Suspension in Fitness to Practise: Interim vs Substantive Orders
The difference between an employer exclusion, an interim suspension and a suspension imposed as a sanction, the test each panel applies, how often interim orders are made, how to prepare for and challenge one, and what being suspended means for your work, pay and title.
Reviewed October 2026 against GMC, MPTS, NMC, HCPC, GDC and GPhC guidance and data
Short answer: an interim suspension order stops you practising while your case is investigated. It is a risk assessment, not a finding that the allegations are true, and the panel must first ask whether interim conditions would be enough. A substantive suspension is a sanction imposed after a final hearing has found your fitness to practise impaired, for up to 12 months at a time, and is usually reviewed before it ends. Both prevent you working in a role that requires registration. Both can be challenged, and in both cases how you use the time affects what happens next.
Key takeaways
- An interim order is a holding measure. The panel assesses risk and does not decide what happened.
- Interim conditions are far more common than interim suspension at the MPTS and GDC. At the NMC, 46% of interim orders in 2024 to 2025 were suspensions.
- A significant share of interim order hearings end with no order at all.
- You can ask the High Court, or the Court of Session in Scotland, to end an interim order, and the regulator must justify any extension to the court.
- Since November 2025, MPTS tribunals use risk-based bandings that set suggested suspension ranges for each type of case.
- An employer exclusion is a separate process, and an interim suspension does not automatically stop your pay.
If you are at the start of an investigation, our guide to responding to a concern covers the first steps, and our guide to how long remediation takes covers the legal time limits on orders. This guide focuses on suspension itself: how it is decided, how it is challenged and how to live with it.
Three different things called "suspension"
Professionals often say they have been "suspended" when they mean one of three quite different processes. Each has its own decision maker, test and consequences, and more than one can apply at the same time.
| Employer exclusion | Interim suspension order | Substantive suspension order | |
|---|---|---|---|
| Who decides | Your employer, under its own policy | An interim orders panel or tribunal of your regulator | A fitness to practise panel or tribunal after a final hearing |
| Are facts found? | No, it is a neutral act pending investigation | No. It is a risk assessment | Yes. Facts proved, and impairment found |
| Test | The employer's policy and your contract | Public protection, otherwise in the public interest, or your own interests | Proportionate sanction for the impairment found |
| Affects registration? | No | Yes, while in force | Yes, while in force |
| Length | Set by the employer, with regular reviews | Up to 18 months, extendable only by a court | Up to 12 months per order, usually reviewed before it ends |
| Pay | Depends on your contract. NHS exclusions for doctors are usually on full pay | Depends on your contract, not automatic loss of pay | Depends on your contract and role |
| Challenge | Internal process, or employment claim | Review, then application to the court | Statutory appeal, then review hearing |
The legal limits on interim and substantive orders are set out in the Medical Act 1983 (sections 35D and 41A), the Nursing and Midwifery Order 2001 and Health Professions Order 2001 (articles 29 and 31), the Dentists Act 1984 and the Pharmacy Order 2010 (article 56). The pay position comes from the Court of Appeal decision in Gregg, discussed below.
Interim orders by the numbers
Most people facing an interim order hearing expect the worst. The official figures show that suspension is not the usual outcome at every regulator, and that many hearings end with no order.
MPTS new Interim Orders Tribunal cases, 2023
- Conditions 173
- Suspension 29
- No order 37
239 new cases, all heard virtually, plus 1,268 reviews. 28 doctors (12%) did not attend.
NMC interim orders imposed, 2024 to 2025
- Conditions 373 · 54%
- Suspension 318 · 46%
691 orders imposed. 65.8% were imposed within 28 days of the concern, against a target of 80%.
GDC initial Interim Orders Committee hearings, 2024
- Conditions 39
- Suspension 23
- No order 37
99 initial hearings, down from 122 in 2023, plus 352 review hearings.
HCPTS interim order work, 2024 to 2025
The HCPTS report does not split outcomes into suspension and conditions.
Sources: MPTS Report to Parliament 2023; NMC Annual Fitness to Practise Report 2024 to 2025 (table 3); GDC Fitness to Practise Statistical Report 2024; HCPC Council, HCPTS report, May 2025. The NMC table counts orders imposed, so it does not show hearings that ended with no order. The GPhC's 2024/25 annual report does not publish interim order figures.
The interim order test, regulator by regulator
Every UK health regulator applies the same three statutory grounds. A panel can make an interim order if it is satisfied that one or more of them is met. What differs is how each regulator's guidance explains them.
Protection of the public
The GMC describes this as "a real and immediate risk to patient safety". The NMC says an order must not be "merely desirable" but needs "a real risk to people receiving care".
Otherwise in the public interest
Public confidence in the profession and proper standards. The NMC says it "would be relatively rare" to make an order on this ground alone where there is no evidence of a risk of harm. HCPTS guidance describes it as a high threshold.
In your own interests
Used mainly where health affects safe practice. The GMC says an order may be needed where "it's not in the doctor's interests to hold unrestricted registration". The NMC calls this "a significant step".
| Regulator | Who decides | Guidance | Findings of fact? |
|---|---|---|---|
| GMC | Interim Orders Tribunal (MPTS) | Decisions on interim orders, June 2025 | No. The IOT assesses "the cogency of the information" (para 20) |
| NMC | Fitness to Practise Committee panel | Interim orders guidance, INT-2, March 2026 | No. Evidence must not be "fanciful", "frivolous" or "obviously contradicted" |
| HCPC | Practice committee panel (HCPTS) | Practice note on interim orders, June 2026 | No, and oral witness evidence is not required |
| GDC | Interim Orders Committee | IOC guidance, December 2023 | No. The IOC "should not engage in fact finding or resolve conflicts of evidence" (para 60) |
| GPhC | Fitness to Practise Committee | Pharmacy Order 2010, article 56 | No. Same three statutory grounds |
Why panels must consider conditions first
Proportionality runs through every regulator's guidance. GMC guidance says being proportionate "means taking only the action that is required but not more than necessary" (para 52). GDC guidance says the IOC "should first consider whether to impose interim conditions" (paras 104 to 105), and HCPTS guidance says conditions must be preferred to suspension where they are proportionate.
When the risk sits in an identifiable area
GMC guidance says conditions suit "failings in identifiable areas of the doctor's practice" where the doctor would not put patients or themselves at harm (para 56). Examples include supervision, chaperones or limits on a type of procedure. Our guide to conditions of practice covers how they work.
When no workable conditions exist
GMC guidance says suspension is appropriate where interim conditions "cannot be identified" or the risk "cannot be safely managed with interim conditions" (para 58). This is common in allegations of serious dishonesty, sexual misconduct, or where the professional does not accept the concerns.
Patterson v General Medical Council [2026] EWHC 1877 (Admin)
The facts. A consultant physician was suspended by an Interim Orders Tribunal for 12 months. The concerns included unsafe advice to vulnerable patients against vaccination, disclosure of identifiable patient information, sending patient samples abroad for research without proper written consent, and a Royal College of Physicians review that raised concerns about his clinical practice. He asked the High Court to terminate the suspension under section 41A(10) of the Medical Act.
The outcome. The application was dismissed. The judge repeated that the IOT "is not engaged in making findings of fact: its role is to conduct a risk assessment", and found there was "ample material" to support the conclusion that no workable conditions could address the risks. The doctor's continuing commitment to the views that underpinned the concerns was relevant to that conclusion.
The lesson: where a professional does not accept the concerns at all, panels and courts may find that conditions cannot be relied on, because conditions depend on the professional's cooperation.
Preparing for an interim order hearing
Notice can be short. The NMC tries to give at least seven days' notice of an initial hearing, but this "may be shorter" where concerns are serious or urgent (INT-3). The GDC aims for at least seven days, with less in "cases of exceptional urgency" (para 11). Hearings are normally virtual, and the NMC will consider a request for a physical hearing.
- Get advice the same day. Contact your defence organisation, union or insurer as soon as notice arrives. Time to prepare is limited.
- Read the case material for risk, not just facts. Ask what risk the regulator says you pose, and in which area of your practice.
- Propose workable conditions. GMC guidance says representations can be made on "the most proportionate type and duration of the order" (para 51). A specific, realistic proposal is more useful than a general request for no order.
- Bring your employer's position. Panels consider restrictions already in place. Written confirmation that your employer can support supervision or a restricted role can make conditions workable.
- Be realistic about testimonials. GDC guidance says testimonial evidence carries limited weight in a risk assessment, because past competence does not rule out failings on other occasions.
- Show early steps, briefly. Learning or reflection already started can show the risk is being addressed. Our guide to insight explains what panels look for.
- Attend if you can. If you cannot attend an NMC initial hearing, the panel should list a review within 14 days to give you a further opportunity (INT-3).
Reviews of an interim order
An interim order is not fixed. It must be reviewed regularly, and you can ask for an earlier review if something material changes.
| Regulator | Review timing | Earlier review |
|---|---|---|
| GMC | Within 6 months, then every 6 months. Within 3 months if conditions are replaced with suspension or the reverse, or after a court extension | You may request one, from 3 months after the last review decision |
| NMC | Every 6 months | Only with relevant new information, not general dissatisfaction with the last outcome (INT-5) |
| HCPC | Within 6 months, then every 3 months | Where new evidence becomes available |
| GDC | Within 6 months, then within 6 months of each review | You may request one from 3 months after the last review |
| GPhC | Within 6 months, then every 6 months | You may request one from 3 months after the last review, or on new evidence |
At a review, the NMC panel can revoke the order, confirm it, vary conditions, or replace interim conditions with an interim suspension. The NMC gives examples of new information that can justify an early review, including evidence that conditions are unworkable or that the order has been breached. A review is also an opportunity: evidence of learning, health treatment or supportive employment gathered since the last hearing may justify replacing suspension with conditions.
Going to court: termination and extension
Two kinds of court application can arise. You can apply to the High Court, or the Court of Session in Scotland, to terminate an interim suspension or to vary or revoke interim conditions: section 41A(10) of the Medical Act 1983, article 31(12) of the Nursing and Midwifery Order and Health Professions Order, and article 56 of the Pharmacy Order. Separately, the regulator must apply to the court if it wants an interim order to run beyond its initial period.
The leading authority on extensions is GMC v Hiew [2007] EWCA Civ 369. The Court of Appeal held that the court is the primary decision maker, not a reviewer of the panel, and listed the factors it can consider: "the gravity of the allegations, the nature of the evidence, the seriousness of the risk of harm to patients, the reasons why the case has not been concluded and the prejudice to the practitioner if an interim order is continued" (para 28). The burden is on the regulator.
Nursing and Midwifery Council v Masih [2026] EWHC 2094 (Admin)
The facts. A nurse had been subject to an interim order since December 2022, extended several times, while a case about allegations dating from 2019 to 2022 moved slowly. The substantive hearing had been postponed and later adjourned part-heard. The NMC applied for a further six-month extension.
The outcome. The court refused. Applying Hiew, it found gaps in the evidence the NMC put before it, and weighed the prejudice to the nurse, who had been restricted for about three and a half years, had difficulty finding work, and faced allegations that were by then several years old. The judge said interim orders "are not a substitute for final orders. They are a holding operation", and that those who benefit from them must "keep the time when they are in force to a minimum".
The lesson: delay is not neutral. Where a regulator has not moved a case on, the prejudice to you becomes a weighty factor, and a court can refuse to extend the order.
LMN v Health and Care Professions Council [2026] EWHC 1860 (Admin)
The facts. A practitioner psychologist was given an interim suspension order after a Family Court judgment made findings against her in private proceedings, including that she had lied to the court. She applied under article 31(12) to terminate the order.
The outcome. The application was refused on both the public protection and public interest grounds. The court accepted that suspension on public interest grounds alone sets a high bar, and described this as "one of those relatively rare cases". It noted that the Family Court judgment "clearly set out findings of dishonesty".
The lesson: findings made by another court can carry significant weight at the interim stage, even though the regulator has not yet investigated them. Conduct outside work can lead to an interim order where it raises questions of honesty.
Court applications are technical and costly. They are generally worth considering where the panel has misapplied the test, where the order is plainly disproportionate, or where the regulator's delay has become unfair. Take legal advice first.
Substantive suspension: when panels choose it
At the end of a final hearing, suspension sits between conditions and removal from the register. A suspension order can last up to 12 months at the GMC, NMC, HCPC and GDC. MPTS guidance says suspension "restricts a doctor's registration and prevents them from practising during the period it is in effect" (para 43), and lists three situations where it may be proportionate (para 45):
- Conditions would not work. They are not appropriate, measurable or workable.
- Time away is needed. The doctor needs to stop working while they gain insight, remediate or receive treatment.
- Public confidence. Suspension is needed to maintain public confidence or professional standards, even where patient safety is not at issue.
NMC guidance lists factors suggesting a suspension order may be appropriate, including "a single instance of misconduct but where a lesser sanction is not sufficient", no evidence of "harmful deep-seated personality or attitudinal problems", no repetition since the incident, and that the professional has insight.
A substantive suspension does not normally take effect until the time for an appeal has passed, which for doctors is 28 days. Where the panel considers it necessary, it can also make an immediate order so that you cannot practise while any appeal is pending. Our guide to outcomes and appeals explains the appeal routes.
The MPTS bandings since November 2025
For doctors' hearings starting from 24 November 2025, MPTS tribunals assess the level of risk and then apply a suggested sanctions banding for the type of case, explaining any departure from it. Two examples from the guidance:
| Case type | Lower level | Medium level | Higher level |
|---|---|---|---|
| Dishonesty | Suspension up to 3 months | Suspension 3 to 9 months | Suspension 9 months to erasure |
| Clinical concerns | Conditions 12 to 24 months | Conditions 24 to 36 months, to suspension of 6 months | Suspension 6 months to erasure |
Bandings are a starting framework, not a formula. Mitigating and aggravating factors, including insight and remediation, still shape where a case falls. If your concern involves dishonesty, our guide to dishonesty in fitness to practise explains how panels approach it.
MPTS guidance also says that whether a doctor can safely return to unrestricted practice "will need to be considered before a period of suspension concludes and so a review should be directed" (para 52). Our remediation timing guide covers what must be shown at that review.
What suspension means day to day
- Work in any role that requires registration with your regulator
- Hold a GMC licence to practise. GMC guidance says a doctor is entitled to a licence "unless their registration is currently suspended" (para 40)
- Present yourself as registered or entitled to practise. Doing so with intent to deceive is a criminal offence under, for example, article 44 of the Nursing and Midwifery Order and section 49 of the Medical Act
- Take a role that does not require registration, if your employer agrees and knows the full position
- Complete learning, reflection and other remediation
- Seek health treatment and keep evidence of it
- Attend reviews, ask for an early review where something material changes, and challenge an interim order in court
You remain on the register while suspended, so your regulator can still consider how you conduct yourself during the suspension. Be completely open with any employer or agency about your status. Answering questions about restrictions accurately matters as much here as in any declaration.
Pay during an interim suspension
North West Anglia NHS Foundation Trust v Gregg [2019] EWCA Civ 387
The facts. A consultant anaesthetist's registration was suspended by an interim order for 18 months, which withdrew his licence to practise. His trust had excluded him on full pay, then stopped his salary on the basis that he could no longer do his job.
The outcome. The Court of Appeal held that the trust was not entitled to withhold his pay. The contract did not allow deductions without written consent, and the suspension was imposed by a third party against his will, so he remained ready and willing to work. Lord Justice Coulson said an interim, non-terminatory suspension "should not attract the deduction of pay" in ordinary circumstances (para 69).
The lesson: an interim suspension does not automatically end your pay. The answer depends on your contract, so check it and take employment advice before accepting a loss of salary. A substantive suspension after findings against you can be treated differently.
Using the time well
Whether the suspension is interim or substantive, the next panel will want to know what you did with it. Keep a simple file from day one, with dated entries.
Courses and reading targeted at the specific concern, with certificates and notes on how each applies to your practice.
Written reflections that show you understand what went wrong and why, and what you would do differently.
Evidence that you have kept your clinical knowledge up to date, which panels expect to see at a review.
References, health reports where relevant, and any offer of supervised work if you return.
Structured learning can help where the concern is about trust, honesty or professional relationships. Our Rebuilding Trust course is designed for professionals in that position, and the insight course supports reflective work. A course is evidence of learning, not proof of insight on its own. Our guide to evidence of remediation explains how to present it.
Frequently asked questions
Is an interim suspension a finding that I did something wrong?
No. An interim order panel assesses risk while the investigation continues. It does not make findings of fact, and the allegations may later be found not proved.
How likely is an interim suspension rather than conditions?
It varies. In 2023, the MPTS imposed interim conditions in 173 new cases and suspension in 29, with no order in 37. In 2024, GDC initial hearings led to conditions in 39 cases, suspension in 23 and no order in 37. At the NMC, 318 of 691 interim orders imposed in 2024 to 2025 were suspensions.
How much notice will I get of an interim order hearing?
The NMC and GDC aim for at least seven days, but notice can be shorter where concerns are serious or urgent. Contact your defence organisation, union or insurer straight away.
Can I work as a healthcare assistant while suspended?
A suspension stops you working in roles that require registration. A role that does not require registration may be possible, but only with full honesty to the employer about your status. Your conduct while suspended can still be considered by your regulator.
Will I still be paid during an interim suspension?
It depends on your contract. In Gregg, the Court of Appeal held that an NHS trust could not withhold a consultant's salary during an interim suspension because his contract did not permit it. Take employment advice on your own position.
Can I get an interim order lifted?
Yes. You can ask for an early review where something material has changed, and you can apply to the High Court, or the Court of Session in Scotland, to terminate an interim suspension or revoke conditions.
What happens when an interim order reaches its time limit?
The regulator must apply to the court to extend it. The court decides for itself whether an extension is justified, considering the gravity of the allegations, the evidence, the risk, the reasons for delay and the prejudice to you. In 2026, the High Court refused an NMC extension after long delay.
How long can a substantive suspension last?
Up to 12 months per order at the GMC, NMC, HCPC and GDC. It is usually reviewed before it ends, and the review panel can extend it, replace it with conditions, allow it to lapse or, in some circumstances, remove you from the register.
What changed in MPTS sanctions in November 2025?
MPTS tribunals now assess the level of risk and apply suggested sanctions bandings for each type of case. For dishonesty, for example, the bandings run from suspension of up to 3 months at the lower level to suspension of 9 months to erasure at the higher level.
Primary sources
22 official documents and judgments
- GMC: Decisions on interim orders (June 2025)
- MPTS: Guidance for medical practitioners tribunal hearings, step 3, sanction (November 2025)
- MPTS: Report to Parliament 2023
- NMC: Decision making factors for interim orders (INT-2)
- NMC: Applications for interim orders (INT-3)
- NMC: Interim order reviews (INT-5)
- NMC: Suspension order (sanctions guidance)
- NMC: Annual Fitness to Practise Report 2024 to 2025
- HCPTS: Practice note, interim orders
- HCPC Council: HCPTS report (May 2025)
- GDC: Guidance for the Interim Orders Committee (December 2023)
- GDC: Fitness to Practise Statistical Report 2024
- Medical Act 1983, section 41A (interim orders)
- Medical Act 1983, section 49 (pretending to be registered)
- Nursing and Midwifery Order 2001, article 31 (interim orders)
- Nursing and Midwifery Order 2001, article 44 (offences)
- Pharmacy Order 2010, article 56 (interim orders)
- General Medical Council v Hiew [2007] EWCA Civ 369, National Archives
- North West Anglia NHS Foundation Trust v Gregg [2019] EWCA Civ 387, National Archives
- Patterson v General Medical Council [2026] EWHC 1877 (Admin), National Archives
- LMN v Health and Care Professions Council [2026] EWHC 1860 (Admin), National Archives
- Nursing and Midwifery Council v Masih [2026] EWHC 2094 (Admin), National Archives