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The Medical Practitioners Tribunal Service (MPTS) took over the adjudication of GMC fitness to practise cases in mid-2012. His Honour Judge David Pearl, chairman of the MPTS, spoke to the MDU Journal about his vision for the new service.
Only a very small proportion of complaints and enquiries to the GMC end up at a fitness to practise (FTP) hearing. In 2011, there were just over 200 FTP cases resulting from 8781 complaints. That's little comfort for the individual doctor facing a stressful process that often takes many months to conclude and, in the most serious cases, may result in erasure from the professional register.
David Pearl understands the distress that an FTP hearing can cause. Having overseen the establishment of the MPTS in June 2012, he is now in the process of refining its procedures, ironing out any impediments that have emerged since the service started. One of his main concerns is to reduce the length of time a doctor's fate hangs in the balance while waiting for a decision. This is among several changes he has proposed which, at the time of writing, are being considered by the Department of Health.
The MPTS exists to manage Interim Orders Panels (IOP) and FTP hearings and its stated aim is to ensure high standards of decision-making. It is part of the GMC but operationally separate – a crucial distinction, Mr Pearl explains, especially in relation to the confidence the profession has in the service. 'GMC FTP panels were always independent but the external perception was that the GMC was investigator, prosecutor and decision-maker. It is of immense importance that the medical profession feels that decisions taken in relation to a small number of fitness to practise cases are made by an independent body.'
A separate adjudication function was recommended following the Shipman enquiry, so that the GMC would handle only the investigation/prosecution of cases. As Mr Pearl points out, 'The MPTS now makes the decisions about whether a doctor should continue to work without conditions when his or her fitness to practise has been called into question. We are not here to punish doctors but to make findings of fact and determine if there are risks involved in allowing a doctor to continue to work. We have a duty to protect the public, but also to uphold the reputation of the medical profession.'
After a distinguished career as a barrister and teacher of law at both Cambridge and the University of East Anglia, Mr Pearl was for seven years president of the Care Standards Tribunal where he heard appeals from decisions by regulators, including the Care Quality Commission and OFSTED. The MPTS represented a new and exciting challenge, he says. 'I was attracted by setting up the tribunal and defining how it should operate, and also by the selection and appraisal of panel members. Ultimately, I am responsible for the quality of the MPTS's decision-making at a strategic level.'
Although he doesn't himself sit on the panels (though he often observes) Mr Pearl is involved in hands-on case management and has seen at first hand where procedures might be improved. A robust case management system is a top priority. 'A lot of time is lost on procedural issues at the start of a hearing which delays the decision-making part of the process, to the detriment of the doctor. I believe these should be ironed out before the hearing, and any decisions taken be binding on the panel. It is one of the changes I have proposed to the GMC and the government. I hope it will be in place later this year.'
Other changes include developing the quality assurance function of the MPTS by providing better explanations for decisions and monitoring why cases are adjourned – for example, if IOP panels are being required to hear more cases than they can fit in in a day.
More far-reaching improvements are on the distant horizon. They include introducing a costs regime, removing the need to appoint legal assessors in all cases, and giving the GMC a statutory right to appeal MPTS decisions it believes are wrong. 'If this passes into legislation, I believe it will underline once and for all that the decisions on fitness to practise are made completely independently of the GMC,' concludes Mr Pearl.
If you have been notified of a GMC complaint against you, please contact the MDU as soon as possible.
11 August 1944
University of Birmingham (LLB)
Queens' College, Cambridge (LLM, MA, PhD)
Called to the Bar
Gray's Inn, 1968
Lecturer in Law, Fitzwilliam College,
Professor and Dean of Law,
University of East Anglia
Circuit judge 1994-2012
Senior judicial appointments include:
President, Immigration Appeal Tribunal
President, Care Standards Tribunal
MPTS panels hear GMC cases in which, after the investigation stage, the doctor's fitness to practise is thought may be impaired for reasons of conduct, performance or health. After hearing evidence, the panel decides on the facts of the case whether or not fitness to practise is impaired.
Panels are made up of three members, both lay and medical. All medical panel members are licensed practitioners. A legal assessor advises the panel on the law.
Where the case involves performance issues, the judicial decision will be based on whether the doctor's actions were reasonable in the specific circumstances of the case. The panel must give its reasons for deciding one way or the other.
If the panel imposes sanctions on a doctor's practice, it expects the doctor to demonstrate that he or she is determined to address and put right any deficiencies that led to impaired fitness to practise. This is known as remediation.
This article originally appeared in the printed edition of the MDU journal April 2013 entitled "Judgment seat"
This guidance was correct at publication . It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
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