Fitness to Practise Vs Fitness for Purpose
The legislative framework for medical, dental and optometric practitioners providing NHS primary care services in England is set out in the National Health Service (Performers Lists) (England) Regulations 2013, as amended. Each of the performer’s groups are also separately regulated by their respective professional body (General Dental Council (GDC), General Medical Council (GMC), General Optical Council (GOC) who derive their powers from the relevant Acts, e.g. the Medical Act 1983, as amended; the Dentists Act 1984, as amended; the Opticians Act 1989, as amended; and the Health Act 1999, as amended.
Currently NHS England has responsibility for managing those already included on the List and for approving inclusion on the List for any new applicants. The List serves the purpose of assuring NHS commissioners, providers and users of primary care services that all primary care performers are fit for purpose.
The difference between Fitness to Practise (FtP) and Fitness for Purpose (FfP) is subtle but fundamental when considering doctors, dentists and optometrists providing NHS services in primary care in England.
Fitness to Practise refers to the standards set by the performer’s professional regulator (GDC, GMC, GOC). The standards set out the minimum requirement for that professional group with a focus on conduct, competence, health or character. It is concerned with whether the registrant has the appropriate qualifications to be on the regulators register. These regulators govern whether the registrant is fit to practise by confirming that they have the required qualifications, knowledge and skills to be a member of that profession. The scope of Fitness to Practise applies to all practise settings – NHS and private. Where a practitioner’s performance is found to be impaired by their regulator, then a Fitness to Practise process may take place which could result in imposing conditions, suspension or removal from the register.
Fitness for Purpose requires the individual to be on the relevant regulatory register AND the ability to perform primary care services in accordance with the contract for services or the employment contract (if employed). Performers working in primary care must be able to demonstrate that they are safe and able to work independently in that setting. This is commonly referred to as being Fit for Purpose. The Fitness for Purpose test therefore is the benchmark that NHS England works to and where a performer is practising unsafely or fraudulently for example, can consider any action under the Regulations separate to that of the regulator.
It is accepted by NHS England, regulators and tribunals that a decision by the regulators (GDC, GMC, GOC) does not bind the commissioning body (NHS England) and vice versa. Regulators operate under different frameworks as opposed to statutory regulation under the Performers List Regulations, apply different criteria from that which applies under the Performers List Regulations and may have differing evidence to consider, for example in the case of an application to the Performers List. The regulators will look at serious professional misconduct or undermining confidence in the profession whereas NHS England considers whether there is prejudice to the efficiency of the service, the suitability of the practitioner to deliver those services or for health reasons. There may be occasions where the regulator under Fitness to Practise may decide to impose conditions whereas under the Fitness for Purpose standard, it may be appropriate for NHS England to impose a suspension or decide to remove.
NHS England’s position with regards to the distinction for fitness for purpose is reinforced by the First Tier Tribunal in the case of Dr Alexander Rajendram v NHS England [217] 3197.PHL: http://phl.decisions.tribunals.gov.uk/
The NHS Performers Lists in England are managed by the seven Regions and the responsibility sits within the Professional Standards Teams which are led by a Medical Director for Professional Standards and System Improvement. The Performers Lists are in the public domain and can be reviewed via the following link:
For further information on Fitness to Practise, please visit the relevant regulatory body website: