What is fitness to practise?

The basic definition

A practitioner's fitness to practise is the suitability of that person to be on the register without restriction. It covers both clinical competence and personal conduct. A practitioner can be fit to practise even if they have made mistakes, and can be unfit to practise even if they have not (for example, due to a serious health problem).

The bar is not perfection. Regulators recognise that healthcare is complex and that errors happen. The fitness-to-practise question is whether the practitioner's overall character, conduct, and competence make them safe and suitable to continue.

Categories of fitness-to-practise concern

The regulators group concerns into four broad categories:

• Misconduct — dishonesty, sexual misconduct, breaches of professional standards
• Deficient performance — clinical errors, failures of competence, gaps in knowledge
• Health — physical or mental health problems that affect safe practice
• Convictions, cautions, or other findings — criminal matters or findings by other regulators or bodies

Impairment: the legal test

When a tribunal or panel decides whether a practitioner's fitness to practise is impaired, it asks not only what happened but also what risk the practitioner poses today. "Impaired" is a finding about current fitness, not a finding about historic fault.

A practitioner can have done something serious in the past but no longer be impaired now, if they have remediated, shown insight, and demonstrated that the conduct will not be repeated. Equally, a practitioner can have done something less serious but be found currently impaired if they show no insight or refuse to engage with remediation.

What happens after a finding of impairment

If a tribunal finds that a practitioner's fitness to practise is impaired, it then considers what sanction to impose. The sanctions range from no action with a warning, through conditions of practice and suspension, up to erasure from the register. The choice depends on the seriousness of the impairment, the level of risk to patients, and the practitioner's insight and remediation.

Regulators have published sanctions guidance that tribunals follow. The guidance is public and is the basis on which decisions are explained.