Impairment and sanction in Medical Practitioners Tribunal Service fitness to practise proceedings.

The principal aims of this research were to assess whether, when imposing sanctions, the aggravating and mitigating circumstances considered by the General Medical Council are first considered when determining impairment of fitness to practise and to determine whether the circumstances described by the General Medical Council in their Indicative Sanctions Guidance as warranting erasure from the Medical Register will lead to that outcome. The consideration of specific aggravating circumstances or points of mitigation when determining impairment of fitness to practise was compared to their subsequent consideration by the General Medical Council when deciding on the severity of sanction to be applied. Additionally, the proportion of cases that highlighted aggravating circumstances the General Medical Council deemed sufficiently serious to warrant erasure and the actions taken were monitored. One hundred forty-six cases heard by the General Medical Council between 1 October 2011 and 30 September 2012 met with the inclusion criteria. Fisher's exact test was used to detect a variation from the expected distribution of data. Three of the four aggravating/mitigating circumstances were more likely to be considered when determining sanction having first been factored into the consideration of impairment. There was a statistically significant correlation between both a risk of harm and dishonesty as aggravating factors and the sanction of erasure from the Medical Register. In general, the General Medical Council consider relevant factors at all stages of their deliberations into practitioner misconduct, as required by the determinations in the cases of Cohen, Zygmunt and Azzam; and subsequently follow the guidance within their Indicative Sanctions Guidance document when determining which sanction to apply.