Many doctors are notoriously bad patients; therefore it will be wise to remind them of the following:

• They should not work if they are ill
• They should not self-medicate
• They should visit their GP/Department of Occupational Health
• They can seek help from the National Counselling Service for Sick Doctors – Advice line: 0870 241 0535.
• The BMA has information about other counselling services

For GMC Fitness to Practise investigations – please see attached briefing on thresholds from the GMC and / or follow this link guide for doctors who have been referred to them.

(Please note that the 'GMC thresholds' document is the English version of the document. This document is valid throughout the UK but for colleagues in Scotland, Wales and Northern Ireland references to "Trust" or "PCT" will need to be interpreted appropriately).

If during an investigation the GMC feel it is necessary in the interests of patient safety, they can refer the doctor to the Interim Orders Panel (IOP) while the investigation continues. The IOP has the power to suspend a doctor or restrict their practice if it is felt necessary.

At the conclusion of the case examiners (GMC decision makers) will either:

• Close the case
• Issue a warning
• Offer the doctor undertakings to restrict their registration
• Refer the doctor to a Fitness to Practise Panel, who may erase (strike off), suspend or restrict the doctor.  FtPPs may also close a case with no action.

Undertakings and conditions are legally binding restrictions on registration that follow the FtP procedure outlined above.  Typically, in cases of poor clinical performance or ill health, there will be number of requirements placed upon the doctor as conditions of registration.

The GMC is a regulatory body and as such does not get directly involved in the remediation of a doctor under referral. The GMC will typically ask the Postgraduate Deanery to help oversee and direct remedial activity, which may include retraining, supervised practice, clinical and educational supervision, mentorship and other support to the doctor.  They will usually ask the Dean Director or the GP Dean in the Deanery to oversee the process and to report back to them. Each doctor subject to these kind of requirements will be allocated a GMC case-worker, who will have responsibility for monitoring progress and ensuring adequate supervision is in place.  The case-worker will be able to give advice to the doctor and to Deanery staff on what to expect from the process.

The Department of Health in 2005 published a document entitled Maintaining high professional standards in the modern NHS.  This document sets out the processes that all NHS Employers should adhere to when they have concerns about a doctor’s performance.

For hospital doctors the NHS Trust that employs the doctor will be responsible for dealing with these issues.

As GPs are independent contractors to the NHS, the local management of their performance is slightly different to that of hospital doctors. The Primary Care Trust (PCT) has the overall responsibility for these issues and guidance was published by the Department of Health in August 2004 entitled Primary Medical Performers Lists: Advice for PCTs on List Management. This document explains that each PCT manages a performance list and GPs must be on this list in order to practice.

GMC guide for referred doctors

The National Clinical Assessment Service (which is part of the National Patient Safety Agency) was set up in 2001 to help NHS organisations handle concerns about the performance of doctors and dentists. It has produced a framework document ‘Back on Track’ which is written from the view-point of an NHS employer and it sets out how to implement and review a return to work programme from doctor. This document is also useful for practitioners who are returning to work after GMC conditions as it explains the steps that the employer must take to ensure adequate procedures are in place for their return to work, enabling practitioners to see where they stand in the process.

Medical Defence organisations These organisations provide support for members

Some useful BMJ articles:

I have GMC conditions on registration and can't find a post—even practices that can't find anyone else make some excuse. Any suggestions? Some good advice for anyone that is in this position.

Investigations you may face as a hospital doctor

Being suspended by the GMC helped me recover from cocaine addiction