In short: GMC concerns generally fall into four areas: misconduct including dishonesty, performance or capability, health, and criminal convictions or cautions. All are measured against Good Medical Practice. The GMC then weighs three things: how serious the concern is, the relevant context, and how the doctor has responded. Dishonesty and probity concerns are treated especially seriously, but insight and remediation still shape the outcome.
One of the hardest parts of an unexpected complaint is not knowing whether it is the kind of thing the GMC will act on at all. The reassuring reality is that the regulator receives far more concerns than it investigates, and a large share are closed early. What matters is understanding which concerns tend to trigger action, and why some carry more weight than others.
This guide sets out the main categories of concern, the framework the GMC now uses to decide whether to act, and why dishonesty and probity sit in a category of their own. If you have just been contacted, our guide on what to do when you receive a letter from your regulator covers the immediate steps to take.
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What actually triggers a GMC referral?
Most concerns fall into one of four broad categories, all judged against the standards set out in Good Medical Practice, the framework that defines what is expected of doctors. A concern in any of these areas can prompt the GMC to take a closer look, though it does not automatically lead to a full investigation.
| Category | Typical examples |
|---|---|
| Misconduct | Dishonesty, inappropriate behaviour, boundary or conduct concerns. |
| Performance | Prescribing errors, poor record keeping, gaps in clinical skill. |
| Health | Alcohol or drug problems, or physical and mental health affecting practice. |
| Convictions | Criminal convictions and cautions, which are often referred directly. |
Referrals can come from many sources, including patients, employers, other doctors, and the police. As covered in our article on why some doctors are referred more often, the source of a referral matters, because employer referrals in particular are more likely to lead to an investigation.
How does the GMC decide whether to act?
The GMC now applies a single, consistent framework built around three questions. Introduced to bring clarity and to align decisions about doctors with those about physician associates and anaesthesia associates, it does not change the underlying thresholds, but it makes the reasoning explicit. These are the three questions every decision maker asks.
Seriousness
How serious is the concern? Repeated behaviour, abuse of position, or harm to vulnerable people all raise seriousness.
Context
What relevant context applies? The working environment and a doctor's personal circumstances are taken into account.
Response
How has the doctor responded? Evidence of insight and remediation weighs directly in the doctor's favour.
The third question is the one you have the most control over. It is also the reason that early, genuine engagement with a concern can change the direction of a case.
Why is dishonesty treated so seriously?
Because honesty and integrity are seen as fundamental to public trust in doctors, and dishonesty undermines that trust directly. The GMC's own data has consistently shown that concerns about honesty and integrity are among the most common it receives. Dishonesty is also viewed as harder to remediate than a clinical knowledge gap, because it goes to character rather than competence. For that reason, a finding of dishonesty carries a real risk of serious sanction, including suspension or, in the most serious cases, erasure. This is not said to alarm, but to explain why these cases demand particularly careful handling and strong evidence of insight.
What counts as a probity or dishonesty concern?
Probity is honesty across the whole of professional life, not just in the consulting room. A probity concern can arise wherever a doctor gives false, misleading or incomplete information. Common examples include:
- Inaccurate or misleading medical reports, forms or certificates.
- False or exaggerated information on a CV, application or reference.
- Dishonesty in research, audit or publications.
- Financial dishonesty, including claims and billing.
- Misleading a patient, employer or the regulator, including by omission.
The common thread is trust. Even where no patient is harmed, dishonesty is treated seriously because it damages the confidence that the whole system depends on.
How do clinical errors lead to a referral, and when do they not?
An isolated clinical error, honestly disclosed and reflected upon, is often managed locally rather than by the regulator. What changes the picture is seriousness, repetition, and above all the response. The contrast below shows how the same underlying mistake can lead to very different outcomes.
Escalates the concern
A serious error that is concealed, denied, or followed by an inaccurate record. Here the clinical issue is compounded by a probity issue, which is far graver.
Contains the concern
The same error disclosed promptly and honestly, with a candid record, an apology where appropriate, reflection, and steps taken to prevent recurrence.
This is why the duty of candour matters so much. Handling an error openly keeps it a clinical matter; concealing it can turn it into a dishonesty matter, which is the more damaging of the two.
Build the evidence a decision maker looks for
Structured CPD aligned with CPD UK guidelines helps you show insight and remediation, the third question every GMC decision maker asks.
What happens after a concern is referred?
Once a concern reaches the GMC, it is first assessed to see whether it raises a real question about a doctor's fitness to practise. Where more information is needed, the GMC may open a provisional enquiry, a short fact-finding stage, before deciding whether a full investigation is warranted. Many concerns are closed at this early point. Our detailed guide to GMC provisional enquiries explains exactly how that early stage works and how to respond to it.
Who is more likely to be referred?
Referral patterns are not evenly distributed, and this is worth understanding without drawing the wrong conclusion from it. GMC research has shown that some groups of doctors, particularly those from ethnic minority backgrounds and those who qualified overseas, are referred by their employers more often than others. That is a pattern about referral behaviour, not about the individuals, and it does not make any single referral either justified or unjustified. Understanding it simply helps you respond in the right frame of mind.
How do insight and remediation change the outcome?
They are decisive, and they are the part of the process most within your control. Because the GMC's framework asks directly how a doctor has responded, demonstrating insight and evidenced remediation can move a case towards closure or towards a more proportionate outcome. This holds even in dishonesty cases, where showing genuine understanding of why the conduct mattered, and what has changed, is central to any hope of a less severe result. Remediation never guarantees a particular outcome, but starting it early and evidencing it well is consistently the strongest thing a doctor can do.
Related courses
The structured CPD most relevant to the concerns that trigger GMC action, each aligned with CPD UK guidelines and mapped to GMC standards:
