How does student discipline and sexual misconduct relate to FtP?

Formal allegations involving student discipline, sexual misconduct and relationship abuse are investigated under the respective University policies and regulations. The HWP Group will simultaneously consider the allegations and if potential FtP concerns are identified, the Group will consider whether the GMC Guidance on the threshold of student fitness to practise might have been reached, and if so, the student will be referred to the WMS FtP Committee. However, the FtP process will be paused, pending the outcome of the University process and once concluded, the FtP process will resume. The finding of a student discipline or sexual misconduct/relationship abuse hearing has no bearing on the FtP concern as the University and GMC criteria are separate.

If I have a complaint, concern or issue that may relate to an FtP matter, can it be resolved so that I remain anonymous?

WMS staff will make every effort to resolve complaints or issues raised locally but if that is not possible, or the person raising the complaint or issue is not satisfied with the outcome, a complaint must be raised formally through the appropriate channel, which cannot be anonymous. It is only at this stage that the HWP Group might become involved, if appropriate.

Can the FtP/HWP process alone be use to address a complaint or issue?

Complaints or issues involving only patient safety and unprofessional behaviour will normally be addressed solely through the HWP/FtP process. Those involving student discipline, sexual misconduct and relationship abuse are handled as described above.

What happens if I self-refer, or are referred, to the HWP Group?

The HWP Group will discuss the issues raised, which may include documentation the student has not seen, supported by any member’s first-hand knowledge. Depending on the circumstances, the case might be closed or reviewed at a future meeting(s). Where there might be potential FtP concerns such as a pattern of unprofessional behaviour, the Group considers the threshold of student fitness to practise and where it might have been reached, the student will be referred to the WMS FtP Committee. The student will normally be written to after each HWP Group meeting at which they are considered and examples of outcome letters can be found on the Health, Welfare and Professionalism pageLink opens in a new window.

Can I be referred to the HWP Group without my knowledge?

There are rare occasions when the HWP Group is advised of a student's difficulties, normally related to health, and the circumstances are such that it is best for the HWP Group to passively monitor the situation without the student's knowledge as there is a risk that the HWP Group's potential involvement might destabilise the situation, especially in the run up to exams. What happens ultimately depends on the circumstances.

What if I don’t agree with, or accept, the HWP Group’s determinations?

The HWP Group is a School arrangement to reflect GMC Guidance and the determinations are made within the scope of its Terms of Reference. There is no right of appeal but you can feedback or complainLink opens in a new window about your experience. Appeals can only be made where it is mandated in University Regulations e.g., a finding of impaired fitness to practise by the WMS FtP Committee. Every effort is made to ensure that the HWP Group has all the available information to be able to make an informed determination but on occasion mistakes are made and/or there is inaccurate information. In this case, the HWP Group should be informed and the matter will be investigated.

Do I have to report that I have been referred to the HWP Group in the future?

No. There is no requirement for you to report that an issue was reviewed by the HWP Group in your application for provisional GMC registration, the Supporting Trainees Entering Practice form, your future studies or employment but you can choose to do so.

Why would I be referred to the WMS FtP Committee?

The HWP Group considers each case on its own merits. When there might be potential FtP concerns such as a pattern of unprofessional behaviour, the Group considers the GMC Guidance on the threshold of student fitness to practise, which asks seven indicative questions.Link opens in a new window The Group considers whether, on the balance of probability, if the threshold may have been reached and a referral is warranted. There is no model or template to follow and the outcome depends entirely on the circumstances and a referral is not always made. Whether a referral to the WMS FtP Committee is made or not, the student will receive an outcome letter, which includes the HWP Group's determination of the seven questions. If the student is not referred, and depending on the circumstances, they might continue to be monitored by the HWP Group and if the concerns continue unresolved, or further concerns emerge, the threshold might be considered again at a future meeting, which may result in a referral.

What happens when I am referred to the WMS FtP Committee?

The student will receive an email, which includes a brief summary of the reason(s) for the referral and an invitation to meet informally with the HWP Group Chair and a member of the WMS Student Support Team to explain the referral more fully, outline the Committee process and answer any questions. This meeting is not to review, discuss or otherwise justify the Group’s determination. This is followed by a detailed outcome letter. Normally, an investigating officer (IO) from an external provider will be appointed unless there is an existing investigation report e.g., from a student misconduct case. The IO will contact the student separately to arrange a meeting and the agreed report will be submitted to the Committee.

Do I continue on my course while waiting for the FtP hearing?

Normally, students continue on the course while waiting for the FtP hearing. However, where there are any patient safety concerns and/or serious health and/or conduct concerns, restrictions might be applied e.g., temporarily prevented from attending placements. In exceptional circumstances, a student can be immediately suspended from the course pending the FtP hearing.

How long will I have to wait for a WMS FtP Committee meeting?

Waiting for an FtP hearing is obviously a very anxious and stressful time and the student should maintain a regular dialogue with the WMS Student Support Team. The Student Union and the University’s Wellbeing Support Services are also there to help.

The WMS FtP Committee meetings are normally scheduled for December, March, June and September. The waiting time varies depending on the circumstances but normally it is between two and four months. This might seem a long time but it is most important that the student has sufficient time to seek advice and prepare. Time will also be needed to allow for an investigation to be carried out, and where relevant, to obtain other reports e.g., medical, court, police, or for an OH, clinical or psychiatric assessment to be undertaken.

What happens in the WMS FtP Committee meeting?

The procedure is explained in Annex C of the Operational ProceduresLink opens in a new window. Briefly, the student has the opportunity to explain their situation and the Committee will ask questions. The student can be accompanied at the meeting. The companion is there to support and advise the student; they are not an advocate, the student is expected to make their own representations. At the end of the meeting, the student and companion leave and the Committee will determine the outcome in private.

When will I know the outcome of the hearing?

The student will normally receive an email outlining the determination the same day followed up with a detailed outcome letter, normally within ten university working days.

What are the outcomes from the WMS FtP Committee?

University Regulation 34 Determination of Fitness to PractiseLink opens in a new window details the outcomes and these apply to all the University’s professional courses (the others are Teaching, Social Work and Counselling) but some explanation is needed for what each determination means for MB ChB students:

1. Fit to practise: The case is closed and the student continues on the course. The Committee might offer advice to help the student avoid having their fitness to practise called into question again.

2. Adjournment: When there is not enough evidence to enable a determination, the Committee will adjourn while further evidence is obtained e.g., medical reports. The student normally continues on the course during the adjournment.

3. Misconduct but FtP is not impaired: There is evidence of misconduct but importantly, FtP is not impaired. A warning is issued, the case is closed and the student continues on the course. The Committee might offer advice to help the student avoid having their fitness to practise called into question again.

4. FtP impaired: There are five sanctions that can be applied:

i. A warning is issued and conditions and/or undertakings are mandated e.g., write a reflection, seek medical interventions. The Committee will meet with the student again to review compliance and further determinations may be made, which may result in a further meeting(s);

ii. When there is not enough evidence to enable the Committee to decide and there are reasons that the student cannot continue on the course or graduate e.g., an unacceptable risk to patient safety, the student is suspended from the course, or the MB ChB award is withheld, for up to 60 days while further evidence is obtained. Depending on the circumstances, the 60 day period may be extended. The Committee will meet with the student again to consider the new evidence and further determinations may be made, which may result in a further meeting(s).

The next three sanctions are applied when the impairment is incompatible with a student continuing on the course i.e, expulsion, and enables them, where possible, to exit with an award recognising the credits they have gained:

iii. Termination of registration is self-explanatory and the student leaves the course with no award. This would normally apply to Phase I and II students and those Phase III students who have not completed enough of the course to be considered under iv or v below;

iv. Transferred to the alternative non-practising award of Bachelor of Medical Science (BMedSci). This normally applies to Phase III students who have completed enough of the course to be considered for this award but do not have enough credits to be considered for the MB ChB. The is an exam board decision and is dependent on academic performance;

v. When a Phase III student has completed enough of the course to be considered for, or has been awarded the MB ChB, it is withheld and they are considered for the non-practising award of the BMedSci, which again is an exam board decision.

How many students are referred to the WMS FtP Committee?

The figures below are comparable with other medical schools:

How many students have been expelled on FtP grounds?

Since the School opened in 2000, around 4000 students have passed though the School and eight have been excluded on FtP grounds, which were all for misconduct.

Can I appeal the WMS FtP Committee’s outcome?

Yes, but only when the finding is that fitness to practise is impaired. Otherwise, students are able to feedback or complainLink opens in a new window about their experience.

How do I do appeal?

This is explained in Regulation 34Link opens in a new window and it typically takes three to twelve months to complete the appeals process. Students should seek advice from the Student UnionLink opens in a new window who will support them through the process. To start the appeal process, the student needs to write to the Academic Registrar requesting a appeal (there is no appeal form) within ten university working days of the date of the written notification of the outcome. This letter is effectively applying to appeal and evidence will need to be provided to support an appeal on one or more of the following grounds:

1. Procedural irregularities;

2. Unfair discrimination or bias;

3. Relevant evidence that was not able to be presented at the meeting but there will need to be good reasons for not having made the Committee aware of this evidence at that time;

4. The decision appears to be unreasonable on the evidence considered.

The evidence provided will be considered by an independent Preliminary Review Panel (PRP) who will consider whether there are grounds for an appeal. If the PRP concludes that grounds are not established, the appeal will be rejected and a Completion of Procedures (CoP) letter will be issued stating the reasons and that the WMS FtP Committee outcome will stand. If this happens, the student has the right to complain to the Office of the Independent AdjudicatorLink opens in a new window (OIA)*.

If the PRP concludes that grounds are established, the appeal will be heard by an independent FtP Appeals Committee administered by the Central University. This Committee will only look at the grounds for appeal, it will not be a re-run of the original Committee meeting. The FtP Appeals Committee can confirm, set aside or vary a finding, decision or penalty imposed by the WMS FtP Committee. The student can either accept the outcome or complain to the OIA*.

*Note: Complaints to the OIA have to be made within twelve months of the appeal outcome and they will normally only consider FtP cases where there is evidence of procedural irregularity in the conduct of the FtP Committee.

Does the medical school report that I have been subject to FtP during my studies to the GMC?

Yes. Every February, the GMC is provided with a student fitness to practise return reporting every student that has been through the FtP process the previous year, which is for two purposes. Primarily, the GMC Registration Team review students who are due to graduate that year and a student may be invited to apply early for provisional GMC registration in April to include full disclosure of their FtP case. The GMC Registration Team may conduct their own independent investigation. To give some context, around 7200 medical students graduate every year in the UK and on average about 200 are invited to make an early application. The School plays no part in whether the GMC grants registration. Secondly, for those students not graduating that year, the GMC have record of a student’s FtP concern(s) throughout their studies. FtP and HWP data will be shared in any fitness to practise requests from any recognised professional, statutory or regulatory bodies.

When I graduate and have been subject to FtP during my studies, do I need to tell anyone?

Yes. Year 4 students who have been considered by the WMS FtP Committee during their studies, including a finding of fit to practise, and are not invited to make an early application for provisional GMC registration, are required to fully disclose their FtP case in their June application. Again, the School plays no part in whether the GMC grants registration. It is also recommended that Year 4 students include their FtP case in their Supporting Trainees Entering Practice (STEP) form and students should seek advice from the WMS Student Support Team on completing the form.

What happens if I am expelled on FtP grounds?

The details of expelled students, including a copy of the FtP outcome letter, are recorded on the MSC Excluded Student Database but only after the completion of any unsuccessful appeal or complaint to the OIA. This also applies to students that leave voluntarily before an FtP hearing has concluded. The details are retained for ten years.

If I am expelled on FtP grounds, does this prevent me from applying to study medicine elsewhere?

No. Students applying to another medical school would be expected to disclose any FtP issues and the institution will also consult the MSC Excluded Students Database as part of their application process.