Fitness to practise expert witness in Scotland
Fitness to practise health assessments sit apart from most medico-legal work because the question is forward-looking and protective rather than compensatory: is this practitioner's fitness to practise currently impaired by reason of a health condition, and if so, what oversight would allow safe practice to continue or resume. I am a GMC Health Examiner and Medical Supervisor and a GDC Medical Advisor, and I bring that regulatory experience to instructions from the GMC, GDC, NMC and other health and social care regulators, as well as from practitioners themselves and from their representative bodies.
Instructions typically arise where a health condition — commonly a mental disorder, or an alcohol or substance use disorder — has come to a regulator's attention through a complaint, a criminal matter, an employer referral or self-referral, and a health assessment is required to inform the regulator's decision on interim measures, undertakings, conditions or, where matters proceed to a hearing, the tribunal's determination.
What I can advise on
- Whether the practitioner has a health condition, its diagnosis under ICD-11, and its current severity and stability.
- Whether that condition currently impairs fitness to practise, addressing the specific domains of practice in issue rather than fitness in the abstract.
- The practitioner's insight into their condition and into the impact it may have had on practice, since insight is central to a regulator's assessment of risk.
- Engagement with treatment to date, its effectiveness, and the practitioner's likely engagement with future treatment and monitoring.
- What conditions, undertakings or monitoring arrangements — for example regular medical review, abstinence monitoring, or supervised practice — would allow safe practice, and over what period they should run.
- Prognosis, including the likely trajectory of the condition with and without continued treatment, and any anticipated need for review.
- Where relevant, the relationship between the health condition and the conduct or performance matters that prompted referral, addressed carefully and without straying into a conduct opinion outside my remit.
- Fitness to attend and participate in a hearing, where that is separately in issue.
A health assessment is not a character reference and it is not commissioned to reach a predetermined conclusion. Where the evidence does not support a finding favourable to the practitioner, the report says so, since the duty is to the regulator or tribunal and not to whichever party has instructed the report.
Typical instructions
- Interim measures assessment following a health referral
- A regulator requires an urgent health assessment to inform whether interim conditions or suspension are necessary pending a full investigation, addressing current risk to patients arising from an acute mental health presentation.
- Return to practice after treatment for alcohol dependence
- A practitioner subject to undertakings following treatment for alcohol dependence seeks a report confirming sustained abstinence, engagement with monitoring, and a recommendation on whether undertakings can be varied or lifted.
- Health assessment ahead of a fitness to practise hearing
- A tribunal requires an independent health report addressing current impairment and prognosis to inform sanction, in a case where the practitioner's representatives and the regulator's presenting officer are likely to rely on the same report.
- Fitness to participate in proceedings
- A practitioner's representatives raise concern about their ability to attend and give evidence at a hearing because of a mental health condition, and the tribunal requires an opinion on fitness to participate and any adjustments needed.
What the report includes
The report sets out the instructions received, documents considered — including any regulator bundle, occupational health records and treating clinician reports — history and current presentation, mental state examination, and a reasoned opinion addressing each question in the letter of instruction with specific reference to the domains of practice in issue.
Because these reports are frequently read by non-clinicians on a panel or committee, clinical terms are explained in plain language and the reasoning linking diagnosis to impairment, and impairment to recommended conditions, is set out step by step rather than asserted as a conclusion.
The report closes with a statement of truth and a declaration that the duty to the regulator or tribunal overrides any duty to the instructing party, in accordance with the Royal College of Psychiatrists' guidance on expert evidence and the relevant regulatory procedure rules.
Timescales and format
Assessment is normally carried out in person, given the emphasis on current mental state and insight, though remote assessment can be arranged where the regulator's process and the practitioner's circumstances make that appropriate. Appointments usually take between 90 minutes and two hours.
Report turnaround runs from receipt of the complete bundle, including any occupational health and treating clinician records: [CLIENT TO CONFIRM: X weeks]. Interim measures assessments requiring urgent turnaround are considered on a case-by-case basis; confirm the timescale needed at enquiry stage.
Supplementary or review reports, joint instruction where practitioner and regulator agree a single expert, and attendance at hearing are all available. Fees and cancellation terms are set out under fees and timescales.
Frequently asked questions
- Can the practitioner and the regulator instruct you jointly?
- Yes, and joint instruction is common in health cases where both parties want a single independent view. The letter of instruction should set out the agreed questions and confirm that the report will be disclosed to both parties.
- Will a favourable report guarantee that conditions are lifted?
- No. The report gives an independent clinical opinion for the regulator or tribunal to weigh alongside other evidence; the decision on sanction, undertakings or conditions remains for the regulator or panel, not the expert.
- How do you assess insight in a fitness to practise context?
- Insight is assessed by reference to the practitioner's own account of their condition and its impact, tested against the objective history, rather than accepted or rejected on the strength of how convincingly it is expressed at interview.
- Can you recommend specific monitoring arrangements such as testing frequency?
- Yes, where the evidence supports a specific recommendation — for example the frequency of abstinence monitoring or medical review — and the reasoning for the particular arrangement proposed is set out rather than a generic condition suggested.
- Do you deal with GDC and NMC matters as well as GMC matters?
- Yes. Instructions are accepted from the GMC, GDC and NMC and other regulators, and the same standard of assessment and reporting applies regardless of which regulator has referred the matter.
Related expertise
- Clinical negligence — Breach of duty and causation opinion in psychiatric and mental health negligence claims.
- Mental health tribunals — Section 22 approved reporting for the Mental Health Tribunal for Scotland.
- Employment and occupational health — Work-related stress, ill-health retirement and employment tribunal psychiatric evidence.
- Letter of instruction — model letter and the records to enclose
Instructing Dr Qureshi
Instructions are accepted from pursuer and defender agents, insurers, regulatory bodies and occupational health providers. A conflict check is carried out before any instruction is accepted.
Or call 07739 587092.