Fears over impact on doctors as GMC overturns fitness to practise ruling

GMC powers to appeal against fitness to practise rulings risk prolonging stress for doctors, medico-legal experts said, after the regulator successfully overturned a fitness to practise ruling for the first time.

Medical defence organisation (MDO) Medical Protection said it was an 'unjust and unnecessary duplication of powers' to allow both the Professional Standards Authority (PSA) and the GMC to have the right to appeal rulings made by the Medical Practitioners Tribunals Service (MPTS).

The MDO warned that the impact on a doctor undergoing a hearing was already ‘significant’, and extending appeal powers to multiple organisations meant they ‘face the prospect of a prolonged period of stress and uncertainty’.

The GMC recently described its powers of right of appeal – which came as a result of changes made to the Medical Act in December 2015 – as ‘a positive step’ and ‘excellent news for patients’.

The comments follow the first time it used these powers earlier this year, following a case relating to a male cardiologist’s treatment of a female patient.

Fitness to practise

The MPTS initially ruled that Dr Nilesh Jagjivan did not have a sexual motivation for his actions during a consultation in October 2013, during which he was accused of suggesting his patient should masturbate to increase her heart rate.

He was also accused of causing her to remain exposed from the waist up throughout the 45-minute appointment and asking her to perform squatting exercises while she was partially undressed, court documents show.

The cardiologist was found guilty of misconduct in a May 2016 tribunal, but no restrictions were placed on his medical practice after he gave evidence that he did not feel sexual attraction to men nor women and had never been sexually active.

The GMC disputed the ruling in the first use of its powers of appeal, resulting in a high court case earlier this year, in May 2017.

This appeal was upheld by the judges, who ruled that the tribunal’s failure to find Dr Jagjivan’s actions as sexually motivated were ‘wrong and unsustainable’. The case will now be reconsidered at a further hearing.


However, Medical Protection warned that it was unjust for the regulator to have this power, especially when others can already appeal against rulings.

It has previously raised concerns that MPTS panels are supposed to be independent of the GMC, and warned that this power blurs the line between the two.

Rob Hendry, medical director at MPS, said: ‘We remain concerned around the GMC’s newly acquired right to appeal against MPTS rulings.

'It is reasonable that decisions are reviewed to ensure confidence in regulation and ensure the public is protected; however it is an unjust and unnecessary duplication of powers for both the PSA and GMC to have a right of appeal.

‘Regulation must strike the right balance between maintaining standards without being inefficient, overly burdensome or increasing costs to proceedings unnecessarily.

‘The impact on the doctor at the centre of a case is also significant. The regulatory process is complex, lengthy and extremely stressful, and doctors now face the prospect of a prolonged period of stress and uncertainty if the GMC disagree with the decision.'

GMC right of appeal

Anthony Omo, GMC director of fitness to practise, said: ‘Gaining the right of appeal has not only underlined the separation of our investigations from the tribunal service, which makes decisions independently of the GMC, but it also strengthens our role as a patient safety organisation.The GMC has an in-house legal team which ensures the costs of any appeals are kept to a minimum.

‘We have implemented many reforms to our processes to make investigations run shorter and lessen the stress on doctors under investigation, and there are still many improvements we intend to make.

‘But we have an important and overriding duty to patients – this right of appeal has further enhanced our ability to protect patients from the very small number of doctors who seriously breach our guidance and who fail to meet the standards which the public are entitled to expect.’

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