How the General Medical Council assesses concerns about doctors, from triage and investigation to case examiner decisions, warnings, undertakings, interim orders and MPTS tribunals. Built on Good medical practice 2024 and the GMC's current decision-making guidance, with a practical focus on insight, remediation and the evidence that actually changes outcomes.
Independent educational information for doctors. IRR Practice is not the GMC or the MPTS and does not provide legal representation.
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GMC fitness to practise is the process the General Medical Council uses to decide whether a doctor's ability to practise safely and effectively is currently impaired, and whether action on their registration is needed to protect the public.
The GMC describes fitness to practise as an assessment of a doctor's ability to practise safely and effectively, taking in their performance in their role, their professional and personal behaviour, and the effect of any health condition on their ability to provide safe care.
Most concerns never get close to a sanction. In 2025, the GMC triaged 13,465 concerns about doctors, a 25% rise on 2024 and the largest year-on-year increase in two decades. It closed 12,146 of them at triage because they did not meet the legal threshold for investigation. Of the 679 cases its case examiners considered, 309 were closed with no further action, often because the issues had already been addressed and there was no ongoing risk.
Source: GMC, Concerns about fitness to practise: Annual statistical report 2025, and the GMC's news release on its publication.
90% of concerns closed at triage in 2025. Bars are illustrative, not to scale.
The GMC is the independent statutory regulator of doctors, physician associates and anaesthesia associates in the UK. Its fitness to practise role is to investigate where patient safety, or public confidence in the profession, may be at risk, and to take action where it is needed. Everything it does in this area is framed by its overarching objective of public protection: protecting the health, safety and wellbeing of the public, maintaining public confidence in the profession, and upholding proper professional standards and conduct.
That objective explains why fitness to practise looks forward rather than back. The question is not "did something go wrong?" but "is this doctor's fitness to practise impaired now, and does anything need to happen to protect patients or public confidence?" A serious past event that has been fully understood, addressed and not repeated can lead to a very different outcome from a lesser concern that is ongoing and unacknowledged.
Under the GMC's Fitness to Practise Rules, a doctor's fitness to practise may be found impaired by reason of misconduct, deficient professional performance, a conviction or caution for a criminal offence, adverse physical or mental health, not having the necessary knowledge of English, or a determination by another regulatory body.
The GMC regulates three distinct professions: doctors, physician associates (PAs) and anaesthesia associates (AAs). Doctors must be registered and hold a licence to practise to work as a doctor in the UK, and the GMC can investigate concerns about any registered doctor, with or without a licence.
Good medical practice 2024 came into effect for doctors on 30 January 2024 and for PAs and AAs on 13 December 2024, when the GMC began regulating them. PAs and AAs have their own fitness to practise procedures, which differ in several respects from those for doctors, including how restrictions can be agreed.
This guide focuses on doctors. If you are a PA or AA, check the GMC's separate information for PAs and AAs under investigation.
GMC fitness to practise rests on several layers, each with a different job. Understanding which layer you are dealing with prevents a lot of confusion.
| Instrument | What it does |
|---|---|
| Medical Act 1983 | The primary legislation. Establishes the GMC, the register, the grounds of impairment, the tribunal's powers, sanctions and rights of appeal. |
| GMC (Fitness to Practise) Rules 2004 | The procedural rules: triage, investigation, disclosure, case examiner decisions, warnings, undertakings and hearings. |
| Good medical practice 2024 | The core professional standards against which a doctor's conduct and performance are measured. |
| More detailed professional guidance | Guidance on confidentiality, consent, prescribing and other areas that builds on Good medical practice. |
| GMC decision-maker guidance | How GMC staff and case examiners decide whether to investigate, how to gather evidence, and how to conclude an investigation. The collection was last updated on 30 March 2026. |
| MPTS guidance | Guidance used by independent medical practitioners tribunals, including on sanctions. |
| Case law | Court decisions that shape how impairment, insight and sanctions are assessed. |
| Professional Standards Authority | Oversees the GMC and can refer final tribunal decisions it considers insufficient to protect the public to the courts. |
GMC and MPTS are not the same decision-maker. The GMC investigates and, where necessary, refers cases. The Medical Practitioners Tribunal Service is operationally separate and runs the tribunals that decide referred cases. The GMC is a party in those hearings, not the judge, and can itself appeal a tribunal decision it considers insufficient to protect the public.
Good medical practice is the GMC's core guidance. The 2024 version, with six pieces of more detailed guidance, came into effect on 30 January 2024 and places stronger emphasis on behaviours and values that create respectful, fair and supportive workplaces. Its four domains are described by the GMC as all equally important. When a concern is raised, identifying which domain and which paragraphs are engaged is one of the first things worth doing.
Being competent; providing good clinical care; maintaining, developing and improving your performance; managing resources effectively and sustainably.
The GMC says good doctors reflect regularly on their standards of practice and use feedback and evidence to develop personal and professional insight. That language maps directly onto what FTP decision-makers look for.
Common concerns: competence, performance, prescribing
Treating patients fairly and with kindness, courtesy and respect; supporting decisions about care; sharing information; caring for the whole patient; safeguarding; helping in emergencies; being open if things go wrong.
Communication failures, consent problems and a lack of candour after an adverse event often sit here.
Common concerns: professionalism, confidentiality
Treating colleagues with respect; contributing to a positive working and training environment; leadership behaviours; continuity of care; delegating safely; recording your work clearly, accurately and legibly; keeping patients safe; responding to safety risks; managing risks posed by your health.
Bullying, poor teamwork, record-keeping failures and not acting on safety risks usually engage this domain.
Common concerns: documentation, conduct
Acting with honesty and integrity; maintaining professional boundaries; communicating as a medical professional; managing conflicts of interest; cooperating with legal and regulatory requirements.
Probity, boundary breaches, social media conduct and failure to cooperate with the GMC fall here, and concerns in this domain tend to carry the greatest weight for public confidence.
Common concerns: probity, boundaries
Good medical practice is not the only standard. The GMC's more detailed guidance builds on it and is often the more precise benchmark in an investigation. It includes guidance on confidentiality, decision making and consent, raising and acting on concerns, leadership and management, protecting children and young people, treatment and care towards the end of life, and good practice in prescribing and managing medicines and devices. A prescribing concern, for example, is usually assessed against the prescribing guidance as well as Domain 1.
The same event can engage more than one area. This matrix shows common concerns, the part of the GMC's framework usually engaged, and where to read about addressing each.
| Area | Examples | GMC framework | Remediation guide |
|---|---|---|---|
| Clinical competence | Inadequate assessment, missed diagnosis, unsafe procedure | Domain 1 | Competence |
| Poor performance | Repeated deficiencies across a body of work | Domain 1; deficient professional performance | Performance |
| Probity | Dishonesty, misleading CVs, false claims, inaccurate declarations | Domain 4 | Probity |
| Professionalism | Rudeness, poor teamwork, bullying, communication failures | Domains 2 and 3 | Professionalism |
| Patient safety | Failing to escalate or respond to risk | Domain 3 | Competence |
| Documentation | Inaccurate, missing or altered records | Domain 3 | Documentation |
| Confidentiality | Inappropriate disclosure or access | Domain 2; confidentiality guidance | Confidentiality |
| Boundaries | Inappropriate relationships or conduct | Domain 4 | Misconduct |
| Prescribing | Unsafe prescribing, self-prescribing, prescribing for family | Domain 1; prescribing guidance | Medication |
| Health | A condition affecting safe practice, not managed safely | Domain 3; health guidance | Specialist support |
| Criminal matters | Convictions, cautions, relevant conduct | Statutory ground | Misconduct |
Concerns reach the GMC from patients and relatives, employers and responsible officers, colleagues, the police and courts, other regulators and organisations, and doctors who self-refer. The GMC can also act on information it identifies itself, such as media reports. The Medical Defence Union has noted that around 70% of complaints to the GMC come from members of the public. Whatever the source, a concern is only information to be assessed. It does not establish impairment.
Not every case passes through every stage. Most end at the first.
An interim order can be considered by an MPTS interim orders tribunal at any stage if restriction is needed while the case continues.
When a concern arrives, the GMC first decides whether it meets the legal threshold for investigation. At this point the doctor and their employer are not usually told. The GMC considers whether the concern relates to fitness to practise at all, whether it is serious enough, the potential risk to patients or public confidence, and whether the GMC is the right organisation to deal with it. Concerns better handled locally may be passed back to the employer or responsible officer.
Since the GMC introduced updated decision-making guidance in 2025, a single set of core principles applies to all its fitness to practise decision-makers. Deciding whether a matter proceeds rests on three questions:
The GMC also applies a five-year rule: it does not usually investigate concerns about events more than five years before the concern was raised, unless it decides that doing so is in the public interest.
If a concern meets the threshold, the GMC opens an investigation and tells the doctor and, usually, their employer or responsible officer. The steps depend on the nature and seriousness of the concern, and the GMC's own guidance notes that investigations often end with no need to take any action.
What happened and the care provided.
From patients, colleagues and others.
Local investigations, appraisal and responsible officer input.
An independent expert opinion on whether care fell below standard.
Emails, messages, complaints and responses.
Relevant learning and development.
Performance, health or English language.
Including context, insight and remediation.
Once the evidence has been gathered, the GMC discloses the allegations and the evidence it relies on and invites the doctor to respond, usually within 28 days. This response is one of the most important documents in the case, because case examiners read it when deciding the outcome. It can address the facts, provide context, and set out insight and any remediation undertaken. Independent advice before submitting it is strongly advisable.
Where the concern is about performance, the GMC can arrange a performance assessment, including tests of knowledge and skills and a peer review of practice. Where health may be affecting practice, it can arrange a health assessment with independent medical examiners. Where there is a concern about English, it can require a language assessment. Failing to comply with an assessment or a requirement to provide information can lead to a non-compliance hearing.
The GMC's decision-making principles commit it to decisions that are proportionate, transparent and fair. At the end of an investigation, the central question in its guidance on deciding the outcome is whether the doctor poses any current and ongoing risk to public protection that requires restrictive action on their registration, and what the proportionate outcome is.
The GMC's principles on impairment frame insight around whether the doctor understands what happened and whether they understand how they could have acted differently. In practice, decision-makers are looking for evidence that the doctor:
Insight is not an apology and it is not a promise. It is understanding that is visible in what a doctor now does. It also does not require admitting every allegation: a doctor can dispute facts while showing that they understand why the conduct alleged would be serious if it had occurred. Take advice before making statements about disputed facts.
The same GMC principles frame remediation around three questions drawn from Cohen v GMC [2008]: is the concern remediable, has it been remedied, and is it likely to be repeated? Clinical and performance concerns are usually more readily remediable than, for example, serious dishonesty or sexual misconduct, where public confidence may require action whatever the remediation.
Course completion is not automatic remediation. A course is evidence of learning. Remediation is the change in practice that follows, shown by evidence from others.
Different concerns need different evidence. This matrix shows what a credible package usually combines for each type of concern. It is a starting point, not a checklist that guarantees any outcome.
| Concern | Evidence that usually carries weight | Guide |
|---|---|---|
| Probity | Targeted probity learning, reflection on Domain 4, evidence of honest conduct over time, testimonials from people aware of the concern | Probity |
| Competence | Assessment, supervised practice, targeted clinical education, workplace-based assessments and feedback | Competence |
| Performance | Root-cause analysis, supervision reports, audit, multi-source feedback | Performance |
| Prescribing | Prescribing learning, prescribing audit, supervision, changed practice | Medication |
| Documentation | Record-keeping learning, records audit, reviewer feedback | Documentation |
| Professionalism | Reflection, communication learning, multi-source feedback, workplace evidence | Professionalism |
| Confidentiality | Confidentiality learning, reflection, changed practice, access audit where authorised | Confidentiality |
At the end of an investigation, two case examiners, one medical and one lay, review the evidence and decide the outcome. In 2025, they considered 679 cases:
Often because issues had already been addressed and there was no ongoing risk.
Guidance about future conduct or performance. Not a restriction.
Not impaired, but a significant departure from standards.
Agreed restrictions or requirements on practice.
A tribunal decides facts, impairment and sanction.
Source: GMC, Annual statistical report 2025.
A warning is used where case examiners, or a tribunal, conclude that a doctor's fitness to practise is not impaired, but there has been a significant departure from Good medical practice, or a significant cause for concern, that warrants a formal response. A warning does not restrict practice.
That distinction matters: a warning is issued because fitness to practise is not impaired. It is a formal record, not a finding of impairment. Warnings are, however, disclosed to employers and published on the medical register for a period, so they have real professional consequences. Check the GMC's current publication and disclosure policy for how long and to whom a warning is disclosed.
If the doctor does not accept a proposed warning, the matter goes to the GMC's Investigation Committee, which decides at a hearing whether a warning should be issued.
Undertakings are commitments a doctor agrees to, usually where case examiners consider that fitness to practise is impaired, or where a continuing or episodic health condition may cause impairment to recur. They can include supervision, specific training, working only in certain settings, or health-related requirements such as treatment and monitoring.
If accepted, the investigation concludes without a hearing. Undertakings are then monitored by the GMC, and a breach can lead to referral to a tribunal. They are not appropriate where there is a realistic prospect that a tribunal would erase the doctor. Unlike suspension, undertakings allow the doctor to keep practising, within the agreed limits.
Undertakings relating solely to health are not published.
The Medical Practitioners Tribunal Service runs the tribunals that decide referred cases. It is operationally separate from the GMC's investigation function. Medical practitioners tribunals usually decide cases in three stages, and each is a separate question:
Are the facts alleged proved, on the civil standard (the balance of probabilities)?
Do the proved facts amount to a statutory ground, and is fitness to practise currently impaired?
If impaired, what is the least restrictive sanction that protects the public?
Hearings are usually held in public, but matters relating to a doctor's health are normally heard in private. A tribunal can find facts not proved, find fitness to practise not impaired (and may issue a warning), or impose a sanction. Evidence of insight and remediation is most influential at the impairment and sanction stages.
If the GMC considers that a doctor's practice may need to be restricted while a case is investigated, it can refer them to an MPTS interim orders tribunal. The tribunal can impose interim conditions or an interim suspension where necessary to protect the public, in the public interest, or in the doctor's own interests.
An interim order is not a finding that any allegation is proved. It is a temporary, protective measure. Interim orders can last up to 18 months, are reviewed at regular intervals, and can be extended only by the High Court or, in Scotland, the Court of Session. The doctor can attend and be represented.
These hearings can be listed at short notice. Contact your defence organisation, union or a regulatory solicitor straight away.
No outcome is automatic. Tribunals start with the least restrictive option and move up only as far as needed to protect the public.
| Outcome | What it means | Who decides |
|---|---|---|
| No action | Regulatory action is not required | Case examiners or tribunal |
| Advice | Guidance on future conduct or performance | Case examiners |
| Warning | Not impaired, but a significant departure from standards | Case examiners, Investigation Committee or tribunal |
| Undertakings | Agreed restrictions or requirements | Agreed with case examiners |
| Conditions | Practice restricted, for up to three years | Tribunal |
| Suspension | Cannot practise, for up to 12 months | Tribunal |
| Erasure | Removed from the register | Tribunal |
Conditions and suspension are usually reviewed before they end, when the tribunal looks at what has changed since. A doctor who has been erased can apply for restoration, but not until five years after erasure, and restoration is not automatic. See FTP outcomes and sanctions for how UK regulators compare.
Domain 4 requires doctors to act with honesty and integrity, including being honest about their experience, qualifications and role, making sure documents and statements are not false or misleading, managing conflicts of interest and financial dealings openly, and cooperating with the GMC and other legal and regulatory requirements. Dishonesty is among the concerns most likely to reach a tribunal, because it goes directly to public trust. The GMC has separate guidance on when violence and dishonesty may represent a lower risk.
Probity remediationA single clinical error rarely indicates deficient professional performance. Performance concerns usually relate to a pattern across a doctor's work, which is why the GMC can require a performance assessment. Competence concerns are generally among the more remediable, through targeted learning, supervised practice and reassessment.
Competence remediationThe GMC's prescribing guidance expects doctors to prescribe only within their competence and only when they have adequate knowledge of the patient's health and are satisfied the medicine serves the patient's needs. Self-prescribing and prescribing for people close to you are specific areas of concern. Medication errors are not automatically misconduct; context and system factors matter.
Medication remediationGood medical practice requires records that are clear, accurate, contemporaneous and legible. In an investigation, your records are also evidence of what you did. A genuine documentation error is very different from altering records after the event, which can raise a separate and serious probity concern.
Documentation remediationThe GMC's confidentiality guidance sets out when patient information can be shared and how it must be protected. Professional confidentiality is not identical to data protection law; a doctor needs to consider both. Deliberate access without a legitimate reason is treated very differently from accidental disclosure.
Confidentiality remediationMany doctors practise safely with health conditions. The GMC becomes involved where a condition may be affecting safe practice and is not being managed safely. Health cases focus on insight into the condition and engagement with treatment and support, not blame. Health information is handled confidentially, and the GMC has specific guidance on assessing the impact of a doctor's health on their behaviour or performance.
How health is treated in FTPDoctors often face several processes at once. They have different purposes, and the outcome of one does not decide another.
| Purpose | Key difference from GMC FTP | |
|---|---|---|
| Employer disciplinary | Manage the employment relationship, often under frameworks such as Maintaining High Professional Standards in England | Concerns employment, not registration. The GMC may wait for, or rely on, a local process, but is not bound by its outcome. |
| Criminal proceedings | Decide criminal guilt | A conviction is generally treated as proof of the offence in FTP. An acquittal does not end GMC interest, because FTP uses the civil standard and asks a different question. |
| Appraisal and revalidation | Annual appraisal and five-yearly revalidation, with a responsible officer's recommendation | Supportive and developmental. Not a disciplinary process, though a responsible officer may refer concerns to the GMC. |
| Performance assessment | A GMC-required assessment of knowledge, skills and practice | Part of an FTP investigation into performance, not ordinary CPD. |
| Civil claims | Compensation for negligence | The GMC does not award compensation. Negligence and impairment are different questions. |
General educational guidance. The right approach depends on your stage and circumstances.
Exactly what is alleged, and what is not.
Triage, investigation, case examiners or MPTS.
Which GMP domain and guidance paragraphs are engaged.
Securely. Never alter records.
Deadlines, information requests, assessments.
Defence organisation, BMA or a regulatory solicitor.
From the root cause, not the allegation's headline.
Relevant, measurable, effective.
From people who have seen your practice.
Over time, not just before a decision.
A simplified map from concern to evidence of current practice.
Targeted learning should match the concern. Course completion is educational evidence of learning; it does not by itself establish insight, competence, remediation or any particular GMC outcome.
Structured CPD · 1.5 CPD ptsStructured CPD · 1.5 CPD ptsStructured CPD · 1.5 CPD ptsStructured CPD · 2 CPD ptsStructured CPD · 2 CPD ptsStructured CPD · 1.5 CPD ptsStructured CPD · 2 CPD ptsStructured CPD · 2 CPD ptsStructured CPD · 3 CPD ptsDepending on the concern, Documentation Professionalism, Confidentiality or Dealing with a Complaint or Investigation may also be relevant. See all GMC remediation courses or the structured Fitness to Practise Remediation programme.
It is the GMC's process for deciding whether a doctor's ability to practise safely and effectively is currently impaired, and whether action on their registration is needed to protect patients, maintain public confidence and uphold standards.
Concerns about misconduct, deficient professional performance, a conviction or caution, adverse health, knowledge of English, or a determination by another regulator. In practice this includes clinical, probity, professionalism, prescribing, documentation, confidentiality and boundary concerns.
No. A concern is information to be assessed. In 2025, the GMC closed 12,146 of 13,465 concerns about doctors at triage because they did not meet the threshold for investigation.
It gathers records, statements, employer information and sometimes expert evidence, may require performance, health or language assessments, then discloses the allegations and evidence and invites the doctor's response before case examiners decide the outcome.
It varies with complexity, the evidence needed and any assessments. Many concerns close quickly at triage; investigations that involve expert evidence or assessments can take many months. Check the GMC's current published performance information.
Clinical records, witness statements, employer and responsible officer information, expert reports, correspondence, training records, assessment results, and the doctor's response, including insight and remediation evidence.
Case examiners are senior GMC decision-makers, one medical and one lay, who review the evidence at the end of an investigation and decide whether to close the case, give advice, issue a warning, agree undertakings or refer to the MPTS.
It refers to whether the evidence justifies further action, such as referral to a tribunal. It is a procedural decision, not a finding that allegations are proved or that fitness to practise is impaired.
The GMC's impairment principles frame insight around whether the doctor understands what happened and how they could have acted differently. Decision-makers look for understanding of impact, causes and responsibility, shown by changed practice.
The steps a doctor takes to address the concern, assessed by asking whether the concern is remediable, whether it has been remedied, and whether it is likely to be repeated.
No. A course shows learning. Insight is understanding that is visible in what a doctor now does, supported by reflection and evidence from others.
Yes. How the doctor has responded, including insight and remediation, is one of the GMC's three core questions from the start. It can influence case examiner decisions and tribunal outcomes, but guarantees none.
A formal response where fitness to practise is not impaired but there has been a significant departure from standards. It does not restrict practice, but is disclosed and published for a period. If not accepted, the Investigation Committee decides.
Agreed commitments, such as supervision, training or health requirements, usually where fitness to practise is impaired. If accepted, the case concludes without a hearing; compliance is monitored.
A temporary restriction or suspension imposed by an MPTS interim orders tribunal while a case continues, where necessary to protect the public. It is not a finding and can last up to 18 months unless extended by the court.
The Medical Practitioners Tribunal Service, which runs the tribunals that decide cases referred by the GMC. It is operationally separate from the GMC's investigation function.
A tribunal decides the facts, whether fitness to practise is currently impaired, and if so the least restrictive sanction needed. Hearings are usually public, except for health matters.
Suspension is imposed by an MPTS tribunal, either as an interim order during an investigation or as a sanction for up to 12 months after a finding of impairment.
Yes, by a tribunal in the most serious cases. An erased doctor can apply for restoration only after five years, and restoration is not automatic.
You can dispute facts. Disputing them does not necessarily mean a lack of insight, but you still need to show you understand why the alleged conduct would matter. Take advice before responding.
Yes. They have different purposes and can run in parallel. The GMC may wait for local processes, but is not bound by their outcome.
Read the letter carefully, note deadlines, identify the stage and concerns, preserve records, and contact your defence organisation or a regulatory adviser before responding.
Yes, and it is strongly advisable. Medical defence organisations, the BMA and specialist regulatory solicitors advise doctors facing GMC investigations. IRR Practice provides education, not legal advice.
Good medical practice 2024 and the GMC's more detailed guidance, such as on confidentiality, consent and prescribing.
It is the standard against which conduct and performance are measured. Identifying which domain and paragraphs a concern engages is one of the first steps in understanding and addressing it.
This guide is based on the GMC's and MPTS's published material. IRR Practice is independent; naming the GMC does not imply endorsement.
Content governance. Last reviewed September 2026. GMC and MPTS procedures and guidance change. Check the current version of any guidance relevant to your case before relying on it.
Identify the concern, understand where you are in the GMC process, then build relevant learning and evidence of change. If your case is active, take independent advice alongside any learning.
Practical guidance on GMC investigations, revalidation, interim orders and remediation.
Writes for IRR Practice on professional standards, fitness to practise, insight, reflection and remediation for UK healthcare professionals.
Last reviewed: September 2026