The Medical Practitioners Tribunal Service (MPTS) makes independent decisions about doctors’ fitness to practise when cases are referred to us by the General Medical Council (GMC). We are a statutory committee of the GMC but are entirely independent in our decision making.
Our establishment came about as a result of the Shipman Inquiry. In 2004 Dame Janet Smith, Chair of the Inquiry, recommended that the GMC’s investigation and adjudication functions should be separated. In June 2012 the MPTS was created, becoming the first tribunal service of its kind in health regulation and carrying out its adjudication function operating separately from the GMC’s role in investigating complaints.
Our Chair is Dame Caroline Swift, who is a former High Court judge and was also leading counsel to the Shipman Inquiry.
Since our inception we have driven forward a number of changes, including legislative reforms, to make our tribunals operate more efficiently and effectively. One such reform was the introduction of legally qualified chairs (LQC) in 2016, which changed the composition of our pool of 300 tribunal members.
What does the role involve?
Since then, legal advice in hearings can be given in two ways – by a legally qualified tribunal member sitting as an LQC or as an independent legal assessor who plays no part in the decision-making process and is separate to the tribunal. The same pool of people can carry out both roles. Now, two years on, we use LQCs in the majority of our hearings. Previously, all tribunals were assisted by a legal assessor, who are now only appointed in exceptional circumstances.
When active case management of a hearing is needed, LQCs are able to act with confidence because of their experience. Combined with more pre-hearing case management, the use of LQCs has resulted in a significant increase in the number of hearings finishing on time or early. We believe it is important to minimise the stressful impact delays can have on doctors, witnesses and all those involved in our hearings.
LQCs chair proceedings during a hearing, provide legal advice as required and then reach decisions with their fellow tribunal members. All our hearings must have three people on each tribunal.
Another key part of their role is to manage the timings of a hearing effectively – this can include using assertiveness skills to manage the parties or setting case management decisions during the hearing. They will also use their interpersonal skills to ensure that those in the hearing room are appropriately supported, for example vulnerable witnesses who may require special measures or doctors without legal representation.
The drafting of decisions is supported by tribunal clerks but the LQC will need to work closely with them and their fellow tribunal members to ensure that a well-reasoned decision is drafted and to ensure it addresses all legal aspects appropriately. LQCs might need to chair preliminary hearings or consider matters on the papers so being able to adapt to working alone or as part of a tribunal when making decisions is essential.
What does the typical LQC look like?
Our pool of tribunal members includes medical members, who are doctors with a licence to practise, lay, who have never been medically qualified, and legally qualified, who are at least five years’ PQE.
The focus on appointment for all types of tribunal members is that each person we appoint must demonstrate that they meet the required competencies for the role. The decisions being made not only impact on the livelihood of those doctors whose fitness to practise they are considering, but most importantly the decisions are there to ensure the public is protected, so having the required competencies to make such decisions is essential.
The criteria for LQCs are no different to the other roles but in addition to experience they should also be able to demonstrate they meet the requirements of their own regulator, for example having a practising certificate.
The competencies for the role are what you might typically expect for those in decision-making or judicial roles. They focus on the need to be able to analyse the evidence carefully and then apply that evidence in order to make a well-reasoned decision. The competencies are integral to the appointment and development of LQCs and it is demonstrating the competencies as opposed to direct experience which is key for appointment to the role.
We are keen to ensure that our pool of tribunal members is diverse. The male to female ratio is almost equal, 20% of the pool identify as black, Asian, and minority ethnic (BAME) and the average age is 54.
Background experience varies too. Of those appointed, a number had previous experience in judicial roles or regulatory work, but some had no such prior experience and came from commercial or criminal law backgrounds. A register of interests of tribunal members is published on our website and details information regarding each person’s experience.
How are LQCs appointed?
We advertise appointments widely and interest in positions can be logged with the MPTS to enable notification of pending opportunities. We take a competency-based approach when appointing LQCs and applicants are required to complete a competency-based application form and, if successful at that stage, are invited to a competency-based interview and assessment.
The assessment in 2017 for LQCs consisted of a written exercise around a case study and a presentation to assess chairing and legal skills. For those that pass the assessment, appointments will be offered subject to usual reference and background checks required and attendance at the mandatory induction training provided.
How can I demonstrate the competencies required?
The nature of the work attracts a large number of applicants, and for LQC roles applicants will be up against those who might have extensive experience of judicial or regulatory proceedings. However, all applicants need to explain how that experience relates to the work of the MPTS. Taking time to understand the role, requirements and specific competencies will help you to demonstrate how your experience is relevant to our work.
Quality assuring our decisions
It is important to us to ensure that our decisions are of the highest quality, so each year, all tribunal members attend a training day tailored to their role. Tribunal chairs and LQCs attend additional training. We use this opportunity to share learning points, clarify procedures and focus on any skills that will assist the development of tribunal members in their role.
We also have a Quality Assurance Group (QAG), which reviews a selection of hearings each month. This meeting helps us to ensure consistency and quality of decisions as well as allowing us to identify any areas that might require further guidance. From these meetings or from our review of appeals we will issue regular communication updating them on learning points that have emerged. We also communicate regularly with tribunal members, informing them of any changes to relevant guidance or procedures. In addition, we have begun using webinars and videos to communicate learning points outside of our annual training, providing a more flexible and responsive way to share learning.
Since 2017 a number of LQCs have been appointed to full-time judicial roles in recognition of the excellent judicial and chairing skills that they would have been using when chairing MPTS hearings. It also highlights the useful experience that sitting as a LQC can provide for those individuals considering a move into a decision-making role.
Further appointments will be made in 2019 and to learn more about the work of the MPTS please contact me at: firstname.lastname@example.org.
Tamarind Ashcroft is the Head of Tribunal Development for the Medical Practitioners Tribunal Service. She is responsible for overseeing the appointment and training of the decision makers in hearings for doctors registered in the UK.
Becoming an LQC: Case study
Tamarind asks barrister Stuart McLeese what drove him to apply, how he found the application process and what he gets out of it:
‘The MPTS introduction of legally qualified chairs was something of immediate interest, combining advising in the regulatory sphere with a decision-making role. The application process was straightforward and one which certainly wouldn’t be alien to anyone who has applied for a role through the JAC. The interview was clear and concise, with only two people interviewing. The training following appointment was comprehensive, with provision of salient materials and gave me confidence that I was well equipped to carry out the role.
‘The MPTS as an organisation is extremely professional and easy to work for. The scheduling of hearings is efficient and months in advance, making diary planning easy.
‘The hearings themselves are challenging and rewarding with a broad spectrum of issues arising. Other members of the tribunal are invariably experienced and from a range of professional backgrounds ensuring a depth of knowledge to inform discussions. Counsel instructed to appear on behalf of the parties are very often senior juniors or Silks and I have found it interesting and beneficial professionally to have the opportunity to listen to different styles of advocacy and case presentation when not performing an advocates’ role myself. It has been a very enjoyable and worthwhile appointment.’
- Stuart McLeese, 30 Park Place Chambers, Cardiff