Council Regulations 2 of 2020

1. The consideration of whether or not a student is fit to practise medicine must take place strictly in accordance with the following procedure.

2. This procedure should be read in conjunction with the associated University Policy “Procedures for medical students causing concern” and “the Code of Conduct for Medical Students”, as may be updated from time to time and any substantial replacement thereof.

3. Any allegation that a medical student may not be fit to practise medicine must be sent to the Medical Sciences Divisional Registrar and Chief Operating Officer (“the Registrar”) and may be accompanied by evidence in support of the concerns being referred. Such evidence may include details of a single significant event or a pattern of behaviour, and/or may include details of procedures which have already been followed but which have failed to resolve the issues.

4. If there is an allegation of abuse or suspected abuse involving under-18s or adults at risk, the Registrar will report this to the University Safeguarding Officer for students within 1 day.

5. If any conflict of interest arises or if it is otherwise impracticable, the Head of Division of Medical Sciences (“the Head of Division”) may delegate their functions under these procedures to one of the Deputy Heads of Division of Medical Sciences (“the Deputy Heads of Division”).

6. If, following receipt of an allegation that a student may not be fit to practise medicine, the Registrar considers that the student may have violated the University’s Code of Discipline as contained in Statue XI, they shall inform the Proctors. If the Proctors choose to investigate the matter separately under Statute XI, the subsequent proctorial judgement may be considered as evidence within the procedures set out below. The Proctors will not themselves make judgements about fitness to practise.

7. If the allegations in question are to be dealt with under either the student’s college’s disciplinary procedures or the University’s disciplinary procedures (in particular Statute XI), and these Regulations, the college’s disciplinary procedure and/or the University’s disciplinary procedure must normally be completed before the Initial Procedure is initiated.

8. If, following receipt of an allegation that a student may not be fit to practise medicine, the Head of Division or their Deputy considers that the issue is primarily one of fitness to study in accordance with Part B of Statute XIII and all other normal fitness to study procedures at college or departmental level have been exhausted or are inappropriate, then the Head of Division will consider making a referral to the Fitness to Study panel. If formal fitness to study procedures are initiated, those procedures must be completed before the Initial Procedure is initiated.

9. The timescales provided within these Regulations may be expedited at the discretion of the Head of Division or the Chair of the relevant panel, if a student presents an immediate or significant risk, or in other exceptional circumstances. The Head of Division will communicate any shortened timeframes to the student. The Head of Division may also extend timeframes where it is necessary to do so in order to ensure a fair outcome.

10. In the event a student voluntarily withdraws from the medical course after an allegation has been sent to the Registrar under regulation 3 above, is expelled from the University or their college as a result of a disciplinary procedure, or is otherwise required to leave the University as a result of a University or college procedure, the Fitness to Practise Procedure may continue, if deemed appropriate by the Head of Division at their sole discretion. All cases that reach the point of referral to a Fitness to Practise panel should, wherever practicable, come to a formal decision and conclusion even if the student in question withdraws voluntarily from the course before the hearing has concluded.

11. The Registrar will inform the Head of the Division within 5 working days from the date of receipt of the allegation.

12. The Head of Division will consider the allegation and any accompanying evidence and will evaluate whether there is a potential fitness to practise issue which warrants further investigation and/ or whether the matter can and should be resolved informally. In deciding whether there is a potential fitness to practise issue, the Head of Division will consider if the student’s behaviour suggests they may be a risk to patients or the public, or may bring the profession into disrepute. The Head of Division will aim to reach a decision within 5 working days following referral of the allegation to him by the Registrar.

13. If the allegation and/or accompanying evidence suggests that there may be a potential fitness to practise issue (as defined in paragraph 12 above), the Head of Division will initiate the formal Fitness to Practise procedure under regulations 21 to 39 of these Regulations, subject to any University or college disciplinary procedure which will normally be conducted first.

14. If the formal Fitness to Practise Procedure is to be initiated, the Head of Division shall decide whether the student may, for the duration of the Procedure:

(a) continue their studies without limitation but they will not be awarded the degrees of Bachelor of Medicine or Bachelor of Surgery while fitness to practise concerns are under consideration;
(b) continue their studies but with specified limitations and conditions;
(c) be suspended from the Register of Medical Students and therefore from the medical course; or
(d) following consultation with the relevant Medical Directors, be prohibited from practising medicine as a student anywhere or at a specified site/sites.

15. If the Head of Division decides to suspend a student under paragraph 14 above, then they will inform the student in writing and state the reasons for that decision. The Head of Division will review any decision to suspend a student pending the outcome of the Procedure at least every 21 days and may change the student’s suspension status at any time during the Formal Fitness to Practise Procedure, including suspending a student at any stage if new evidence comes to light to suggest that there is a serious risk to patient and/or public health, safety and/or welfare.

16. The Registrar will, within 15 working days from the date of receipt of the allegation, notify the student in writing of the allegations made against them and the decision of the Head of Division as to whether to initiate the formal Fitness to Practise procedure. If the Formal Fitness to Practise Procedure is to be initiated, information about the process and available support will be sent with the notification, along with confirmation of the student’s status during the Procedure. Sources of support for the student will include senior welfare officers within the Medical School, University Student Welfare and Support Services, the welfare team at the student’s college, and Oxford SU advice service.

17. A student may appeal to the Proctors against the decision of the Head of Division to suspend them within 7 working days of being informed of the decision. During the consideration of any such appeal to the Proctors, the student shall remain suspended. An appeal can only be brought on one or more of the following grounds:

(a) there was an error in the decision-making process or a procedural irregularity;
(b) there was any bias or perception of bias in the decision-making process;
(c) the decision made was unreasonable; and/or
(d) there is new, material information which had not been available prior to the decision being appealed.

18. If the Proctors uphold the appeal they will refer the matter back to the Division for reconsideration by one of the Deputy Heads of Division. The decision of the Deputy Head of Division will be final.

19. If the Head of Division considers that the allegation and/or accompanying evidence are not sufficiently strong to suggest that the student may be a risk to patients or the public, or may bring the profession into disrepute, they must:

(a) take no further action; or
(b) refer the student back to a particular stage of the Medical Sciences Division's Procedures for medical students causing concern, which may include the student receiving a warning or agreeing one or more undertakings.

20. Any action to be taken will be documented and sent to the student.

The Investigation

21. The Head of Division will refer the case to a suitably trained individual who will take on the role of an investigator (“Investigator”). The Investigator’s role is to gather evidence to inform a decision on whether the student's fitness to practise is impaired and produce a written report of the results of the investigation, which will detail all of the evidence gathered.

22. The Investigator will not be the student’s personal tutor or, as far as possible, anyone else who is involved in supporting the student or making decisions about their academic progress. The Investigator should keep a full record of all complaints, meetings, interviews, statements and other evidence collected for the purpose of their investigation.

23. The Investigator will present their findings in a written report which will be sent to the Registrar who will in turn present the Investigator’s report to the Head of Division.

24. If, during the investigation, there is an allegation of abuse or suspected abuse involving under-18s or adults at risk, the Investigator will immediately inform the Registrar, who will report this to the University Safeguarding Officer for students within 1 day.

25. If, on the basis of the Investigator’s report, the Head of Division considers that the student’s behaviour is serious or persistent enough to call into question their fitness to continue on the medical course, or their fitness to practise as a doctor after graduation, they will refer the case to a fitness to practise panel (established in accordance with sections 28 to 32 of this Procedure) for a decision. This decision will be made no later than 10 working days after the receipt of the written report from the Investigator.

26. If the Head of Division does not consider there is sufficient evidence to call into question a student's fitness to practise, they must:

(a) take no further action; or
(b) refer the student back to a particular stage of the Medical Sciences Division’s procedures for medical students causing concern, which may include the student receiving a warning or agreeing one or more undertakings.

27. The decision will be communicated in writing to the student within 5 working days.

Establishing the Fitness to Practise Panel

28. The Head of Division, acting on behalf of the Medical Sciences Board, shall appoint a panel of three members to make a decision on a student's fitness to practise, based on the evidence gathered and presented to them by the Investigator (the “Panel”).

29. The Panel will be made up of:

(a) a registered medical practitioner with a licence to practise who is a member of the Faculty of Clinical Medicine or the Faculty of Physiological Sciences;
(b) a senior member from another faculty to act as Chair;
(c) a medically qualified member of the Faculty of Clinical Medicine or the Faculty of Physiological Sciences, or, where there are health issues, a relevant health specialist who is not involved with the student's treatment, eg a psychiatrist or occupational health physician.

30. The Head of Division should aim to have appointed all members of the Panel no later than 20 working days after the decision was taken to refer the case to a Panel. No member of the Panel shall have had any involvement or interest in the case or the student or be a current teacher of the student. Any potential conflict of interest should be communicated at the first opportunity and dealt with appropriately. The University will aim to hold the meeting within 20 working days of the appointment of all members of the Panel.

31. Following the appointment of the Panel, the student will be invited to attend the meeting of the Panel in person. The student will be given at least 10 working days’ notice of the date and time of the meeting. The Registrar will provide the student with copies of all documents circulated to the Panel and will provide guidance on the procedures to be followed, including confirmation of their entitlement to bring a supporter or legal representative to the meeting.

32. The Panel may invite any other persons to attend the meeting who may have information relevant to the case and whose evidence may, in the Panel’s view, assist them in reaching a conclusion. That person will first be asked to provide a written statement in advance of the meeting, which will be provided to the student. Any person attending the meeting may be accompanied by another person.

The Meeting of the Fitness to Practise Panel

33. The following process must be followed:

(a) Once all parties have convened, the Chair will introduce by name and explain the functions of the members of the Panel, the staff and others present. The Chair will explain the powers of the Panel and invite the Head of Division or their nominee to make an opening statement and then invite the Panel to ask questions.
(b) The Chair will invite the student (or their representative) to make a statement although the Panel may wish to hear from the student in their own words. The Panel will be invited to ask questions of the student. The student will have the opportunity to present evidence.
(c) If the student fails to attend the meeting without a prior reasonable explanation the meeting will continue in their absence. The Chair will have discretion as to what constitutes "a reasonable explanation". Where the student provides a reasonable explanation for their failure to attend, the meeting will be adjourned and reconvened in accordance with paragraph 33(j) below.
(d) The meeting will be held in private unless the student wishes it to be held in public in which case the Chair will usually agree to a public meeting, but will have a discretion to order that certain evidence may be given in private. Meetings involving health issues must always be conducted in private.
(e) All evidence or material submitted as part of the investigation will be regarded as strictly confidential, unless, following consideration of submissions, the Panel decides otherwise, for example where disclosure of information may be necessary to protect the safety or vital interests of others. The student will be notified (unless the University is prevented from doing so by law) if confidential information is to be disclosed to a third party not directly linked to the fitness to practise procedure.
(f) At each stage, the Chair will allow reciprocal questioning.
(g) The Chair may provide for protective measures to be put in place for any person who is speaking to the Panel who is considered to be vulnerable. Such measures could include allowing the individual to answer questions via video link, behind a screen or through written questions.
(h) Once the Chair is satisfied that the Panel has completed its questioning and the student and others have had a full opportunity to convey information to the Panel, all parties will withdraw, leaving the Panel to discuss the case. Clarification may be sought by the Panel at any stage by inviting either the student or other individual(s) who have given evidence, back to the meeting. They will then be asked to leave by the Chair once the Panel has raised its additional questions.
(i) The Panel must consider the case on its own merits, make decisions on the balance of probabilities about the facts of the case and use its own independent judgment to determine whether the student's fitness to practise is impaired.
(j)The proceedings can be adjourned at the sole discretion of the Chair, the reasons for which will be clearly articulated to the student together with information regarding the next stage. Timeframes for any reconvened meeting must be provided. Where practicable, the Head of Division will attempt to reconvene the meeting within 20 working days.

The Decision of the Fitness to Practise Panel

34. The Panel, following consideration of the case, must decide one of the following outcomes:

(a) The student has sufficiently addressed any concerns relating to health or conduct and poses no risk to the safety of patients or the public, nor any risk of undermining the public's trust in the medical profession. The Panel therefore can conclude that the medical student's fitness to practise is not impaired; or
(b) Where the medical student's fitness to practise is not impaired but their behaviour has significantly departed from expected standards, a warning detailing the behaviours will be given together with details of the consequences of any repeat behaviour; or
(c) The student's fitness to practise is impaired and after considering any mitigating or aggravating factors, the Panel can at its discretion, having considered all available options:
(i) Agree an undertaking with the student;
(ii) Apply reasonable conditions;
(iii) Suspend the student from the medical course and from the Register of Medical Students for a specified period of time;
(iv) Expel the student from the medical course and remove him/ her from the Register of Medical Students; or
(v) In the case of a pre-clinical student, remove the student from the Register of Medical Students but allow them to remain enrolled as a student following the course of study for the BA (Hons) in Medical Sciences.

35. Where students receive a sanction, short of expulsion, under 34 (b) or (c) above, the Head of Division will ask the appropriate Director of Studies to implement an action plan in order to provide the student with appropriate support and monitoring.

36. Information about students who have been through the Fitness to Practise procedure and have been found unfit to practise will be held securely and confidentially and may be shared between UK medical schools (through the Medical Schools’ Council (MSC)) and the General Medical Council (GMC).

37. Where the outcome is expulsion, the Registrar will inform the University’s Designated Safeguarding Lead as this may need to be reported to the government’s Disclosure and Barring Service.

38. The determination of the Panel should be recorded in writing and sent to the student within 3 working days of the decision.

39. A further document containing details of the reason for imposing any sanction, including the purpose of the sanction and any mitigating or aggravating factors taken into account, together with the relevant commencement date and applicable time period, will be sent to the student within 20 working days of the decision. Details of how compliance will be measured and who is responsible for monitoring will also be documented.

Appeals to the Fitness to Practise Appeal Panel

40. A student shall have the right of appeal against any determination made by the panel. A request for an appeal must be sent in writing to the Head of Division and must be received within 20 working days of receipt of the second document containing the details of the determination issued under regulation 39 above. The appeal request must state that it is brought on one or more of the following grounds:

(a) there was an error in the decision-making process or a procedural irregularity;
(b) there was any bias or perception of bias in the decision-making process;
(c) the decision made was unreasonable; and/or
(d) there is new, material information which had not been available prior to the decision being appealed.

41. The Head of Division will ask a member of the Faculty of Clinical Medicine or the Faculty of Physiological Sciences who is also a registered medical practitioner with a licence to practise who has not had any involvement or interest in the matter and is not a current teacher of the student to act as Reviewer. The Reviewer will consider the ground(s) of appeal and decide whether to reject or uphold, in full or in part, the request for an appeal. The Reviewer will not consider the matter afresh and will not carry out a further investigation.

42. The decision of the Reviewer should be recorded in writing with reasons and sent to the student within 15 working days of receipt by the Head of Division of the appeal request.

43. If the appeal request is refused the Reviewer’s decision will be in the form of a Completion of Procedures letter. If a student remains dissatisfied with the outcome determined by the Appeal Panel they have the right to pursue a complaint with the Office of the Independent Adjudicator for Higher Education (OIA).

44. If the appeal request is upheld, in full or in part, the Head of Division shall appoint an Appeal Panel to reconsider the case in light of the Reviewer’s decision.

45. The Appeal Panel will be constituted in the same way as the Panel (see regulations 28 to 32 above) and shall not involve any member of the original Panel.

46. If the determination by the Panel resulted in suspension or exclusion, the student shall remain suspended or excluded during the consideration of any appeal.

47. The process for arranging the hearing of the Appeal Panel will be the same as for the Panel (see regulations 28 to 32 above).

48. The process followed by the Appeal Panel at the hearing will be as followed by the Panel (see regulation 33 above). The Appeal Panel will reconsider the facts of the case in light of the Reviewer’s decision and will have the same powers of investigation and enquiry as the Panel. If the Reviewer has determined that there was a failure to follow due process, this does not automatically overrule the decision about whether the student is fit to practise.

49. Following consideration of the appeal, the Appeal Panel must either:

(a) Uphold the appeal (either in full or in part), following which the Appeal Panel must either uphold or make a new decision as to whether the student’s fitness to practise is impaired and may overturn, amend or endorse the sanctions imposed by the Fitness to Practise Panel; or
(b) Reject the appeal.

50. The determination of the Appeal Panel should be recorded in writing and sent to the student within 5 working days of the decision.

51. A further document containing details of the reason for imposing any sanction, including the purpose of the sanction and any mitigating or aggravating factors taken into account together with the relevant commencement date and applicable time period, will be sent to the student within 20 working days of the decision. Details of how compliance will be measured and who is responsible for monitoring will also be documented.

52. Where necessary, the written determination will be in the form of a Completion of Procedures letter. If a student remains dissatisfied with the outcome determined by the Appeal Panel they have the right to pursue a complaint with the Office of the Independent Adjudicator for Higher Education (OIA). If a student's complaint to the OIA under regulation 52 of this procedure is found to be justified or partly justified, this does not overrule any decision about whether a student is fit to practise. In these circumstances, the case will need to be reconsidered by the University.