UNIVERSITY OF WARWICK

WARWICK MEDICAL SCHOOL HEALTH, WELFARE AND PROFESSIONALISM AND FITNESS TO PRACTISE PROCESS

Abbreviations

FtP – Fitness to Practise

GMC – General Medical Council.

HWP – Health, Welfare and Professionalism

MSC – Medical School’s Council.

Glossary of terms

Committee – The WMS FtP Committee.

Companion – The individual accompanying the applicant, conditional offer holder or registered student.

Group – The WMS HWP Group.

Threshold – GMC/MSC guidance on the threshold of student fitness to practise (Reference 2, paragraphs 79 and 80).

References

GMC/MSC:

1. Achieving good medical practice: guidance for medical studentsLink opens in a new window
2. Professional behaviour and fitness to practiseLink opens in a new window
3. Outcomes for GraduatesLink opens in a new window
4. Supporting Medical Students with Mental Health ConditionsLink opens in a new window
5. Welcomed and valuedLink opens in a new window - Supporting disabled learners in medical education and training.
6. The GMC’s role in the Medical Act 1983Link opens in a new window
7. British Medical Association – Doctors’ titles: explainedLink opens in a new window.

Warwick University Policies and Regulations:

8. Social InclusionLink opens in a new window
9. Regulation 6: Admission to the UniversityLink opens in a new window
10. Regulation 23 Student Discipline OffenceLink opens in a new windows
11. Regulation 34 Determination of Fitness to PractiseLink opens in a new window

12. Student Sexual Misconduct and Relationship Abuse PolicyLink opens in a new window

13. Student Recruitment Outreach and Admissions Service Complaints ProcedureLink opens in a new window
14. Student Complaints and Resolution Procedure.Link opens in a new window
15. University of Warwick Records Retention Schedule (RRS)Link opens in a new window

Introduction

The GMC/MSC provide guidance for managing professionalism concerns and fitness to practise to provide a consistent framework that each university and medical school adapts to suit local processes and institutional regulations.

This document outlines the process to be followed when health and/or conduct issue(s) have been identified for an MB ChB applicant, conditional offer holder or registered student.

The consideration of patient safety shall always be paramount.

Allegations made against registered students that fall under the University’s Student Disciplinary and Misconduct policies and regulations, including sexual misconduct and relationship abuse, shall be dealt with through the respective policy or regulation before being considered under this process. FtP concerns are considered under GMC/MSC Guidance (References 1 and 2) hence, findings and sanctions applied under Student Disciplinary and Misconduct policies and regulations have no bearing on this process.

Police, Court and Medical Reports

The Group and Committee might ask an applicant, conditional offer holder or a registered student to:

• Provide evidence that is material to the consideration of any concerns e.g., Disclosure and Barring Service certificates, police records, court documentation and occupational health, clinical or psychiatric reports.
• Undertake an independent occupational health, clinical or psychiatric assessment. They shall be expected to share all relevant documentation with the assessing health professional, who shall provide a report to be shared with the individual, the Group and the Committee, where relevant.

Should the applicant, conditional offer holder or registered student not consent to any of the above, including by omission or failure to respond to requests, this shall be considered in any subsequent determination(s) made by the Group and/or the Committee. 

General Principles

1. An applicant, conditional offer holder or a registered student who has been referred to the Committee will always be specifically informed of the details of the referral and be given the opportunity to represent themselves.
2. A student may be accompanied at any meeting with an Investigating Officer, an FtP hearing or appeal hearing by someone who has not been part of the case. This may be a member of University staff, Students’ Union, a student friend or someone with legal training. The student will be expected to speak on their own behalf; the companion is there in a support role not as an advocate.
3. When an applicant, conditional offer holder or registered student does not appear on the date appointed for a Regulation 34 (Reference 10) hearing and/or gives notice that they do not intend to appear and has not provided a satisfactory explanation for their absence, and the Committee is satisfied that they had received notice to appear, the Committee may proceed to deal with the case and if appropriate, impose an appropriate sanction in their absence.
4. Subject to the terms of Regulation 34 and any procedural guidelines, the Chair of the Committee has the power to determine their own procedure for hearing a case, always providing that they observe the rules of natural justice at each stage. The Chair of the Committee has the discretion to postpone, continue or adjourn the case.
5. In all cases a written record of the proceedings will be kept.
6. The student will be notified in writing of the outcome of any FtP hearing under Regulation 34 normally within ten University working days of the Committee reaching its decision.
7. The University may vary any part of Regulation 34 in order to comply with its duty to make reasonable adjustments for people with disabilities.
8. No-one involved in deciding an FtP appeal under Regulation 34 will have had a prior involvement with the case.

WMS Health, Welfare and Professionalism Group

Conditional Offer Holders

The Group shall consider conditional offer holders’ Health and Conduct Surveys to identify support that might be needed during the course and any potential FtP concerns.

When a conditional offer holder does not make any declarations, or a declaration is made and no health or conduct concerns are identified, the conditional offer holder will be cleared for admission.

Where health and/or conduct concerns are identified, the conditional offer holder shall be either:

• Cleared for admission and might be asked to undertake remediation or seek appropriate early support, or,
• Asked for more information to be considered at as many future meetings as required until they can be cleared for admission or potential FtP concerns are identified.

Where potential FtP concerns are identified, the Group shall consider the threshold:

• Where the threshold is not reached, the conditional offer holder will be cleared for admission and might be asked to undertake remediation or seek appropriate early support.
• Where the threshold might have been reached, they shall be referred to the Committee.

If a conditional offer holder does not take up a place at WMS, all information they have provided shall be destroyed.

Registered students

Students with health and/or conduct difficulties are encouraged to self-refer to the Group and have the option to self-refer directly to the Committee. Failure to self-refer may be considered by the Group/Committee in relation to insight and other professional behaviours.

Allegations about a student’s health and/or conduct can come from several sources (Reference 2, paragraph 57), which may be with or without the student’s knowledge.

When an allegation is raised by a third party, with or without the student’s knowledge, the Group shall consider the possibility that it is vexatious or malicious.

The Group shall consider each case on its own merits and the outcome shall depend on the circumstances, normally:

1. The case is closed with or without recommendations.
2. The student is asked to undertake activities and the case shall be considered at as many Group meetings as required until the case can be closed, or potential FtP concerns emerge.
3. When potential FtP concerns are identified, the Group shall consider the threshold:
   • If it has not been reached paragraphs 1 or 2 above shall normally be applied.
   • If it might have been reached the student is referred to the Committee.
   • If the potential FtP concerns remain unresolved or further potential FtP concerns arise during the period of the same case, the threshold shall be re-considered.

If a case is closed without a referral to the Committee and fresh potential FtP concerns are identified about the same student, previous concerns will be noted as part of gaining a full view of their professionalism and to fulfil the School’s duty to consider the totality of concerns raised about a student (Reference 2, paragraph 70).

If there is insufficient information to enable the Group to make a determination, an Investigating Officer (IO) will be appointed to provide a report to the student and the Group.

When a student is referred to the Committee:

• If an investigation report is not already available e.g., from a Student Disciplinary investigation for the same incident/allegation, an IO shall be appointed to provide a report to the student, the Group and the Committee, but only if evidence is not readily available.
• If relevant, the student shall be asked to undertake an independent occupational health, clinical or psychiatric assessment.
• The student shall be given the option to informally meet with the Group’s Chair solely for the purpose of outlining the referral and Committee process and does not form part of any hearing or investigation. The Senior Tutor or nominated deputy shall be present to support the student.

Outcomes shall normally be communicated in writing within ten University working days of the Group’s meeting at which the determination was made.

WMS FtP Committee

The Committee is constituted under Regulation 34 and shall consider applicants in accordance with Regulation 6 (Reference 9) and MB ChB conditional offer holders and registered students.

Retention of data

Group and Committee data will be retained in accordance with the University of Warwick Records Retention Schedule (RRS) (Reference 15).

Appendices:

A. WMS Health, Welfare and Professionalism Group Terms of Reference.

B. WMS Fitness to Practise Committee Terms of Reference.

C. WMS Fitness to Practise Committee Procedural Guidance.

D. Investigating Officer Terms of Reference.

Appendix A. WMS Health, Welfare and Professionalism Group Terms of Reference

1. Purpose:

• To consider all conditional offer holders’ Health and Conduct surveys.
• To consider and continue to review cases as required to help prevent issues becoming more serious, a greater cause of difficulty and potentially an FtP concern. With any new referral, any previously closed or ongoing separate referrals will also be considered.
• To consider students that have been subject to the University’s student disciplinary and misconduct policies and regulations.
• To commission an independent investigation as required.
• To commission an independent occupational health, clinical or psychiatric assessment as required.
• To consider the threshold of student fitness to practise when potential FtP concerns are identified.
• To refer registered students and conditional offer holders to the WMS Fitness to Practise Committee when the threshold of student fitness to practise might have been reached.
• To refer registered students to the MB ChB Course Progress Group (CPG) where academic progress is a concern.

2. Membership:

• Head of Governance and Quality (Chair).
• Head of Medical Education.
• Director of Medical Studies.
• MB ChB Senior Tutor.
• Head of Professional Standards.
• Chair of the MB ChB CPG.
• One member of MB ChB clinical teaching staff.
• One representative from Wellbeing Support Services.
• One independent member from another university department with courses that have responsibility to a Professional, Statutory or Regulatory Body.

3. Quorum:

Chair (or nominated deputy) and at least three members.

4. Frequency:

The Group shall normally meet at least once per month with additional meetings scheduled as required.

5. Reporting Structure.

Outcomes, actions, and recommendations may be directed to other services, university officers, committees, or groups as required.

6. Records.

Meetings will not have a published agenda or minutes due to the sensitive and confidential nature of the discussions. Data will be retained in accordance with the University of Warwick Records Retention Schedule.

7. Secretariat.

The Secretariat will be provided by WMS Professional Support Services.

Appendix B. WMS Fitness to Practise Committee Terms of Reference

1. Purpose

• To determine an applicant’s, conditional offer holder’s or registered student’s fitness to practise.
• To commission an independent investigation, occupational health, clinical or psychiatric assessment as required and receive the report.
• To refer registered students to the MB ChB Course Progress Group where academic progress is a concern.

2. Membership

• The Chair will be selected from the membership of the following Committees:
  • Continuation of Registration Committee.
  • Graduate Appeals Committee.
  • 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.
• One junior doctor (they have completed a medical degree and foundation training and have anywhere up to eight years’ experience working as a hospital doctor, depending on their specialty, or up to three years in general practice. All junior doctors work under the supervisor of a senior doctor (British Medical Association – Doctors’ titles: explained, Reference 7).

3. Quorum

The Committee shall be quorate when the Chair and three members are in attendance with at least one member being a GMC registrant.

4. Frequency.

The Committee shall normally meet at least four times a year with additional meetings scheduled as required.

5. Reporting Structure.

An annual Student Fitness to Practise report is provided to the GMC. Excluded students are reported to the MSC Excluded Students Database.

6. Records.

Meetings will not have a published agenda or minutes due to the sensitive and confidential nature of the discussions. Data will be retained in accordance with the University of Warwick Records Retention Schedule.

7. Secretariat.

The Secretariat will be provided by WMS Professional Support Services.

Appendix C. WMS Fitness to Practise Committee Procedural Guidance

All cases are different, and the Chair has the discretion to vary procedures in response to necessary adjustments, individual case features or in considering events within the session. Normally:

1. The Chair will invite the applicant, conditional offer holder or registered student to make an opening statement.
2. The Committee may ask questions of anyone present.
3. Once the Committee has finished asking their questions, the applicant, conditional offer holder or registered student and companion (if present) will normally be invited to add any final comments and then invited to withdraw.
4. The Committee will arrive at its determination(s) in private.

Appendix D. Investigating Officer (IO) Terms of Reference

1. The IO should provide an evidence-based report on what has been investigated, noting that the standard of proof for an investigation is based on the balance of probabilities.
2. The IO will:

• Inform interviewees 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.
• Obtain such information considered by the IO to be appropriate to the case.

3. Interviewees may be accompanied 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, or someone with legal training. Interviewees are expected to speak on their own behalf; the companion is there in a support role not as an advocate. The companion cannot be anyone who has been involved in the alleged behaviour/incident e.g., witnesses to any associated alleged incident. The WMS Head of Governance and Quality can advise on eligibility.
4. The investigation shall normally include meetings with, but not limited to:

• Those named in the allegation(s).
• 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.
• Any other person who may have knowledge of those named in the allegation that the IO believes may have information/evidence that may be relevant and/or proportionate to the investigation.

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

• Those named in the allegation(s) and their companion.
• Members of the Group, Committee and supporting professional services staff.
• Other University officers and committees in any other related University regulatory procedures, for example, appeals.

6. Those named in the allegation(s) may be asked to provide evidence that is material to the consideration of any concerns e.g., health reports. Should consent not be given, including by omission or failure to respond to requests, this shall be considered in any subsequent determination(s) made by the Group and/or the Committee.
7. The IO’s report shall include all material gathered during the investigation, including the agreed notes of meetings.