MPTS introduces new ‘banding’ system for fitness-to-practise sanctions

MPTS panels will use a new banding system to determine sanctions for doctors found unfit to practise medicine.

Medical tribunals will use the new bandings to make decisions about doctors facing serious allegations, including sexual misconduct, discrimination and violent and abusive behaviours. 

The bandings indicate the range of outcomes that can be expected in different case types, once a tribunal has decided whether a doctor poses a low, medium or high level of risk to the public. 

This is part of new guidance issued by the Medical Practitioners Tribunal Service (MPTS) this week. It will come into effect on 24 November and will help tribunals to reach ‘fair, proportionate and transparent decisions’, according to the MPTS.

The tribunals will need to refer to the new sanctions bandings, decide where on the ‘spectrum of seriousness’ an allegation lies to determine a starting point for sanctions, and finally consider any features which may increase the seriousness. 

The service also announced all tribunal members will receive further training on sexual misconduct ‘later this year’. 

Interim chair of the MPTS Gill Edelman said: ‘Hearings involving allegations of sexual misconduct remain an area of scrutiny and concern. 

‘We recognise the impact tribunal decisions have on doctors and on complainants. It is therefore paramount that our tribunals reach fair, proportionate and transparent decisions and that there is clarity for all concerned in the range of outcomes that can be expected. The updated guidance aims to support consistent and well-reasoned decisions.’ 

Sanctions bandings for cases are determined by the perceived risk to public protection. For example, the starting point in a sexual misconduct case at the ‘lower’ risk level is suspension up to six months; ‘medium’ risk is a six to 12-month suspension, and ‘higher’ ranges from 12-month suspension to erasure. 

The new guidance also elaborates on the factors which would increase the seriousness of sanctions to be imposed – some demonstrated in a doctor’s professional life only, and others applicable outside their working role as well, including:

• The behaviour or poor performance was persistent or repeated (professional and personal);

• Relevant fitness to practice history;

• The behaviour was directed towards, or the poor performance involved interaction with, a person with impaired capacity or a person with a particular vulnerability (professional and personal);

• Premeditated behaviour (professional and personal);

• Predatory behaviour (professional and personal);

• Abuse of professional position (professional and personal);

• Reckless disregard for patient safety or professional standards (professional, personal in some circumstances);

• Undermining a system designed to protect the public (professional);

• Undermining collaborative working (professional);

• Putting own interests before those of patients (professional);

• Attempt to hide and/or avoid taking responsibility for behaviour or poor performance (professional). 

This updates and develops on current guidance which listed aggravating and mitigating factors. 

Commenting on the new guidance, Sara Foster, joint head of legal at Medical and Dental Defence Union of Scotland (MDDUS), welcomed the changes but warned against tribunals moving away from judging on a case-by-case basis. 

She said: ‘The revisions announced today are a welcome recognition of the impact tribunal decisions can have on doctors. 

‘We are happy that the points we made to MPTS have been reasonably included within the wording of the new guidance. 

‘However, while the new “banding” processes are in principle welcome, we will expect to see tribunals continue to decide outcomes on a case-by-case basis and in response to the allegations that have been found proven not just alleged. 

‘Care needs to be taken so this step in the right direction does not become a straitjacket.’ 

In August, NHS England wrote to ICBs asking them to ensure GP practices and primary care providers received support to protect staff and patients from sexual misconduct. 

Practices and primary care organisations were also being urged to notify commissioners of any allegations of sexual misconduct made against a member of their team. 

Further NHS England guidance on tackling sexual misconduct, which it said would soon be available to primary care organisations, will focus on how the Sexual Safety Charter can be adapted to primary care ‘structures’. 

An audit will take place this autumn to review the progress of the charter, launched in 2023, NHS England has said.