there will be no publication of a doctor's health matters. The GMC will refer a case to the MPTS for a hearing if they believe the allegation is such that a doctor's fitness to practise is impaired, this can be proven and

780-415: The profession must be protected. The hearings are likely to take place remotely by Microsoft Teams and they are usually private. They may be public only if it is in the public interest or a doctor requests it is heard publicly. The Tribunal consists of a legally qualified chair, a medically qualified tribunal member and a lay member. If the IOT does decide some restriction is necessary it may only be for

810-637: The public library in Hyde , where Shipman had lived, in order for the town's inhabitants to follow it more easily. The Administration of the Inquiry was managed by Henry Palin, who was supported by Michael Taylor and later Mark Dillon. Oonagh McIntosh was the Secretary to the Inquiry. There were four main areas investigated: The inquiry found major flaws in the processes of death registration, prescription of drugs and monitoring of doctors. In all, including

840-542: The records kept, with the use of digital recordings, instead of shorthand writers. Specialist advisers were used less often, only in exceptional circumstances. In March 2015, changes to the Medical Act mean that the GMC gained the ability to appeal against decisions made by the MPTS. In 2014 legislation was introduced the GMC gained powers around demanding proof of competence in English from doctors coming from within

870-569: The responsibility of a new body, the Medical Practitioners Tribunal Service. In June 2012 the MPTS assumed responsibility for medical tribunals, with their panels given the power to remove or suspend a doctor's ability to work within the UK. It was expected that the service would handle some 340 doctors' fitness-to-practise hearings a year. The MPTS was located in a dedicated hearing centre in Manchester which has 16 hearing rooms. There were changes in

900-669: The true number could be even higher. The inquiry took approximately 2,500 witness statements and analysed approximately 270,000 pages of evidence. In total the six reports ran to 5,000 pages and the investigation cost £21 million. In May 2001, it was announced that the inquiry would be investigating a total of 618 deaths between 1974 and 1998. On 1 February 2000, the Secretary of State for Health , Alan Milburn , announced that an independent private inquiry would take place into Shipman's activities. It would decide what "changes to current systems should be made in order to safeguard patients in

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