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. He is a GMC Health Examiner and Medical Supervisor and a GDC Medical Advisor, and he brings 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 panel's determination.
What Dr Qureshi 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 his 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 panel 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 fitness to practise panel 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 panel 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 panel 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.