The great majority of complaints to the GMC are closed without action on the doctors' registration, but a GMC investigation is still a source of great anxiety to any doctor under scrutiny.
Understanding the process and knowing what to expect can help ease these fears, so here we give an overview of the GMC's fitness to practise (FTP) procedures.

Initial handling

Triage

An initial triage is carried out to consider whether a complaint or enquiry should be investigated.

About 70% of complaints to the GMC come from the public. The GMC also receives concerns raised by employers, the police, doctors, and other healthcare groups and organisations. Additionally, it identifies potential issues about doctors through sources like the media, and doctors may sometimes need to self-refer.

The GMC does not usually investigate complaints about events that took place more than five years before the date of the complaint, unless it considers it in the public interest to do so.

The GMC can only investigate concerns where the facts, if proven, could suggest a doctor's fitness to practise may be impaired. About 80% of concerns are closed at triage because they don't meet the threshold.

Concerns not relating to fitness to practise are closed immediately - for example, complaints about late appointments or disagreements about content of medical reports. The doctor is not informed about those closed cases.

Some concerns are not investigated because they don't meet the threshold on their own. Instead, they're passed to the doctor and their responsible officer to consider as part of their ongoing appraisal and revalidation.

If this happens to you, make sure to keep good notes of your discussions and reflections. Members are always welcome to call us for advice.

Provisional enquiries

Sometimes, it's not clear whether a FTP investigation is needed. In those cases, the GMC carries out provisional enquiries (PEs) at the triage stage in cases that meet certain criteria.

These enquiries can be done within a few weeks, as the GMC needs only a few pieces of information to help it decide whether to close a complaint or open a full investigation.

If you receive notification of a provisional enquiry, please contact us for advice.

A proportion of PE cases do become full investigations, but around three-quarters of PE cases are closed with no further action.

Complaints requiring full investigation

When opening a FTP investigation, the GMC will write to the doctor with an explanation and copies of the documents. At this stage, the doctor has an opportunity to respond but is not obliged to do so. There are pros and cons to responding, depending on the circumstances of each case.

If you have received a letter from the GMC about an investigation or provisional enquiry, please contact the MDU as soon as possible.

Investigation stage

GMC investigators gather information about the case, such as medical records and statements, and may obtain an expert report.

The GMC will conduct any enquiries needed to investigate whether a doctor's fitness to practise is impaired. It also has the power to order an assessment of a doctor's performance, health or knowledge of English. A doctor who fails to comply may be referred to an FTP tribunal for non-compliance.

Performance assessment

A team from the panel of performance assessors is selected to evaluate the standard of the doctor's professional performance. The assessment typically includes a peer review - including a visit to the doctor's workplace and knowledge-based and practical assessments.

The doctor will have an opportunity to comment on both the information provided to the team by others, and the outcome of the assessment.

The assessment team will report on the standard of the doctor's performance.

Health assessments

In cases where initial concerns or information received by the GMC during the investigation suggest a health issue, the GMC may invite the doctor to be examined by two medical examiners.

The medical examiners will assess the doctor's physical or mental condition and indicate whether they believe the doctor is fit to practise, either generally or with limitations, along with recommendations for managing the case.

English language assessments

If there are concerns about the doctor's knowledge of English, the GMC may direct the doctor to take an English language assessment.

Decision by case examiners

If the GMC believes there may be a case to answer after the initial investigation, it will send the doctor a letter setting out the allegations it needs to investigate further.

It will ask the doctor to comment on these allegations and provide any additional information that could help the GMC with the investigation. The doctor only has 28 days to respond to this letter.

The GMC invites some doctors to a meeting with a case examiner and GMC lawyer to hear about the allegations and the types of evidence the GMC might want to see in the doctor's response. Attendance at the meeting is not mandatory and the doctor can be accompanied.

If you have received a letter setting out allegations or if you're invited to a meeting but haven't yet contacted the MDU, it's vital to do so as soon as possible to seek help.

The GMC expects doctors to show insight into the gravity of what has happened, to say sorry when appropriate, and demonstrate they have taken action to address any issues identified by the complaint. This process is known as remediation and can significantly improve the outcome of the case.

Regardless of whether there has been a meeting and/or a written response from the doctor, the case examiners will consider all the evidence and apply the 'realistic prospect' legal test. This means that only cases with a realistic prospect of establishing that the doctor's fitness to practise is sufficiently impaired to justify action on their registration will be referred to an FTP tribunal hearing.

Outcome of the investigation

Around 80% of investigations conclude with no action or a letter of advice.

Other possible outcomes at the case examiner decision stage are:

a warning
referral for adjudication before an FTP tribunal
undertakings (where an assessment of health or performance has been carried out).

In some cases where the case examiners believe the facts do amount to impaired fitness to practise, but an FTP tribunal would not erase the doctor, the case examiners may also offer undertakings.

Warnings

The GMC has power to issue warnings. It may do so where it decides the allegations don't justify referral to an FTP tribunal, but there is evidence to suggest the doctor's behaviour or performance has fallen below acceptable standards and warrants formal censure.

The doctor will be invited to give comments for the GMC to consider before it decides whether to issue a warning and under what terms. If the doctor chooses not to comment or does not dispute the allegations, and is assumed to have accepted the warning, two case examiners may agree a warning is appropriate.

The complaint will proceed to an oral hearing of the investigation committee if:

the doctor does not accept the warning, or
the case examiners consider it appropriate to do so, or
they cannot agree on whether a warning is appropriate based on the evidence.

The investigation committee may decide:

to issue a warning
to conclude the case, or
where information provided to the investigation committee casts a fresh light that suggests the case is serious enough to be referred for adjudication by an FTP tribunal.

In practice, oral hearings are rare. They are held in public unless there is an overriding public interest reason to hold them in private. For example, if there are any health matters that must remain confidential.

Warnings will be disclosed to the person or body who brought the allegation to the GMC's attention, and to doctors' employers, or any person or body for whom they provide medical services.

Warnings are visible on the online register for two years. After that, the warnings will be removed from public view but will remain available to employers.

Reviews of decisions

In some circumstances, the GMC registrar may decide it is in the public interest to review a decision by the GMC to conclude a case.

This happens rarely. It might be because significant new information has become available, or because an apparent error is found in the case-handling or decision-making process.

Interim orders tribunals

A case that raises serious concern about the safety of patients or others can be referred to the interim orders tribunal (IOT) at any stage of a FTP investigation.

The Medical Practitioners Tribunal Service (MPTS) is accountable to the GMC council but operates separately from the GMC's FTP investigation process. It is responsible for both IOT and FTP hearings.

The IOT may decide to suspend a doctor or impose conditions on their registration on an interim basis to protect patients or in the interests of the public or the doctor while an FTP investigation is ongoing. IOT hearings are held virtually, with no physical attendance required at the MPTS hearing centre.

There may be very short notice when a decision is made to refer a case to an IOT, so it's crucial to tell the MDU immediately.

Suspensions or conditions imposed by the IOT are reviewed every six months and will usually remain in place for up to 18 months if it takes that long for the GMC to do a full investigation into the allegations. They may be extended by a high court order.

Adjudication stage and FTP tribunals: MPTS

FTP tribunals are held by the MPTS. Some are held virtually; others at the MPTS hearing centre in Manchester.

Once a doctor is referred to an FTP tribunal, the case management stage begins. There is usually a case review, generally a phone conference, between the GMC and the solicitor instructed by the MDU.

It will often take several months for a case to progress to an FTP tribunal hearing, during which time the GMC will investigate further and may seek expert evidence, as may the MDU.

FTP tribunals have three members, including at least one medical and at least one non-medical member. Most hearings will have a legally qualified chair who sits as part of the tribunal and advises on points of law. If the chair is not legally qualified, there will be a legal assessor to advise the tribunal on points of law (but not to take part in the tribunal's decision-making).

The FTP tribunal has three stages.

First stage

The evidence is heard and the panel must determine whether or not the facts of the case are found proved. If the facts are not proved, the case will not go to the second and third stages.

Second stage

If the facts are admitted or proved, the FTP tribunal must decide whether the doctor's fitness to practise is impaired due to the allegations proved during the 'facts stage'. It is the doctor's fitness to practise at the time of the hearing that is relevant, though the nature of the original misconduct will be taken into account.

The panel will also consider:

any evidence of the doctor's insight
steps the doctor has taken to address concerns
testimonial evidence.

Third stage

If fitness to practise is found to be impaired, the FTP tribunal will then decide what sanction (if any) should be applied to the doctor's registration during the 'sanctions stage'.

In doing so, the tribunal must take into account the protection of patients, public confidence in the medical profession and the need to uphold proper professional standards and conduct for the members of the profession. The tribunal may also consider further character or mitigation evidence.

Evidence of this may come from testimonials from colleagues, patients and others.

The FTP tribunal can take the following actions:

accept written undertakings from the doctor
impose a period of conditions on a doctor's registration
suspend the doctor's registration for a specified period
erase the doctor's name from the medical register. This will not happen where the allegations relate solely to the doctor's health.

If the doctor's fitness to practise is not found to be impaired, the FTP tribunal may decide to issue a warning, if appropriate.

Between 2019 and 2023, there were more than 45,000 enquiries and complaints. Of these, just over 5,000 led to FTP investigations, resulting in 321 erasures and 515 suspensions. Find out more.

The proportion of erasures is low. If erased, a doctor will be able to apply to have their name restored after five years.

However, a doctor must be able to demonstrate fitness to practise in order to be restored, and erasure usually marks the end of a medical career.

Attendance at hearings

Doctors are expected to attend hearings at the MPTS. If they don't, the committee or tribunal may proceed to hear the case in their absence.

Please contact the MDU as soon as possible if you are asked to attend a hearing.

Publication of decisions

Information about FTP decisions is published on the GMC and MPTS websites.

The GMC website includes the medical register, which is publicly available and records active measures in place on the doctor's registration. That includes interim action such as suspension imposed at the IOT. The investigation committee page on the GMC website contains decisions of investigation committee hearings that conclude with a warning, available for one year.

The recent decisions page of the GMC website includes a list of recent decisions by case examiners to agree or vary undertakings or issue a warning (unless any of these relate solely to health), available for one year.

The MPTS website contains decisions of FTP hearings, review hearings and others - such as hearings relating to an application for voluntary erasure and applications for restoration to the register - for one year.

Appeals

The GMC has the power to appeal MPTS decisions to the High Court if they are considered to be unduly lenient and it is necessary for the protection of the public to do so. The Professional Standards Authority for Health and Social Care can also join such an action.

Insight and remediation

Demonstrations of insight into the causes of the incident that led to the complaint, and providing evidence of remediation to put things right, can be powerful ways for a doctor to demonstrate they are fit to practise.

A GMC study of cases that were considered by FTP tribunals (but not cases relating to health or convictions) showed that evidence of insight correlated with whether a doctor was erased or given a less serious sanction.

Doctors who showed insight and said sorry were 10 times less likely to be erased than those who did not.

Last word

GMC fitness to practise investigations are stressful for doctors, so we encourage any MDU member receiving notification of a complaint to the GMC to contact us as soon as possible, before responding. This applies even if the GMC plans to pass the complaint to the responsible officer or treat it as a provisional enquiry.

We are experts in assisting doctors with GMC matters, and it's never too soon to ask for help.

References

In 2024, data was published showing that between 2012 and 2023, 77.7% of PE cases had been closed with no further action. Find out more.

The GMC publication and disclosure policy can be accessed here.

Fitness to practise (FTP) procedures

Related articles

Membership in your pocket