Sanctions overhaul for doctors - changes in effect from 24 November 2025

Generally, the new guidance largely reflects the guidance already in place, or expands upon it (particularly in sexual misconduct and dishonesty cases), and consolidates it into four easily accessible and navigable guidance documents.

However, the new guidance does implement significant changes in the appropriate approach to sanctions. In this briefing, we look in more detail at what has changed.

What has changed?

Set out in the guidance introduction and MPT hearings guidance are 8 case types: sexual misconduct, dishonesty, violent or abusive behaviour, discrimination, clinical concerns, impact of a health condition, insufficient knowledge of the English language, and convictions, cautions, misconduct arising from breach of court sanctions and determinations by other regulatory bodies.

The guidance introduction provides detail on each of these 8 case types, greatly expanding on the guidance previously available on those specific concerns. Particular emphasis is placed on the seriousness of sexual misconduct and dishonesty concerns. This was certainly no accident, with the MPTS's interim chair acknowledging that 'allegations of sexual misconduct remain an area of scrutiny and concern'. The new guidance seeks to allay these concerns by setting out clear guidance on the seriousness and impact of sexual misconduct, and how the MPT should approach decisions at every stage of the process. This applies not only to sexual misconduct and dishonesty, but to each of the 8 case types.

The most significant change, however, comes to the decision-making process in respect of sanctions for all allegations, with the new guidance providing a completely new framework not dissimilar to the sentencing guidelines in criminal cases. The previous approach involved starting at the least restrictive option (taking no action) and only progressing to more restrictive sanctions when less restrictive options have been discounted as insufficient. The new guidance provides a new approach based on sanctions bandings.

Each of the 8 case types is then given a sanction range dependant on the level of risk to public protection. For example:

The new guidance makes clear that, in each case, the MPT should assess the level of risk to public protection (lower, medium, or higher). Once the level has been established, the MPT should use the new sanctions bandings by referring to the type of case it is dealing with and the relevant level of risk. In deciding on the level of risk, the MPT must consider the seriousness of the facts found proved, context about the doctor and their working environment, and the doctor's response to the allegations. Each banding contains the appropriate starting sanction range for each case type at each level of risk to public protection.

The proportionate approach to sanction will still involve considering whether the least restrictive action is appropriate and assessing the sanctions options above and below the MPT's final decision on sanction. However, the new starting point is for the MPT to assess the risk to public protection and then apply this to the sanctions bandings, rather than starting at the least restrictive sanction and working up. It is then for the MPT to consider all the relevant factors in the case and make a determination as to the most appropriate and proportionate sanction within that range.

The new guidance makes very clear that if the panel departs from the guidance 'which includes the sanctions bandings', it must carefully explain how and why this was justified. The guidance acknowledges that there will be cases in which it is appropriate to go outside the sanctions bandings range. Any such decision will involve considering further contextual evidence (such as impact on patients, the public, the doctor, and references and testimonials). If the MPT take such evidence into account, it must explain the weight they apportioned it and what impact it had on their decision on sanction. This will include justifying a departure from the sanctions bandings if one occurs.

The new guidance further acknowledges that the 8 case types are not exhaustive. Where a specific concern is not covered by the sanctions bandings, the MPT should apply the general principles set out at 'stage 3 – sanction' of the new MPT hearings guidance that precedes the sanctions bandings. This part of the guidance reiterates that the starting point, as with case types covered by the bandings, is to consider the level of current and ongoing risk, but that the MPT should still refer to the guidance on proportionality, including a consideration of the least restrictive action and those options 'immediately above and below the action the MPT is minded to take'.

Comment

The new sanctions bandings are clearly inspired by criminal sentencing guidelines. This should be a welcome change for panels and doctors. It should provide greater consistency of sanction, with doctors and their representatives able to go into hearings with a much clearer indication of what sanction they will be facing if the facts of their case are found proved and they are found to be impaired.

The guidance, in several places, makes clear that a good justification will have to be provided when the MPT is minded to impose a sanction that is not within the range in the relevant sanctions bandings. This should reinforce the consistency intended by the new sanctions bandings. The guidance also makes clear that, when assessing character evidence that may lead a panel to reduce a sanction below the sanctions bandings range, 'this type of evidence may have limited, if any, impact because the need to protect the public will outweigh any relevant evidence about the doctor’s character'.

The guidance also accounts for the possibility that multiple facts are found proved that relate to more than one case type. In such a case, the MPT should consider the sanctions bandings for all of the relevant case types. In practice, it is likely that the most serious case type and/or risk to public protection will take precedence in guiding the MPT towards the most appropriate sanction. For example, in a case involving sexual misconduct and clinical concerns in which the MPT find a higher level of risk to public protection in respect of the sexual misconduct but only a lower level in respect of the clinical concerns, the starting point for the MPT will inevitably be the more serious of the two (the sexual misconduct), with the clinical concerns aggravating the seriousness of the case.