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HWP and FtP Operational Procedures

UNIVERSITY OF WARWICK

HEALTH, WELFARE AND PROFESSIONALISM AND FITNESS TO PRACTISE OPERATIONAL PROCEDURES FOR THE MB ChB COURSE COVERED BY REGULATION 34 IN WARWICK MEDICAL SCHOOL

Introduction

The General Medical Council (GMC) sets out the standards expected of medical students in relation to their professional behaviour both inside and outside medical school in Achieving good medical practice: guidance for medical students. MB ChB graduates may apply for provisional registration with the GMC, which is required before an individual can undertake foundation training and ultimately begin practising as a doctor.

Medical students and medical schools are not regulated by the GMC but medical schools are responsible for establishing fitness to practise procedures outlined in the GMC’s and Medical Schools Council’s (MSC) document Professional behaviour and fitness to practise: guidance for medical schools and their students. Guidance is also provided on determining the threshold of student fitness to practise.

The consideration of patient safety shall be paramount at all times. This document outlines the operational procedures to be followed when a health, welfare or professionalism issue has been identified about a conditional offer holder for, or a registered student on, the Warwick Medical School (WMS) MB ChB course which may lead to a concern about their fitness to study medicine and practise as a doctor following successful completion of the course. These procedures may be additional to, and run in parallel with, other university regulations and procedures.

The University’s Equality, Diversity and Inclusion Policy is followed in the application of these procedures to achieve fair and equal representation for all.

Medical Reports

Throughout these procedures various medical reports may be regarded as necessary and requested at various times, for example, occupational health, specialist reports and GP letters. A conditional offer holder or student may be requested to ask their GP, other health care professional and any healthcare organisation where they have received treatment either currently or in the past, to provide reports detailing their current health, their health history, any treatment regime, potential reasonable adjustments and any support requirements. Should the conditional offer holder or student not consent, this will be noted and they shall be advised that this may influence the determination of the Health, Welfare and Professionalism Group (MB ChB) or the WMS Fitness to Practise (FtP) Committee.

WMS Health, Welfare and Professionalism Group (MB ChB)

The WMS Health, Welfare and Professionalism Group (MB ChB) (hereafter referred to as the ‘Group’) acts as the low-level professionalism committee described in GMC/MSC guidance and is recognised as best practice amongst all medical schools. Its role is to identify and review in the first instance (and continue to review as required) all conditional offer holders and students’ self-referred or referred health, welfare or professionalism issues with the aim of providing support and reasonable adjustments to help prevent any issues becoming more serious and a greater cause for difficulty. The Group also considers whether the threshold of student fitness to practise may have been reached and should this be the case, the matter will be referred to the WMS FtP Committee (hereafter referred to as the ‘Committee’).

Conditional Offer Holders

Conditional offer holders are required to complete a Health and Conduct Survey and declare any and all, current or historic, health and conduct issues, including criminal convictions. UCAS also require applicants to declare any criminal records (including cautions and spent convictions). The Group may use or request such information as necessary to arrive at a determination, which may include but is not limited to:

1. Medical reports;

2. A reflective statement;

3. An informed reference.

The Group will consider any such declarations in accordance with Regulation 6: Admission to the University:

1. Health (paragraph 6.3 (3) (f)) – A conditional offer holder may also be referred to the Group by the Senior Tutor or their nominee.

2. Conduct (paragraphs 6.3 (3) (b), (c) and (d)) – For example, a criminal conviction. These will be considered in terms of the severity, nature, timings and impact of the offences in relation to previous cases, criteria established, and GMC guidance.

3. General Dishonesty (paragraph 6.3 (3) (d)) – Where the Admissions Tutors or other School or University officers have reason to question the honesty of a conditional offer holder, for example, suspected fraudulent completion of application documents or misrepresentation of qualifications, the Admissions Tutors or other officers involved will compile a report and refer the matter to the Group.

Group Outcomes for Conditional Offer Holders

1. The determinations of the Group will normally include:

a. Where it is determined that the threshold of student fitness to practise has not been reached:

i. The case will be signed off as no further action but may include recommendations, for example, meet and maintain a dialogue with the WMS Student Support Team or to seek support from the University’s Wellbeing Support Services;

ii. Cases of conduct and general dishonesty will be referred to the Committee on the Admission of Students to Courses of Study (CASCS) for consideration of any remaining concerns about the conditional offer holder’s suitability to register as a student of the University.

b. Where it is determined that the threshold of student fitness to practise may have been reached, the Group will refer the matter to the WMS FtP Committee, Regulation 34 refers, and:

i. May appoint an Investigating Officer (IO);

ii. May request further information such as medical reports;

iii. If any element of a referral is due to a conditional offer holder having a criminal record or any other issue that could present a child-safeguarding issue, then the University Designated Person for Child Safeguarding will be notified in accordance with University of Warwick Child Protection Policy.

2. The outcome will be communicated in writing to the conditional offer holder within ten University working days and include the reasons for the Group’s determination(s);

3. If a conditional offer holder becomes a registered student, the outcome and any related information will be retained and may be considered if the registered student is referred to the Group in the future.

Registered students

There may be circumstances that do not present a risk to patients but still bring into question a student’s fitness to study medicine and practise as a doctor following successful completion of the course. Students’ health, welfare and professionalism issues may be identified and referred to the Group from a number of sources, which may include but is not limited to:

1. Members of medical school or other university staff;

2. Staff who work in placement provider organisations;

3. Occupational health practitioners;

4. Fellow students;

5. The police;

6. Self-referral;

7. Members of the public;

8. Anonymous complaints, through a separate raising concerns policy or through the media;

9. The Course Progress Group (CPG), where concerns have arisen in the review of a student’s progress.

The Group may use or request such information as necessary to arrive at a determination, which may include but is not limited to:

1. The appointment of an IO;

2. Medical reports;

3. Referral documents and correspondence;

4. A reflective statement;

5. An informed reference.

Consideration shall be given to the potential for vexatious or malicious allegations raised by others whenever an issue is raised by a third party.

Group Outcomes for Registered Students

1. The determinations of the Group will normally include:

a. Where it is determined that the threshold of student fitness to practise has not been reached, the case will be signed off as no further action but may include recommendations, for example, meet and maintain a dialogue with the WMS Student Support Team or to seek support from the University’s Wellbeing Support Services;

b. Where it is determined that the threshold of student fitness to practise may have been reached, the Group will refer the matter to the Committee and:

i. May appoint an IO;

ii. May request further information such as medical reports;

iii. The student will be invited to meet with the Group’s Chair and the Senior Tutor where the reasons for the Group’s determination and the Committee process will be explained. The meeting will not revisit the Group’s discussions or seek to justify the determination.

2. The outcome(s) will be communicated in writing to the registered student within ten University working days and include the reasons for the Group’s determination(s).

3. The outcome(s) and any related information will be retained and may be considered if the student is referred to the Group in the future.

WMS FtP Committee

The Committee is subject to University Regulation 34 Determination of Fitness to Practise. Where issues relate to other University Regulations but have fitness to practise dimensions, they will also be considered under this Regulation. All regulatory procedures will operate independently from each other, but information or outcomes may be shared between relevant committees.

Committee Outcomes

1. The determinations available to the Committee are detailed in Regulation 34 Determination of Fitness to Practise, in particular:

a. Conditional offer holders, paragraphs 3 (a) and (b);

b. Registered students, paragraphs 3 (c) to (f) (iv).

2. The outcome(s) will be communicated in writing to the conditional offer holder/registered student within ten University working days and include the reasons for the Committee’s determination(s);

3. Where the academic progress of a registered student is also a concern, the case will be referred to the CPG.

Appeals

There is no right to appeal against the determinations of the Group but any registered student may feedback or complain about their experience in line with the University’s policies. The right to appeal against determinations of the Committee is set out in Regulation 34 Determination of Fitness to Practise, Paragraphs (5) to (15).

Complaints

Any registered student may feedback or complain about these procedures in line with the University’s policies.

Appendices:

Appendix A: Terms of Reference of the Health, Welfare and Professionalism Group (MB ChB)

Appendix B: Terms of Reference of the WMS Fitness to Practise Committee

Appendix C: WMS FtP Committee Procedure (MB ChB)

Appendix D: Investigating Officer Procedure (MB ChB)

Appendix E: Fitness to Practise References (MB ChB)

Appendix F: HWP and FtP Process Flow


 

Appendix A. Terms of Reference of the Health, Welfare and Professionalism Group (MB ChB)

1. Purpose

  • To act as the low-level professionalism committee to reflect the appendix diagram in the General Medial Council’s and Medical School Council’s ‘Professional behaviour and fitness to practise: guidance for medical schools and their students’;
  • To provide support in helping to prevent health, welfare or professionalism issues becoming more serious and a greater cause for concern;
  • To consider in the first instance, and continue to review as required, all conditional offer holders’ self-declared and registered students’ referred or self-referred health, welfare or professionalism issues;
  • To determine insight, consider additional support mechanisms and any subsequent reasonable adjustments, as required for each case;
  • To refer cases to other University Officers or Committees, where appropriate;
  • To appoint an Investigating Officer, where appropriate;
  • To sign off cases as no further action and make recommendations as appropriate, where it is determined that the threshold of student fitness to practise has not been reached;
  • To refer cases to the WMS Fitness to Practise Committee where it is determined that the threshold of student fitness to practise may have been reached;
  • To refer registered students to the MB ChB Course Progress Group (CPG) where academic progress is determined as a concern.

2. Membership

  • Head or Deputy Head of MB ChB;
  • Head of Governance and Quality (Chair);
  • MB ChB Senior Tutor or a Deputy Senior Tutor;
  • Chair of the MB ChB CPG or nominated deputy (e.g. Phase Lead);
  • Two representatives from Wellbeing Support Services;
  • Head of Professional Standards.

3. Quorum

Chair and at least three members.

4. Frequency

The Health, Welfare and Professionalism Group shall normally meet at least once per month and be scheduled one year in advance (meetings will be cancelled if there is no business). There may be the need to have further meetings dependent upon the cases.

5. Reporting Structure

Actions and recommendations may be directed to other services, committees or groups at the discretion of the Chair.

6. Records

Health, Welfare and Professionalism Group meetings will not have a published agenda or minutes due to the sensitive and confidential nature of the discussions and the minutes will be reserved.

7. Secretariat

Secretariat will be provided by the Dean’s Office and Professional Support Services (DOPSS) who will receive agenda items, and will be responsible for the administration of the Health, Welfare and Professionalism Group’s process.

Appendix B. Terms of Reference of the WMS Fitness to Practise Committee

1. Purpose

  • MB ChB – To consider the cases of conditional offer holders or registered students where their health and conduct concerns have raised significant doubts about their fitness to study medicine and practise as a doctor following successful completion of the course;
  • Diploma in Orthodontic Therapy – To consider the cases of registered students where their health and conduct concerns have raised significant doubts about their fitness to study and practise as a member of the dental team following successful completion of the course;
  • To appoint an Investigating Officer, where appropriate;

2. Membership

  • The Chair will be selected from the membership of the following Committees:

o Continuation of Registration Committee;

o Graduate Appeals Committee;

o Faculty Board Undergraduate Appeals Committee.

  • One member of academic staff within WMS;
  • One member of clinical academic staff within WMS;
  • One senior clinician from a local NHS Trust with undergraduate teaching responsibilities;
  • MB ChB cases – One junior doctor;
  • Diploma in Orthodontic Therapy cases – One General Dental Council (GDC) registrant.

3. Quorum

The Committee shall be quorate when the Chair and three members are in attendance with at least one member being a General Medical Council (GMC) registrant for MB ChB conditional offer holders and medical students, or a GDC registrant for Diploma in Orthodontic Therapy students.

4. Frequency

The WMS Fitness to Practise Committee will meet at least four times a year with the dates set one year in advance. There may be the need to have further meetings dependent upon the cases.

5. Reporting Structure

MB ChB – An annual Student Fitness to Practise report is provided to the GMC.

Diploma in Orthodontic Therapy – A Student Fitness to Practise report is provided to the GDC.

6. Records

The meeting will not have a published agenda or minutes due to the sensitive and confidential nature of the discussions.

7. Secretariat

The Secretary will receive agenda items and, in conjunction with administrative support provided through Dean’s Office and Professional Support Services (DOPSS), manage the secretariat function for the Committee.


 

Appendix C. WMS Fitness to Practise Committee Procedure (MB ChB)

1. The Secretary shall, on an annual basis, identify four dates within each academic year, establish the WMS Fitness to Practise (FtP) Committee and publish this information

2. For each meeting, the Secretary shall:

a. Agree with the Chair the time allocations for each case (where there is more than one);

b. Invite the conditional offer holder or student, and Investigating Officer (IO) if relevant, to the meeting advising them of the date, time and place of the meeting, providing notice of at least ten University working days;

c. Provide the Committee members and each conditional offer holder or student with copies of:

i. Regulation 34 Determination of Fitness to Practise;

ii. Professional behaviour and fitness to practise: guidance for medical schools and their students;

iii. Health, Welfare and Professionalism and Fitness to Practise Operational Procedures for the MB ChB Course Covered by Regulation 34 in WMS;

iv. All information relating to the case.

d. Invite the conditional offer holder or student to make written representations setting out their response to the issue(s) giving rise to the concerns. This may include supporting statements from other persons. The Secretary shall make these available to members of the WMS FtP Committee;

e. Invite the conditional offer holder or student, if they wish, to bring one companion who can be a student friend, a representative of the office of the Dean of Students, or representative of Warwick’s Students’ Union. The role of the companion is to provide support and advice for the conditional offer holder or student and they will not be permitted to act on behalf of the conditional offer holder or student who must make their own representations. The name and status of the companion must be notified to the Secretary before the meeting;

f. If the conditional offer holder or student chooses not to attend, the WMS FtP Committee may proceed in their absence, taking account of all the information available to it.

3. The order of proceedings for each case shall be:

a. Where an IO report has been provided, the Chair will summarise the contents and invite members of the WMS FtP Committee to question the IO about any matters relating to the report. Once concluded, the IO shall play no further part in the proceedings and will withdraw;

b. The conditional offer holder or student will be asked if they wish to elaborate on the contents of any written statement(s);

c. The Chair will invite the companion (if present) to make a brief statement in support of the conditional holder or student;

d. The Committee may ask questions of anyone present;

e. The conditional offer holder or student will be asked if they have anything further to add;

f. All parties will withdraw except for members of the WMS FtP Committee and the Secretary;

g. The WMS FtP Committee will arrive at its determination(s) in private;


 

Appendix D. Investigating Officer Procedure (MB ChB)

1. The duties of an Investigating Officer (IO) are as follows:

a. To investigate the factual aspects of a case within the criteria stipulated by the Health, Welfare and Professionalism Group (MB ChB) or WMS Fitness to Practise (FtP) Committee;

b. To inform the conditional offer holder or student of the concerns that have been raised and arrange to meet with them to establish the facts. It may be necessary to meet more than once;

c. To obtain such information considered by the IO to be appropriate to the case;

d. To submit a report to the Health, Welfare and Professionalism Group or WMS FtP Committee;

2. The IO shall not make any recommendations or otherwise anticipate any determinations of the Health, Welfare and Professionalism Group (MB ChB) or WMS FtP Committee;

3. The conditional offer holder or student may be accompanied at the IO meeting(s) by one companion, who can be a student friend, a representative of the office of the Dean of Students or a representative of Warwick Students’ Union. The role of the companion is to provide support and advice for the conditional offer holder or student and not act on their behalf as the conditional offer holder or student must make their own representations;

4. The investigation shall normally include meetings with but not limited to:

a. The conditional offer holder or student concerned;

b. Students, WMS staff, other School or University officers and NHS staff who have either raised the concerns, or have been involved in, or witness to, the issues giving rise to the concerns;

c. Any other University staff where knowledge of the conditional offer holder or student may be relevant to the investigation.

5. The investigation shall be conducted confidentially with the report and any related information only being made available to those directly involved on a need to know basis, which may include:

a. The conditional offer holder or student being investigated;

b. The conditional offer holder or student’s companion;

c. Members of the Health, Welfare and Professionalism Group (MB ChB) and supporting administrative staff;

d. Members and Secretary of the WMS FtP Committee and supporting administrative staff;

e. Other University officers and committees in any other related University regulatory procedures, for example, appeals.

6. The conditional offer holder or student may be requested to provide medical reports. Should they not consent, this shall be noted and advised that this may influence the determination of the Health, Welfare and Professionalism Group (MB CHB) or WMS FtP Committee;

7. The IO’s report shall include all material gathered in the course of the investigation, including the agreed notes of meetings.


 

Appendix E. Fitness to Practise References (MB ChB)

 


 

Appendix F. HWP and FtP Process Flow