Fitness to Practise for Healthcare Professionals
What happens when a concern is raised about a healthcare professional's practice, conduct, competence or professional standards? Fitness to practise (FTP) is the framework UK regulators use to consider those concerns and decide whether any regulatory action is needed. The exact process, terminology and decisions depend on your regulator and profession.
Independent educational information for UK healthcare professionals. Not legal representation or regulator advice.
Where are you in the process?
Choose your current stage. See what typically happens and what you can usefully do now.
Select your stage to see where to focus.
- UK healthcare focusedCovering regulators across the four UK nations
- Regulator-awareReviewed against current regulatory sources
- Evidence-led guidanceBased on published guidance and data
- Independent providerEducation, not a regulator or legal service
What is fitness to practise?
Fitness to practise is the regulatory process through which a professional regulator considers concerns about a registered professional's practice, conduct, competence, health or other matters relevant to professional standards and public protection. A professional is generally considered fit to practise when they have the skills, knowledge, character and health to practise safely and effectively without restriction.
The process looks forward, not back. Regulators ask whether a professional's fitness to practise is currently impaired, and whether action is needed to protect the public, maintain confidence in the profession or uphold standards. The HCPC puts it plainly: its process is not about punishing people for past mistakes.
How does fitness to practise work?
Most UK regulators follow a broadly similar sequence, although the names of each stage, the decision-makers and the thresholds differ.
- Concern raisedBy a patient, employer, colleague, the police or through self-referral
- Initial assessmentScreening or triage: does it meet the threshold?
- InvestigationEvidence gathered; you are given a chance to respond
- Case decisionOften by case examiners or a committee
- Meeting or hearingWhere the case is referred
- OutcomeFrom no action to removal
- Review or appealWhere applicable
Not every case follows every stage. Many close at the first or second stage. The General Dental Council, for example, describes four stages: initial assessment, assessment, case examiners and hearings. The NMC describes screening, investigation, case examiners and its Fitness to Practise Committee. Interim orders, which can restrict practice temporarily while a case continues, can be considered at any point and are not a finding. Read the full FTP process guide.
A concern is not a finding
A complaint, referral, allegation or concern is not itself a regulatory finding. Each step in the process requires the regulator to apply its own procedures and decision-making framework.
The data shows how few concerns reach the end of the process. The General Dental Council's 2025 statistical report found that of every 100 cases it received, on average 81 progressed to assessment, 34 to case examiners and 15 to a Practice Committee hearing. It removed 18 dental professionals from the register in 2025, about 0.01% of all registrants, from 1,766 concerns received.
Figures differ between regulators and years. Source: GDC Fitness to Practise Statistical Report 2025, published June 2026.
GDC, 2025: 18 removals from the register, about 0.01% of registrants.
What can lead to a fitness to practise concern?
The grounds a regulator can consider are set by its legislation, and they vary. Common categories include the following. Each links to guidance on remediation where it exists.
Is fitness to practise the same as workplace disciplinary action?
No, although the two can run alongside each other and information from one may be relevant to the other.
| Workplace process | Regulatory FTP | |
|---|---|---|
| Led by | Usually your employer | Your professional regulator |
| Concerns | Your employment relationship | Your professional registration |
| Framework | Employer policies and contract | Regulatory legislation, rules and standards |
| Consequences | Employment outcomes | Regulatory outcomes affecting registration |
| Focus | Workplace conduct and performance | Public protection and professional standards |
Many regulators expect employers to manage lower-level concerns locally first, and some check whether a local process has concluded before deciding whether regulatory action is needed.
Where does remediation fit into fitness to practise?
Because fitness to practise asks about the present, what a professional has done since a concern arose can be highly relevant. Each concept answers a different question.
FTP
What is the regulatory concern?
Insight
Does the professional understand the concern and its significance?
Reflection
What has the professional learned?
Remediation
What has been done to address the concern?
Evidence
What demonstrates the learning and change?
The NMC's current guidance, for example, considers insight, reflection and the steps taken to strengthen practice when deciding whether a concern has been addressed, and encourages professionals to engage early and share relevant information such as context, training, insight and reflection. Remediation does not guarantee any particular outcome.
What happens during an FTP investigation?
Investigations vary by regulator and case, but commonly involve reviewing the concern, requesting information, gathering records and statements, considering the relevant professional standards, obtaining further evidence such as expert opinion, giving you an opportunity to respond, and assessing whether further regulatory action is needed.
The HCPC, for example, explains that where a concern meets its threshold for investigation, allegations may be drafted and the registrant is given the opportunity to respond before a decision is made.
What happens after an investigation?
Depending on the regulator and circumstances, possible outcomes can include:
Not every regulator uses every outcome, and terminology differs. Read the FTP outcomes and sanctions guide.
Which UK regulator handles your fitness to practise?
There is no single UK fitness to practise process. Each regulator has its own legislation, rules, standards, thresholds, decision-makers, terminology and outcomes.
This page is a UK-wide educational overview. For an active case, always check the current guidance and rules published by your own regulator.
If you have received an FTP concern
This is general educational guidance, not case-specific advice. The right approach depends on your regulator, the stage and the seriousness of the concern.
Read the correspondence carefully
Identify exactly what the regulator is asking and by when.
Identify the concerns or allegations
Understand precisely what is being considered, and what is not.
Check the relevant professional standards
In the version that applied at the time of the events.
Keep relevant records
Preserve correspondence and appropriate documents securely.
Consider your learning needs
Whether education, supervision, assessment or other development is relevant.
Consider independent advice
Especially where the matter is serious, complex or approaching a hearing.
Don't create new evidence problems
Never alter records, and protect patient confidentiality in anything you submit.
Engage appropriately with the regulator
Early engagement is encouraged by several regulators; requirements vary by stage.
What evidence may be relevant?
Depending on the case, relevant evidence can include professional records, reflective work, relevant education, assessments, supervision reports, workplace feedback, audit, competency evidence, appraisal information, action plans and evidence of changed practice.
The relevance and weight of evidence depend on the regulator, the concern and the stage of the case. For how decision-makers weigh different types, see the remediation evidence guide.
Are you currently under investigation?
This website can help you understand general concepts and educational options. It does not provide legal representation or case-specific regulatory advice.
Consider independent advice from a regulatory solicitor, your professional defence organisation, your union where applicable, or another appropriately qualified adviser.
Fitness to practise guides
Go deeper into the part of the process most relevant to you.
What do you need to understand?
Structured learning for professionals facing FTP
IRR Practice courses are educational resources that can form one documented part of your response to a concern. They do not guarantee any regulatory outcome.
Fitness to Practise
- How FTP concerns are raised and investigated
- Current impairment and how it is assessed
- Where insight and remediation fit
Structured CPD · 3 CPD ptsDealing with a Complaint or Investigation
- Responding to a complaint or referral
- Managing the process and its pressure
- Engaging constructively
Structured CPD · 2 CPD ptsInsight
- What insight means to regulators
- How its quality is judged
- Expressing insight clearly
Structured CPD · 1.5 CPD ptsReflection and Reflective Practice
- Structured reflection on a concern
- Linking learning to practice
- Writing a focused account
Structured CPD · 1.5 CPD ptsRemediation
- What remediation involves
- Building a remediation plan
- Presenting evidence of change
Structured CPD · 1.5 CPD ptsFor a structured multi-course pathway, see the Fitness to Practise Remediation programme.
Fitness to practise: frequently asked questions
What is fitness to practise?
Fitness to practise is the process through which a UK professional regulator considers concerns about a registered professional and decides whether their ability to practise safely and effectively is currently impaired, and whether any action is needed.
What does FTP mean in healthcare?
FTP is short for fitness to practise. In healthcare it refers to the regulatory framework used by bodies such as the GMC, NMC, GDC, GPhC and HCPC to consider concerns about registered professionals.
What can trigger a fitness to practise investigation?
Concerns about conduct, probity, competence, performance, patient safety, health, criminal convictions or findings by other bodies, among others. Each regulator's legislation sets out the grounds it can consider.
Does an FTP complaint mean I am guilty?
No. A concern is not a finding. Most concerns close before a hearing. GDC data for 2025, for example, shows that of every 100 cases received, on average 15 reached a Practice Committee hearing.
What happens during a fitness to practise investigation?
The regulator reviews the concern, gathers information such as records and statements, considers the relevant standards, may seek expert opinion, and gives you an opportunity to respond before a decision is made.
How long does a fitness to practise investigation take?
It varies significantly by regulator, case complexity and stage, from weeks for cases closed early to well over a year for complex cases. The GDC reported, for example, that its assessment stage took an average of 78 working weeks in 2025. Check your regulator's published data for current figures.
What is the difference between FTP and workplace disciplinary action?
Workplace processes are led by your employer and concern your employment. FTP is led by your regulator and concerns your professional registration and public protection. They can run alongside each other.
What is insight in fitness to practise?
Insight is a professional's understanding of what went wrong, why it happened, its significance and impact, and what needs to change. Decision-makers assess its quality when considering current impairment.
Can remediation help with an FTP concern?
It can be highly relevant, because FTP looks at current impairment and risk of repetition. It does not guarantee any outcome, and some concerns, such as serious dishonesty, are harder to remediate.
What happens if a regulator finds impaired fitness to practise?
The panel decides what, if any, sanction is needed, usually starting with the least restrictive. Outcomes can range from no action or a warning to conditions, suspension or removal from the register.
Can a fitness to practise case be closed without a hearing?
Yes. Many cases close at initial assessment or after investigation, and several regulators can resolve cases through advice, warnings, undertakings or agreed outcomes without a hearing.
Does every UK healthcare regulator follow the same FTP process?
No. Each regulator has its own legislation, rules, stages, terminology and outcomes. Always check your own regulator's current guidance.
Sources for this guide
This guide draws on current regulator publications. 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.
- GDC Fitness to Practise Statistical Report 2025Published June 2026
- NMC FtP library: examining cases; early engagement; insight and strengthened practiceFTP-16b updated 25 March 2026
- HCPC Fitness to practise and investigation guidanceCurrent published version
- Social Work England Impairment and sanctions guidanceLast updated 23 April 2026
Understand your fitness to practise position
Whether you are researching an FTP concern, trying to understand an investigation or looking for relevant remediation learning, start with the part of the process most relevant to you.
More from the IRR Practice blog
Practical articles on fitness to practise, insight, reflection, remediation and each UK regulator.
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