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Fitness to Practise Process in the UK

What happens after a fitness to practise concern is raised? This guide walks through each common stage, from the first referral to hearings, outcomes and reviews: what happens, who decides, whether the case can end there, and what you can usefully do. It also shows where each regulator's process differs.

Walk through the stages Understand the investigation stage

Independent educational information for UK healthcare professionals. Not legal advice or regulator guidance.

See the process for your regulator

Stage names and decision-makers differ. Choose your regulator for an overview.

Select a regulator to see its stages.

What are the main stages of the FTP process?

  1. Concern raisedReferral or information received
  2. Initial assessmentScreening, triage or threshold
  3. InvestigationEvidence gathered, response invited
  4. Case decisionCase examiners or committee
  5. Meeting or hearingWhere referred
  6. OutcomeFrom no action to removal
  7. Review or appealWhere applicable

Not every case follows every stage, and terminology and decision-making differ between regulators. Dashed stages only apply to cases that progress that far. An interim order, a temporary restriction while the case continues, can be considered at almost any point and is not a finding.

The process, stage by stage

For each stage: what happens, who usually decides, whether the case can end there, and what you can usefully do.

1

A concern is raised

Concerns can come from patients, relatives, employers, colleagues, other professionals, the police or courts, other regulators and organisations, or from information the regulator identifies itself. The NMC, for example, says referrals usually come from individuals or organisations such as employers or the police, but it can also act on other information, such as media reports, where regulatory action may be needed.

Who decidesNo decision yet. The regulator receives information.
Can it end here?Yes, if the matter is outside the regulator's remit.
What you can doRead the correspondence carefully and note deadlines. A concern is not a finding.
2

Initial assessment or screening

The regulator decides whether the concern is within its remit and raises an issue it needs to investigate. Typical questions: is the person registered? Does the concern relate to professional practice or public confidence? Is there enough information? Is there an immediate risk? Does it meet the regulator's threshold? Each regulator has its own test. The NMC's screening looks at whether the information suggests a risk to public safety, public confidence or professional standards that could require regulatory action. The HCPC applies a published threshold policy. The GDC separates initial assessment from a later assessment stage.

Who decidesRegulator staff, applying screening or threshold criteria.
Can it end here?Yes, often. The GDC closed 19% of new concerns at initial assessment in 2025.
What you can doIf asked for information, respond accurately and on time. Consider advice.
3

Investigation

The regulator gathers the information decision-makers need: documents, records, statements, the relevant standards, context and, where appropriate, independent expert opinion. You are usually told what the concerns are and invited to respond. The HCPC, for example, drafts formal allegations where its threshold is met and gives the registrant an opportunity to respond before its Investigating Committee considers the case.

Who decidesInvestigators gather evidence; they do not decide the outcome.
Can it end here?Sometimes, if evidence shows no further action is needed.
What you can doUnderstand the concern, check the standards, explain context, reflect and consider learning needs. Take advice.

Read the full FTP investigation guide

4

The case decision

Once the investigation is complete, decision-makers, often called case examiners, decide what should happen. At the NMC, case examiners decide whether there is a "case to answer" and, if so, what should happen next. They can also ask for further investigation first.

Who decidesCase examiners, an Investigating Committee or equivalent.
Can it end here?Yes. Closure, advice, a warning or undertakings can resolve a case without a hearing.
What you can doMake sure your response, insight and any remediation evidence are clear and relevant.
5

Meeting or hearing

Cases that are referred go to a panel, committee or tribunal. Depending on the regulator, this may be a meeting on the papers or a hearing with evidence and witnesses. The panel typically decides the facts, whether they amount to the relevant ground such as misconduct, whether fitness to practise is currently impaired and, if so, what outcome is needed. Some regulators also allow cases to be resolved by agreement, such as the NMC's consensual panel determination.

Who decidesAn independent panel or tribunal, for example the MPTS for doctors or the HCPTS for HCPC registrants.
Can it end here?Yes. A panel can find facts not proved or fitness to practise not impaired.
What you can doRepresentation is strongly advisable. Insight and remediation are central at the impairment and sanction stages.

How panels decide in stages

6

Outcome

Possible outcomes range from no further action, advice or a warning, through conditions of practice and suspension, to removal from the register. Not every outcome is available to every regulator, and the terminology and legal effect differ.

Who decidesThe panel, usually starting from the least restrictive outcome.
Can it end here?Yes, for most cases. Some orders are reviewed.
What you can doComply with any order and keep building evidence for any review.

Explore FTP outcomes and sanctions

7

Review, appeal or further process

Conditions and suspension orders are often reviewed before they expire, where the panel considers what has changed since. Professionals can generally appeal final decisions to the courts, and the Professional Standards Authority can appeal decisions it considers insufficient to protect the public. Some regulators also allow case examiner decisions to be reviewed.

Who decidesReview panels, the courts, or the regulator for internal reviews.
Can it end here?Yes, when an order is revoked or expires without further action.
What you can doTake advice on appeal deadlines. For reviews, focus on evidence of change.

What does "case to answer" mean?

"Case to answer" is a procedural test, not a finding that allegations are proved. The NMC defines it precisely: whether there is a realistic possibility that its Fitness to Practise Committee would find the professional's fitness to practise currently impaired, based on the evidence gathered so far.

Other regulators use their own frameworks. The HCPC's Investigating Committee applies its own case to answer test, and the GMC's case examiners decide whether to refer a doctor to a tribunal.

Case to answer
Final finding
Case examiner decision (NMC example)
No case to answer
  • Close the case
  • Give advice
  • Issue a warning
Case to answer
  • Recommend undertakings
  • Refer to the Fitness to Practise Committee

Source: NMC FtP library, Examining cases (FTP-7), updated 25 March 2026.

Why can early engagement matter?

The NMC's current guidance encourages professionals to engage as early as possible, and explains that information about context, training, insight, reflection and steps taken to address concerns can be relevant to its decisions. Other regulators take a similar view: Social Work England's guidance says insight and remediation carry more weight the earlier they begin.

Early engagement does not mean admitting allegations. It means engaging appropriately with the process and providing relevant information when requested or appropriate. You can dispute facts and still engage constructively. How to do this in your case is a matter for your adviser.

Where do insight and remediation fit?

Concern → Investigation → Reflection → Insight → Remediation → Evidence → Regulatory consideration

Insight and remediation can be relevant at several stages, particularly case decisions and the impairment and sanction stages of hearings. They do not guarantee any outcome.

Insight and remediation in FTP

How long does the fitness to practise process take?

There is no single UK-wide timeframe. Duration depends on the complexity of the case, the number of allegations, the volume of evidence, witnesses and expert evidence, parallel investigations, interim orders, hearing availability and the regulator's workload. Published regulator data gives a realistic sense of scale.

Stage (GDC, 2025)Average time
Assessment stage78 working weeks
Assessment decision to final case examiner decision36 working weeks
Case examiner decision to first Practice Committee hearing57 working weeks
Streamlined single-patient clinical concerns, assessment stage16 weeks
Referral to first Interim Orders Committee hearing19 working days

Source: GDC Fitness to Practise Statistical Report 2025, published June 2026. Other regulators' timescales differ; check their published performance data.

Two points follow. First, cases that go all the way to a hearing can take well over a year, so remediation started early has time to show sustained change. Second, many cases close much sooner, at screening or case examiner stage.

Can FTP run alongside other proceedings?

Yes. A professional may face an employer investigation or disciplinary process, a police investigation or criminal proceedings, a coroner's inquest, civil proceedings or another regulator at the same time. Regulators have guidance on how they handle this; the NMC, for example, publishes guidance on investigating at the same time as other organisations, and regulators sometimes wait for another process to conclude.

How the processes interact depends on the circumstances, and what you say in one can be relevant to another. This is an area where independent advice is particularly important.

 EmployerRegulator
RelationshipEmploymentRegistration
FrameworkWorkplace rulesLegislation and rules
ConcernEmployment mattersPublic protection
ResultEmployment actionRegulatory action

Received a fitness to practise letter?

The right response depends on your regulator, the stage and the circumstances. This checklist is general educational guidance.

  1. Read it carefully

    Twice, before doing anything else.

  2. Identify the regulator and stage

    Screening, investigation or later.

  3. Identify what is requested

    Information, a response, or both.

  4. Note any deadline

    Ask for more time early if you need it.

  5. Review the standards

    In the version in force at the time.

  6. Preserve relevant records

    Securely. Never alter existing records.

  7. Consider learning needs

    Whether remediation is relevant.

  8. Get independent advice

    Defence organisation, union or solicitor.

  9. Respond through the proper route

    As the regulator directs.

  10. Keep a learning record

    Dated evidence of development.

Common misunderstandings about the FTP process

A complaint means I'll be sanctioned.Not necessarily. Most concerns never reach a hearing.
Every FTP case goes to a hearing.No. Many close at screening or case examiner stage.
An investigation means the allegation is proved.No. Investigation gathers evidence; it decides nothing.
Case to answer means I'm guilty.No. It is a test of whether a finding is realistically possible.
One course will resolve my case.Not necessarily. Relevant learning is one part of remediation.
All UK regulators follow the same process.No. Stages, tests and outcomes differ.
Remediation guarantees no sanction.No. It can be highly relevant, but decisions rest with the regulator.
An interim order means I've been found guilty.No. It is a temporary protective measure, not a finding.

Continue your FTP research

01What is fitness to practise?Meaning, grounds and impairment. 02The FTP processYou are here. 03FTP investigationHow concerns are investigated. 04Insight and remediationWhat regulators look for. 05Outcomes and sanctionsPossible regulatory outcomes.

Structured learning for professionals in an FTP process

IRR Practice courses are educational resources. They do not guarantee any regulatory outcome.

Process

Fitness to Practise

  • Each stage of the FTP process
  • Current impairment explained
  • Where insight and remediation fit
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Dealing with a Complaint or Investigation

  • Responding to a referral
  • Managing the process
  • Engaging constructively
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Insight

  • What insight means to decision-makers
  • How its quality is judged
  • Expressing insight clearly
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Remediation

  • Starting remediation early
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  • Presenting evidence of change
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FTP process: frequently asked questions

What is the fitness to practise process?

It is the procedure a UK regulator follows when a concern is raised about a registered professional: typically initial assessment, investigation, a case decision, and in some cases a meeting or hearing, an outcome and a review. Stages and names vary by regulator.

What happens after an FTP concern is raised?

The regulator first assesses whether the concern is within its remit and meets its threshold. Many concerns close at this stage; others move to investigation.

What happens during an FTP investigation?

The regulator gathers documents, records, statements and sometimes expert evidence, considers the relevant standards and gives you an opportunity to respond before decision-makers consider the case.

Does every FTP case go to a hearing?

No. Many cases close at screening or after investigation, and several regulators can resolve cases with advice, warnings or undertakings. GDC data for 2025 shows that of every 100 cases received, on average 15 reached a hearing.

What does "case to answer" mean?

At the NMC, it means there is a realistic possibility that its Fitness to Practise Committee would find fitness to practise currently impaired on the evidence gathered so far. It is not a finding that allegations are proved.

How long does an FTP investigation take?

There is no universal timeframe. GDC data for 2025 shows an average of 78 working weeks for its assessment stage, with further time for later stages. Some cases close far sooner. Check your regulator's published data.

Can an FTP case be closed after investigation?

Yes. Case examiners or equivalent decision-makers can close a case, sometimes with advice or a warning, if there is no case to answer.

What happens at an FTP hearing?

A panel typically decides the facts, whether they amount to a statutory ground, whether fitness to practise is currently impaired and, if so, what outcome is needed. Some cases are considered at meetings on the papers instead.

Can remediation be considered during an FTP process?

Yes. Evidence of insight and remediation can be relevant at the case decision stage and at the impairment and sanction stages of a hearing. It does not guarantee any outcome.

Can an FTP investigation happen alongside an employer investigation?

Yes. Employer, police, coroner and regulatory processes can run at the same time. Regulators have guidance on how they manage this, and independent advice is important.

Do all UK healthcare regulators follow the same FTP process?

No. Each has its own legislation, rules, stages, decision-makers and outcomes. Use the regulator selector at the top of this page, and always check your regulator's current guidance.

What should I do if I receive a fitness to practise letter?

Read it carefully, identify the stage and what is requested, note deadlines, review the relevant standards, preserve records, consider learning needs and take independent advice before responding through the proper route.

Sources for this guide

Naming a regulator does not imply that it endorses IRR Practice or its courses.

Last reviewed September 2026. Procedures change; always check your regulator's current guidance.

  • NMC FtP library: Examining cases (FTP-7); screening; investigations; early engagementFTP-7 updated 25 March 2026
  • GDC Fitness to Practise Statistical Report 2025Published June 2026
  • HCPC Threshold policy and investigation guidanceCurrent published versions
  • Social Work England Impairment and sanctions guidanceLast updated 23 April 2026

Understand where you are in the FTP process

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Practical articles on fitness to practise, insight, reflection, remediation and each UK regulator.

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Dr Anthony Whitfield

Dr Anthony Whitfield

Writes for IRR Practice on professional standards, fitness to practise, insight, reflection and remediation for UK healthcare professionals.

Last reviewed: September 2026