GMC Fitness to Practise: Complete Guide for Doctors
How the General Medical Council handles concerns about doctors, physician associates and anaesthesia associates: the legal grounds, every stage from triage to the MPTS, the real 2025 numbers at each step, how decisions are made, your responsible officer's role, fairness data, support, and the reforms now under way.
Reviewed October 2026 against the Medical Act 1983, the GMC (Fitness to Practise) Rules 2004, GMC and MPTS guidance, the GMC's 2025 fitness to practise statistics and its equality reporting
Short answer: GMC fitness to practise is the process the General Medical Council uses to decide whether a doctor, physician associate or anaesthesia associate is safe to practise without restriction. Most concerns end at the first stage: in 2025 the GMC triaged 13,465 concerns and closed 12,146 of them without an investigation. Where a concern is serious, GMC case examiners decide the outcome or refer the case to an independent tribunal run by the Medical Practitioners Tribunal Service (MPTS). In 2025, 48 doctors were erased from the register, out of 410,566. The process looks at whether you are safe to practise today, so your insight and remediation matter at every stage.
Key takeaways
- About 80% of concerns come from members of the public, and nine in ten of all concerns are closed at triage.
- The GMC investigates, the MPTS decides at hearings, and the GMC can appeal tribunal decisions it thinks are too lenient.
- Since 30 May 2025, all GMC decision makers ask the same three questions: how serious is it, what was the context, and how has the doctor responded.
- Nine in ten tribunal cases involve misconduct, convictions or both. In 2024, no hearing was brought solely on clinical performance.
- Free, confidential peer support is available through the Doctor Support Service, run independently of the GMC.
This guide covers the GMC only. For how all 11 UK healthcare regulators compare, see our complete guide to fitness to practise in the UK.
Who is involved
Five bodies can be involved in a GMC case. Knowing which one you are dealing with explains who decides what.
GMC
Receives concerns, triages and investigates them. Case examiners decide most cases without a hearing.
MPTS
Runs medical practitioners tribunals and interim orders tribunals. Part of the GMC but operationally separate, reporting to Parliament.
Your responsible officer
The senior doctor in your designated body who oversees revalidation and decides whether to refer local concerns to the GMC.
PSA
The Professional Standards Authority reviews final decisions and can appeal those it considers insufficient to protect the public.
High Court
Hears appeals by the doctor, by the GMC, or by the PSA, against tribunal decisions.
Since 13 December 2024, the GMC has also regulated physician associates (PAs) and anaesthesia associates (AAs), under their own rules. The GMC's decision-making guidance now uses the same core principles for doctors, PAs and AAs. The GMC does not yet publish separate fitness to practise figures for PAs and AAs, because the numbers are too small to report without identifying people, so the data in this guide is about doctors.
The six legal grounds
Under section 35C(2) of the Medical Act 1983, a doctor's fitness to practise can be impaired only by reason of one of six grounds. Every allegation must fit at least one.
Misconduct
Serious departures from Good medical practice, such as dishonesty, sexual misconduct or serious failures of care.
Deficient professional performance
A fair sample of your work falls below the standard expected, usually tested by a performance assessment.
Conviction or caution
In the British Islands, or a conviction elsewhere for something that would be an offence in England and Wales.
Adverse physical or mental health
Only where health affects safe practice. Having a condition is not impairment.
Knowledge of English
Not having the English language knowledge needed to practise safely. Added in 2014.
Another regulator's finding
A determination by another UK health or care regulator, or a regulator abroad, that your fitness to practise is impaired.
The law also allows the GMC to act on events that happened outside the UK or before you were registered (section 35C(3)). Health concerns are explained in our guide to health and fitness to practise.
The 2025 numbers, stage by stage
The GMC's annual statistical report for 2025 shows how sharply the numbers fall at each stage. Concerns rose by 25% on 2024, and by 60% since 2020, but the number reaching a tribunal stayed small.
Bars show stages, not scale. Source: GMC, Concerns about fitness to practise, annual statistical report 2025. Counts are decisions in the year, so one doctor can appear at more than one stage.
| Where concerns came from | 2025 | Share |
|---|---|---|
| Members of the public | 10,717 | About 80% |
| People acting in a public capacity (including 190 from employers) | 552 | About 4% |
| Other sources | 2,196 | About 16% |
Over nine in ten tribunal cases involved misconduct, criminal convictions or both. Speaking in July 2026, the GMC's chief executive said that of 185 new MPTS hearings about doctors in 2024, "there were no hearings brought solely on the grounds of a doctor's clinical performance."
How a GMC case moves
- 1
Triage
Every concern is assessed against the GMC's threshold for investigation. In 2025, 11,679 were closed at first triage and 291 were passed to the doctor's employer or responsible officer to handle locally.
- 2
Provisional enquiries
Where the picture is unclear, the GMC gathers targeted information first, such as records or a statement from your employer. In 2025, 554 cases went to provisional enquiries and 467 were then closed. The GMC says these take about nine weeks on average, compared with around nine months for a full investigation.
- 3
Investigation and the rule 7 letter
The GMC writes to you setting out the allegation and the documents it holds, and invites your written comments "within the period of 28 days from the date of the letter" (rule 7). It may also direct a performance or health assessment. Our guide to writing your response explains how to use those 28 days.
- 4
Case examiners
Two senior GMC staff, one medical and one lay, decide the outcome, and their decision must be unanimous (rule 8). If they cannot agree, the case goes to the Investigation Committee, which held 13 hearings in 2025.
- 5
Medical practitioners tribunal
An independent MPTS panel decides the facts, whether your fitness to practise is impaired, and the sanction. What happens on the day is covered in our guide to fitness to practise hearings.
What case examiners decided in 2025
Source: GMC annual statistical report 2025, table 2a (679 decisions). Tribunal referrals include 13 where the doctor did not agree undertakings.
Undertakings are not an option in every case. Under rule 10(4), they cannot be offered where there is "a realistic prospect that, if the allegation were referred to a FTP Panel, his name would be erased from the register." If you are offered undertakings, you have 28 days to confirm in writing that you will comply (rule 10(3)). Warnings and undertakings, and when to accept them, are explained in our guide to warnings and undertakings.
Interim orders while you are investigated
If there may be a risk while the case continues, the GMC can refer you to an MPTS interim orders tribunal. In 2025 there were 350 interim orders decisions, up from 324 in 2024: 229 imposed interim conditions, 55 imposed interim suspension, and 66 made no order. Interim conditions are four times more common than interim suspension. The test and your options are in our guide to interim and substantive suspension.
What happens to you at each stage
| Stage | What usually happens | What you can do |
|---|---|---|
| Triage | Most doctors never hear about a concern closed at triage. Some are passed to your employer or responsible officer to handle locally. | Nothing is needed unless you are contacted. |
| Provisional enquiries | The GMC asks your employer or others for targeted information, such as records or a statement, to decide whether a full investigation is needed. | If you are asked for information, take advice and respond accurately. |
| Investigation opens | You are told about the concern and asked for details of everywhere you work. The GMC usually contacts your employers and responsible officer. It may direct an assessment of your performance, health or knowledge of English (rule 7(3)). | Tell your employers and anyone you contract with. GPs on a performers list should check whether they must notify it. |
| Rule 7 letter | The allegation, the documents the GMC holds, and an invitation to comment "within the period of 28 days from the date of the letter". | Send a considered response with your defence organisation's help. You can ask for more time if you need it. |
| Case examiners | A decision by two case examiners, one medical and one lay: close, advice, warning, undertakings or referral to a tribunal. | If offered undertakings, you have 28 days to agree. You can refuse a proposed warning and ask for an Investigation Committee hearing. |
| Tribunal | An MPTS hearing, usually in public, deciding facts, impairment and sanction. | Attend, be represented, give evidence and call witnesses. |
Unless an interim order restricts you, you can keep working during an investigation. A GMC warning is shown on the medical register for two years in total; when a warning is appropriate is explained in our guide to warnings and undertakings.
How GMC decision makers decide
Since 30 May 2025, every GMC fitness to practise decision maker has applied a single set of core principles, for the first time. The GMC says its thresholds are unchanged, but decisions now turn on three questions.
How serious is the concern?
Factors such as repeated behaviour, abuse of position and the involvement of vulnerable people increase seriousness.
What was the context?
Relevant circumstances, such as your working environment or personal situation at the time, are taken into account.
How have you responded?
Your insight and remediation: whether you understand what went wrong and what you have done about it.
The third question is the one you control. Our guides to insight and remediation explain what decision makers look for. At tribunals, new MPTS guidance has applied to doctors' hearings starting from 24 November 2025, with suggested sanction bandings based on the level of risk.
The sanctions a tribunal can impose
Undertakings or no action
Rare after a finding of impairment, but possible.
Conditions
For up to three years, such as supervision or limits on certain work.
Suspension
For up to 12 months, often with a review hearing before it ends.
Erasure
No application to return for five years (section 41).
Erasure is not available where impairment rests on health alone, as explained in our guide to health and fitness to practise. After directing suspension or erasure, a tribunal can make an immediate order so the restriction starts straight away rather than after the 28-day appeal period. For hearings starting from 24 November 2025, MPTS tribunals first assess the level of risk and then apply a suggested sanction banding, explaining any departure from it.
What tribunals decided in 2025
| Outcome | Hearings |
|---|---|
| Impaired: erasure | 48 |
| Impaired: suspension | 68 |
| Impaired: conditions | 7 |
| Impaired: no further action | 1 |
| Not impaired: warning | 11 |
| Not impaired: case concluded | 23 |
| Voluntary erasure | 2 |
Some doctors under investigation apply for voluntary erasure instead. In 2025 the GMC recorded 25 voluntary erasure decisions at the case examiner stage and 2 at tribunals; how this route works is explained in our guide to outcomes and voluntary removal. Suspension or erasure followed in 116 of 160 hearings, which reflects how serious cases have to be to reach a tribunal at all. How long each outcome stays on your record, and your own right to appeal to the High Court within 28 days, are explained in our guide to fitness to practise outcomes. After erasure, you cannot apply to be restored to the register for five years, as explained in our guide to how long remediation takes.
When the GMC appeals
The GMC can appeal a tribunal decision to the High Court if it considers it insufficient to protect the public. It had 10 appeals in 2025: three were allowed by the court, one was dismissed and six were still outstanding. The GMC reports that since 2016, sexual misconduct cases have made up over 40% of its appeals, and about seven in ten concluded appeals have succeeded. A recent example, GMC v Tripathi (2026), is summarised in our guide to professional boundaries.
Sastry and Okpara v General Medical Council [2021] EWCA Civ 623
What happened. Two doctors appealed against erasure: one after a patient died following treatment abroad, the other after repeated sexual misconduct towards a nurse. In both cases the High Court had dismissed their appeals, in one case saying a court was "totally ill-equipped" to judge public protection in a clinical case.
The decision. On 30 April 2021 the Court of Appeal held that a doctor's appeal under section 40 is "by way of a rehearing in which the court is fully entitled to substitute its own decision" (para 102). The judge "was required to exercise her own judgment as to whether the sanction imposed was excessive and disproportionate" (para 110). The narrower approach from Bawa-Garba applies only to appeals brought by the GMC itself under section 40A.
The lesson: if you appeal a tribunal decision, the High Court must form its own view of whether the sanction was proportionate. It does not simply ask whether the tribunal was within its range of options. You still have only 28 days to appeal.
Your responsible officer and employer
Most doctors are connected to a designated body, such as an NHS trust or health board, with a responsible officer (RO) who oversees revalidation and local concerns. Many concerns are dealt with locally and never reach the GMC; in 2025 the GMC passed 291 concerns back to employers or ROs. The GMC also has employer liaison advisers who work with ROs, so local and national processes can share information. Your RO also makes your revalidation recommendation to the GMC, usually every five years, so an open local or GMC process can affect its timing.
The GMC expects doctors under investigation to tell their employers and anyone they contract with, and any restrictions apply wherever you practise. What else happens during this stage is covered in our guide to the investigation stage. Whether you must report something yourself is covered in our guide to self-referral.
Fairness: what the GMC's own data shows
The GMC publishes who is involved at each stage compared with the register. Some groups are over-represented at the later stages.
| Group | Share of register | Share of tribunal hearings |
|---|---|---|
| Men | 50.5% | 76.9% |
| Black or Black British doctors | 7.3% | 13.8% |
| Asian or Asian British doctors | 33.7% | 31.9% |
| White doctors | 44.6% | 35.6% |
| Doctors who declared a disability | 5.3% | 11.9% |
Source: GMC annual statistical report 2025, table 5a. The GMC cautions that these figures do not control for the type of concern or who raised it, so they do not on their own show differences in treatment.
The GMC has a target to eliminate disproportionate referrals from employers based on ethnicity and place of qualification by 2026. Its latest equality report, covering 2020 to 2024, shows the referral gap between ethnic minority and white doctors fell from 0.28 to 0.11 percentage points, and between non-UK and UK qualified doctors from 0.42 to 0.13 points. In 2021, ethnic minority doctors were twice as likely, and internationally qualified doctors three times as likely, to be referred by their employer. The GMC has also carried out a regulatory fairness review and says it accepted all of its recommendations, with progress reported each year. Trust is still an issue: in the GMC's 2025 survey, 27% of GPs said they felt the GMC would deal with concerns about them fairly and appropriately.
The concerns that most often lead to action
The GMC's figures show that what reaches a tribunal is very different from what most complaints are about. Over nine in ten tribunal cases involve misconduct, convictions or both, and in 2024 none was brought solely on clinical performance. The areas below are where doctors most often find themselves in difficulty.
Dishonesty
In CVs, applications, research, records, claims or responses to the GMC itself. Usually treated more seriously than the original issue. See our guide to dishonesty allegations.
Sexual misconduct and boundaries
Over 40% of GMC appeals since 2016 have concerned sexual misconduct. See our guide to professional boundaries.
Convictions and cautions
Including drink driving and offences outside work, and not declaring them. See our guides to self-referral and failure to disclose.
Prescribing for yourself or people close to you
The GMC's prescribing guidance says that "wherever possible, you must avoid prescribing for yourself or anyone you have a close personal relationship with".
Records and openness
Altering records after an incident, or not being open with patients, turns a clinical issue into a probity case. See our guides to records and probity and the duty of candour.
Conduct outside work
The GMC can act on conduct in your private life, online, and outside the UK (section 35C(3)), where it affects trust in the profession.
The GMC standards your case is measured against
Every GMC case is judged against Good medical practice, in its current form since 30 January 2024, and the more detailed guidance that sits beneath it. These are the areas that come up most, with our guide to each.
| Area | Where the GMC sets the standard | Our guide |
|---|---|---|
| Honesty and probity | Good medical practice, domain 4: trust and professionalism | Probity in healthcare |
| Dishonesty allegations | Good medical practice and the test in Ivey | Dishonesty allegations |
| Records | Good medical practice and confidentiality guidance | Medical records and probity |
| Boundaries and sexual misconduct | Maintaining personal and professional boundaries (2024) | Professional boundaries |
| Openness after mistakes | Joint GMC and NMC guidance on the professional duty of candour | Duty of candour |
| Gifts, fees and interests | Identifying and managing conflicts of interest | Conflicts of interest |
| Declarations | Good medical practice, domain 4 | Failure to disclose |
Support during a GMC case
Doctor Support Service
Free, confidential peer support from doctors who are "completely independent from the GMC", run by the BMA on the GMC's behalf. You do not need to be a BMA member, and a supporter can come with you to a hearing for up to two days. Phone 020 7383 6707 or email doctorsupportservice@bma.org.uk.
Treatment comes first
The GMC says that, where necessary, a process "can now be paused so that treatment and recovery can take priority." If your health is part of the case, see our guide to health and fitness to practise.
For legal advice, contact your medical defence organisation or union as soon as you receive any letter from the GMC, and before you reply. If you are struggling, you can also contact Samaritans at any time on 116 123.
What is changing
New GMC decision-making guidance: one set of core principles for all decision makers, built on seriousness, context and the doctor's response.
New MPTS guidance for tribunals in doctors' hearings, with risk-based sanction bandings.
The Department of Health and Social Care launched a consultation on reforming the GMC's legislation, to make fitness to practise "swifter, fairer and less adversarial". The GMC would keep its right to appeal tribunal decisions.
The GMC published a redesigned fitness to practise report for 2025, showing outcomes at each stage.
Any new legislation will need to pass through Parliament before it changes the process, so the current rules described in this guide still apply.
If you have just heard from the GMC
- Read the letter carefully and note the deadline. A rule 7 letter gives 28 days.
- Contact your defence organisation before you reply to anything.
- Tell your responsible officer and employers if you are asked or required to.
- Do not alter any records connected to the concern.
- Start reflecting and learning now, rather than waiting for the outcome. Our guide to reflective accounts explains how.
- Use support, including the Doctor Support Service.
Real GMC tribunal and court decisions are summarised in our fitness to practise case studies.
Frequently asked questions
How many doctors are struck off by the GMC each year?
In 2025, 48 doctors were erased by a medical practitioners tribunal, out of 410,566 registered doctors. A further 68 were suspended.
How long does a GMC investigation take?
The GMC says provisional enquiries take about nine weeks on average, and full investigations around nine months on average. Cases that go to a tribunal take longer.
What is a GMC rule 7 letter?
It is the letter the GMC sends under rule 7 of its Fitness to Practise Rules, setting out the allegation and documents and inviting your written comments within 28 days.
Can the GMC investigate something from years ago?
Usually not if more than five years have passed since the most recent events, unless the Registrar decides it is in the public interest in the exceptional circumstances of the case.
Who decides my case, the GMC or the MPTS?
GMC case examiners decide most cases. Only cases referred to a tribunal are decided by the MPTS, which is operationally separate from the GMC.
Does the GMC regulate physician associates?
Yes. Since 13 December 2024 the GMC has regulated physician associates and anaesthesia associates, under rules that follow the same core decision-making principles.
Can the GMC appeal a tribunal decision?
Yes. The GMC can appeal to the High Court if it considers a tribunal decision insufficient to protect the public. The Professional Standards Authority can also appeal.
Can I remove myself from the GMC register while under investigation?
You can apply for voluntary erasure, but it is not automatic while a fitness to practise case is open, and the GMC decides whether to agree. In 2025 there were 25 voluntary erasure decisions at the case examiner stage.
Will the GMC tell my employer?
Usually yes, once an investigation opens. The GMC asks for details of where you work and contacts your employers and responsible officer. You are also expected to tell your employers and anyone you contract with.
Can I keep working during a GMC investigation?
Yes, unless an interim orders tribunal imposes conditions or suspension. Most doctors under investigation continue to practise.
How long is a GMC warning published?
A warning is shown on the medical register for two years in total.
What sanctions can an MPTS tribunal impose?
Undertakings or no action in rare cases, conditions for up to three years, suspension for up to 12 months, or erasure. After erasure you cannot apply to be restored for five years.
How does the High Court treat a doctor's appeal?
As a rehearing. In Sastry v GMC (2021) the Court of Appeal held that the court must form its own view of whether the sanction was excessive and disproportionate. You have 28 days to appeal.
Can the GMC act on something that happened abroad or outside work?
Yes. Section 35C(3) of the Medical Act allows action on events outside the UK or before you were registered, and conduct outside work can be relevant where it affects trust in the profession.
Is there free support for doctors under GMC investigation?
Yes. The Doctor Support Service, run by the BMA on the GMC's behalf, offers free and confidential peer support. You do not need to be a BMA member.
Primary sources
18 official documents, laws and judgments
- GMC: Concerns about fitness to practise, annual statistical report 2025
- GMC: GMC publishes fitness to practise data for doctors (30 July 2026)
- GMC: Fitness to practise in focus, speech by the chief executive (2 July 2026)
- GMC: New guidance on handling fitness to practise concerns (May 2025)
- GMC: Equality, diversity and inclusion targets, progress and priorities
- GMC: Doctor Support Service
- Medical Act 1983, section 35C
- Medical Act 1983, section 40 (appeals)
- General Medical Council (Fitness to Practise) Rules 2004, rules 4 and 7
- MPTS: Guidance for MPTS tribunals (in effect from 24 November 2025)
- PSA: GMC regulation of anaesthesia associates and physician associates from 13 December 2024
- UK Parliament: Written statement HCWS1443 on GMC legislative reform (24 March 2026)
- GMC: Response to the healthcare regulation consultation (June 2026)
- GMC: Good medical practice (2024)
- Sastry and Okpara v General Medical Council [2021] EWCA Civ 623
- Medical Act 1983, section 41 (restoration)
- GMC: Good practice in prescribing and managing medicines and devices, para 66
- General Medical Council v Tripathi [2026] EWHC 1653 (Admin)
