What Is Fitness to Practise?
A registered healthcare professional is fit to practise when they have the skills, knowledge, character and health to practise safely and effectively without restriction. "Fitness to practise" is also the name for the process regulators use when that is called into question. This guide explains what it means, the legal test behind it, and why it is about protecting the public now rather than punishing the past.
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What does "fit to practise" mean?
Social Work England's guidance gives a clear working definition that reflects the approach across UK health and care regulation: a professional is fit to practise when they have the skills, knowledge, character and health to practise their profession safely and effectively without restriction.
Two things follow from that definition. First, fitness to practise is not only about clinical skill. Character and health matter too, which is why honesty, behaviour and health can all be relevant. Second, the question is whether you can practise without restriction. A regulator can find that a professional needs conditions or supervision without concluding that they cannot practise at all.
"Fitness to practise" therefore has two meanings: the state of being fit to practise, and the regulatory process (often shortened to FTP) that examines it when concerns are raised.
What is fitness to practise for?
UK health and care regulators share an overarching objective: to protect the public. That objective has three parts, and every fitness to practise decision is measured against them.
Protect the public
Protect, promote and maintain the health, safety and wellbeing of patients and the public.
Maintain public confidence
Promote and maintain public confidence in the profession.
Uphold standards
Promote and maintain proper professional standards and conduct.
This is why fitness to practise is not a complaints service, a compensation scheme, an employment process or a criminal court. Its purpose is protective and forward-looking. As Social Work England's guidance puts it, the purpose of sanctions is not to punish but to protect the public.
On what grounds can fitness to practise be impaired?
Regulators can only act on the grounds set out in their legislation. The lists are similar, but not identical.
| Ground | GMC | NMC | HCPC | Social Work England |
|---|---|---|---|---|
| Misconduct | Yes | Yes | Yes | Yes |
| Performance or competence | Deficient professional performance | Lack of competence | Lack of competence | Lack of competence or capability |
| Conviction or caution | Yes | Yes | Yes | Yes |
| Physical or mental health | Yes | Yes | Yes | Yes |
| Finding by another regulator | Yes | Yes | Yes | Yes |
| Knowledge of English | Yes | Yes | See current rules | Yes |
| Barred list | See current rules | See current rules | See current rules | Yes |
Summary for orientation only. Other regulators (GDC, GPhC, GOC, GOsC, GCC, SSSC) have their own statutory grounds and terms. Check your regulator's legislation and guidance for the precise wording.
Each ground links to a different kind of concern, and to different remediation. See the guides on misconduct, poor performance and competence.
What does "impaired" fitness to practise mean?
Finding that a ground is made out, such as misconduct, is not the end of the question. A decision-maker must then decide whether fitness to practise is currently impaired. Social Work England's guidance, reflecting the wider case law, divides this into two elements that carry equal weight.
The personal element
Is there a current risk from this professional? Drawing on Cohen v GMC [2008] EWHC 581 (Admin), decision-makers ask whether the conduct:
- is easily remediable
- has already been remedied
- is highly unlikely to be repeated
This is where insight and remediation carry most weight.
The public element
Is a finding of impairment needed to maintain public confidence in the profession and uphold proper standards, even if there is no ongoing personal risk?
This is why impairment can still be found in serious cases, such as dishonesty, sexual misconduct or abuse of trust, even where a professional has remediated well.
Remediation alone cannot answer this element.
The four questions from the Shipman Inquiry
Many panels use a test drawn from the Fifth Shipman Report and approved in CHRE v Grant and NMC [2011] EWHC 927 (Admin). It asks whether the professional's misconduct, performance, health, conviction or other finding shows that they:
- have in the past acted, and/or are liable in the future to act, so as to put a patient or patients at unwarranted risk of harm
- have in the past brought, and/or are liable in the future to bring, the profession into disrepute
- have in the past breached, and/or are liable in the future to breach, one of the fundamental tenets of the profession
- have in the past acted dishonestly, and/or are liable to act dishonestly in the future
Paraphrased from the test as set out in Social Work England's published guidance. The wording varies between regulators' guidance.
What fitness to practise is not
Much of the anxiety around FTP comes from treating it as something it isn't.
| FTP is not | Because |
|---|---|
| A punishment for mistakes | It asks about current risk and public confidence, not retribution. Most people referred are safe to practise. |
| A complaints resolution service | Regulators do not resolve individual complaints or provide refunds; they decide whether regulatory action is needed. |
| A compensation scheme | Regulators do not award compensation. That is a matter for civil claims or other routes. |
| A criminal trial | It uses the civil standard of proof for disputed facts, and its outcomes concern registration, not liberty. |
| An employment process | Employers manage employment; regulators manage registration. The two can run in parallel. |
The NMC reflects this in its guidance, which starts from the principle that most people referred to it are normally safe to practise.
Does fitness to practise cover life outside work?
It can. Because the objective includes maintaining public confidence in the profession, conduct outside professional practice can be relevant where it could undermine that confidence. Dishonesty, violence, some criminal offences and discriminatory behaviour are common examples. Social Work England's guidance, for instance, notes that dishonesty in a professional's private life is still likely to undermine public confidence.
This does not mean regulators scrutinise private life generally. The question is always whether the conduct is relevant to the professional's fitness to practise and the regulator's objective.
Is health treated like misconduct?
No. Health is a separate ground, and regulators handle health cases differently, with a focus on whether the professional is managing their condition safely rather than on blame. Many professionals with health conditions practise safely without any regulatory involvement.
Health information in published decisions is usually kept private. Where a health concern arises, regulators typically look at insight into the condition and engagement with treatment and support.
Who decides, and who oversees the regulators?
The regulator
Receives and assesses concerns, investigates and presents cases. Examples: GMC, NMC, GDC, GPhC, HCPC, GOC, GOsC, GCC, Social Work England, SSSC.
View regulatorsIndependent decision-makers
Case examiners, committees and panels decide cases. Some hearings are run by separate tribunal services, such as the MPTS for doctors and the HCPTS for HCPC registrants.
The FTP processOversight
The Professional Standards Authority oversees the statutory health and care regulators, reviews their performance and can appeal final fitness to practise decisions it considers insufficient to protect the public.
Outcomes and sanctionsKey fitness to practise terms
Structured learning on fitness to practise
Understanding the framework is the first step. IRR Practice courses are educational resources and do not guarantee any regulatory outcome.
Fitness to Practise
- The purpose and grounds of FTP
- Current impairment explained
- Where insight and remediation fit
Structured CPD · 3 CPD ptsHow to Avoid a Complaint or Investigation
- Common routes into FTP
- Practice habits that reduce risk
- Early action when concerns arise
Structured CPD · 2 CPD ptsInsight
- The personal element of impairment
- How insight is judged
- Expressing insight clearly
Structured CPD · 1.5 CPD ptsRemediation
- Remediable, remedied, unlikely to recur
- Building a remediation plan
- Presenting evidence of change
Structured CPD · 1.5 CPD ptsWhat is fitness to practise? FAQs
What does fitness to practise mean?
A professional is fit to practise when they have the skills, knowledge, character and health to practise safely and effectively without restriction. Fitness to practise is also the regulatory process that examines this when concerns are raised.
What is the purpose of fitness to practise?
To protect the public: protecting health, safety and wellbeing, maintaining public confidence in the profession and upholding proper professional standards. It is not intended to punish.
What does impaired fitness to practise mean?
It means a decision-maker has found that a professional's fitness to practise is currently compromised, on one of the statutory grounds, such that regulatory action may be needed to protect the public or maintain confidence and standards.
What are the grounds for impaired fitness to practise?
Commonly misconduct, deficient performance or lack of competence, convictions or cautions, physical or mental health, findings by another regulator and insufficient knowledge of English. The exact list depends on each regulator's legislation.
What is the difference between the personal and public elements of impairment?
The personal element asks whether there is a current risk from the professional, considering whether conduct is remediable, remedied and unlikely to be repeated. The public element asks whether a finding is needed to maintain confidence and standards, even without ongoing risk.
Can I be found impaired even if I have remediated?
Yes, in some cases. Strong remediation can address the personal element, but in serious cases such as dishonesty or abuse of trust, a finding may still be needed to maintain public confidence.
Can conduct outside work affect fitness to practise?
It can, where it is relevant to public confidence in the profession, for example dishonesty, some criminal offences or discriminatory behaviour. Regulators do not scrutinise private life generally.
Is fitness to practise a punishment?
No. UK regulators consistently state that FTP is protective, not punitive. Outcomes can still have serious consequences for a professional, but their purpose is public protection.
Who oversees healthcare regulators' fitness to practise decisions?
The Professional Standards Authority oversees the UK's statutory health and care regulators and can appeal final fitness to practise decisions it considers insufficient to protect the public.
Does fitness to practise work the same way for every profession?
No. The principles are shared, but each regulator has its own legislation, grounds, processes and terminology. Check your own regulator's guidance.
Sources for this guide
Naming a regulator does not imply that it endorses IRR Practice or its courses.
Last reviewed September 2026. Law and guidance change; check your regulator's current publications.
- Social Work England Impairment and sanctions guidanceLast updated 23 April 2026
- NMC FtP library, including taking account of contextCurrent published version
- Case law Cohen v GMC [2008] EWHC 581 (Admin); CHRE v Grant and NMC [2011] EWHC 927 (Admin)Test for current impairment
- HCPC Sanctions policy and FTP guidanceSanctions policy in effect from 2 March 2026
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