GMC investigations · Rule 7

GMC Rule 7 Letter: How to Respond Within 28 Days

A Rule 7 letter is the point at which the GMC sets out the allegation against you, shares its evidence, and asks for your side before two case examiners decide what happens next. This guide explains what the letter is, a week-by-week plan for the 28 days, how to structure your response, what to enclose, the mistakes that make things worse, assessments, what case examiners can decide, how warnings and undertakings work, a High Court case about Rule 7, and where to get support.

Reviewed October 2026 against the GMC (Fitness to Practise) Rules 2004, GMC guidance on undertakings (June 2025) and Investigation Committee decisions (January 2026), and High Court case law

28-day plan Response structure Warnings and undertakings

Short answer: A Rule 7 letter is sent under rule 7 of the GMC (Fitness to Practise) Rules 2004. It sets out the allegation, encloses the documents the GMC relies on, and invites you to respond in writing "within the period of 28 days from the date of the letter". Your response goes to two case examiners, who decide whether to close the case, give advice or a warning, agree undertakings with you, or refer you to a Medical Practitioners Tribunal. It is often the most important document you will write in the whole process. Contact your defence organisation straight away, use the 28 days well, answer each allegation honestly, and show what you have understood and changed since.

Key takeaways

The 28 days run from the date on the letter, not the day you open it. An extension request should go to your investigation officer before the deadline, in writing, with a reason.
Your response can be shared with the person who raised the concern, so write it for a careful outside reader.
Address every allegation: admit what is true, explain what is disputed, and give your evidence.
Insight and remediation can change the outcome at this stage, before any tribunal.
In 2025, 309 of 679 case examiner decisions closed the case with no further action.

This guide is about the Rule 7 letter itself. The whole GMC process, from triage to tribunal, is explained in our GMC fitness to practise guide.

What a Rule 7 letter is

Rule 7 of the GMC's Fitness to Practise Rules governs how an allegation is investigated once it has been referred for investigation. The GMC must write to you, describe the allegation, provide the supporting documents, and invite your written representations. Those representations may be shared with the person who made the allegation. The GMC may also carry out further enquiries and direct an assessment of your performance, health or knowledge of English.

What it is

Your chance to be heard in writing

The case examiners decide on the papers. They do not meet you. What you write, and what you enclose, is how they learn your side of the story.

What it is not

A finding against you

Receiving a Rule 7 letter means the GMC has investigated and wants your response. It does not mean the GMC has decided anything about your fitness to practise.

Many doctors find the letter frightening. That is normal. Read it once, put it down, and come back to it the next day with your defence organisation.

A plan for the 28 days

1
Days 1 to 3: get advice and take stock
Contact your medical defence organisation or legal adviser and send them the letter and bundle. Note the exact deadline from the date on the letter. If you need more time, ask the GMC early and give a reason. Tell your responsible officer and employers if you have not already.
2
Days 4 to 10: read the evidence closely
Go through every document. List each allegation and, for each, what you accept, what you dispute and why. Note any documents or witnesses that support your account, and any factual errors in the GMC's papers.
3
Days 11 to 18: gather your evidence
Collect what you need: relevant records you are permitted to use, your CPD and appraisal records, audit results, testimonials from colleagues who know about the concern, and evidence of any learning or changes you have made.
4
Days 19 to 25: write and review
Draft the response using the structure below. Ask your adviser to review it. Read it aloud: it should sound honest, calm and specific.
5
Days 26 to 28: finalise and send
Check every enclosure is labelled and referred to. Send it with time to spare and keep a copy of exactly what you sent.

How to structure your response

There is no required format, but case examiners read many responses, and a clear structure helps them find what matters. Since May 2025, GMC decision makers ask three questions in every case: how serious the concern is, what the context was, and how you have responded. A good response answers all three.

Section	What to put in it
1. Introduction	Who you are, your role and experience, and that you take the concern seriously. Keep it short.
2. Response to each allegation	Take the allegations in the GMC's order. For each one, say whether you accept, partly accept or dispute it, and why, referring to the evidence.
3. Context	Relevant circumstances at the time, such as workload, staffing, systems or personal factors. Explain, do not excuse.
4. Insight	What you now understand about what went wrong, why it mattered, and its effect on patients, colleagues and public confidence.
5. Remediation	What you have done since: targeted learning, audit, supervision, changes to your practice, with evidence for each.
6. Current practice	How you are practising now, including any feedback or appraisal evidence that shows the concern has not recurred.
7. Health, if relevant	Only if it is relevant and you choose to share it, with appropriate evidence. Take advice first.
8. Conclusion and enclosures	A short summary, and a numbered list of every document you are sending.

How to show insight is explained in our guide to insight in fitness to practise, and how to write the reflective part in our guide to reflective accounts.

If you dispute the facts

You are entitled to dispute allegations you believe are wrong, and you should not admit something that did not happen. But be careful how you do it. The High Court has said that remorse and shame expressed while maintaining denials "are unlikely to be viewed as genuine evidence of insight and remediation". You can deny a disputed fact and still show insight into the wider concern, for example the importance of clear communication or good records. Our guide to evidence of remediation explains how to strike that balance.

What to enclose

Testimonials

From colleagues who know about the concern and can speak to your practice now. A testimonial that does not mention the concern carries little weight.

Learning certificates

From learning matched to the concern, showing hours and outcomes. See our guide to choosing a course.

Reflective pieces

Reflection on what happened and what has changed, written for the case examiners, not copied from a template.

Audit and feedback

Record-keeping audits, multisource feedback, patient feedback or supervisor reports that show improvement.

Appraisal records

Recent appraisal outputs and personal development plans, showing the concern has been discussed.

Supporting records

Documents that support your account, used lawfully and with patient information protected. Take advice before including any clinical records.

Mistakes that make things worse

Answer every allegation, in order
Be specific, with dates and evidence
Accept what is true, early and clearly
Show what you have learned and changed
Keep the tone calm and respectful about the person who raised the concern
Get your defence organisation to review it before you send it

Do not

Ignore the deadline or send nothing
Attack the complainant or colleagues
Blame the system for everything
Alter, add to or "tidy up" any record after a concern is raised
Overstate your remediation or enclose learning you did not complete
Send a generic apology that does not engage with the allegation

Altering records is the mistake with the worst consequences, because it turns a clinical concern into a probity concern. The case below shows how.

If the GMC directs an assessment

Rule 7 allows the GMC to direct an assessment of your performance, your health or your knowledge of English as part of the investigation. A performance assessment report can also be sent to your employer or contracting body. Engage with any assessment and take advice on preparing for it. Under the rules, if you fail to submit to or comply with an assessment, the allegation can be referred to a tribunal. If your health is involved, our guide to health and fitness to practise explains how health cases are handled.

What happens after you respond

Two case examiners, one medical and one lay, consider the allegation, the evidence and your response. Under rule 8 they must agree, and if they cannot, the case goes to the Investigation Committee. Their decisions in 2025 were:

No further action309

Referred to a tribunal184

Warning110

Undertakings60

Advice16

Source: GMC annual statistical report 2025, table 2a (679 decisions).

If a warning is proposed

If the case examiners are considering a warning, the GMC writes to you and you can make written representations within 28 days. If you do not dispute the facts, a warning can be given without a hearing. If you dispute the facts or ask for one, the case goes to an oral hearing before the Investigation Committee. Under the GMC's guidance for that committee, in effect from 19 January 2026, a warning is appropriate where your conduct or performance "has fallen significantly below the professional standards expected to a degree warranting a formal regulatory response", but restrictive action is not needed. At the hearing the committee can take no further action, give a warning, or refer the case to a tribunal if new information makes that appropriate. A GMC warning is shown on the medical register for two years.

If undertakings are offered

Undertakings are agreed restrictions or requirements on your practice, such as supervision or limits on certain work. Under the GMC's guidance on undertakings (June 2025, updated November 2025), they must be "appropriate, workable and measurable", and case examiners usually consider them where you have shown some insight and willingness to remediate. They must not be recommended where there is a realistic prospect of erasure, and are generally not appropriate for concerns suggesting an attitudinal problem, such as dishonesty. If you are offered undertakings, you have 28 days to confirm in writing that you will comply. If you do not agree, the case can be referred to a tribunal. Our guide to warnings and undertakings sets out how each option is recorded and when it ends.

A High Court case about the Rule 7 stage

Real case · High Court · December 2018

R (Rudling) v General Medical Council [2018] EWHC 3582 (Admin)

What happened. A GP's Rule 7 letter in 2013 raised concerns about clinical care and record keeping after the death of a 12-year-old patient, including a backdated entry about a telephone call. The case was paused for criminal proceedings, which ended in 2016. In 2017 the GMC relied on new IT evidence to add allegations of probity and dishonesty about the record, without sending a new Rule 7 letter or returning the case to the case examiners. The doctor challenged this.

The outcome. On 20 December 2018 Mrs Justice Farbey dismissed the challenge. She held that an allegation is not "frozen in time" at the Rule 7 stage, that "the Rules are silent as to the need to refer new material to Case Examiners", and that the probity matters were "an expansion of the existing allegation". She also said "the practitioner has the right to know the full extent of the allegation" and "Delay is contrary to the public interest."

The lesson: the Rule 7 letter is not the last word on what you may face. Records, especially any later changes to them, will be examined closely. Answer fully and honestly from the start, because new evidence can widen the case.

More real decisions are collected in our fitness to practise case studies.

Support while you respond

Legal and professional advice

Your defence organisation

Your medical defence organisation or a regulatory lawyer can review the evidence and your draft. Contact them as soon as the letter arrives, because the 28 days pass quickly.

Emotional support

Doctor Support Service

Commissioned by the GMC and run by the BMA, it offers confidential emotional support from fellow doctors, independent of the GMC, from notification until your case ends. Membership of the BMA is not required to use it. It offers up to six hours of support by phone or video on 020 7383 6707, Monday to Friday, 9am to 5pm. It does not give legal advice.

If you are struggling with your health, NHS Practitioner Health offers confidential support to doctors in England. Samaritans is free to call on 116 123 at any time.

Frequently asked questions

What is a GMC Rule 7 letter?

A letter sent under rule 7 of the GMC (Fitness to Practise) Rules 2004. It sets out the allegation, encloses the documents the GMC relies on and invites your written response before case examiners decide the case.

How long do I have to respond to a Rule 7 letter?

28 days from the date of the letter. If you need longer, ask the GMC as early as possible and explain why.

Do I have to respond to a Rule 7 letter?

You are not forced to, but it is your main chance to give your side before the case examiners decide. Not responding usually means they decide without your account or any evidence of insight and remediation.

Who reads my Rule 7 response?

Two case examiners, one medical and one lay. Your representations may also be shared with the person who raised the concern.

Should I admit the allegations?

Admit what is true, clearly and early. Do not admit what did not happen. Take advice on any disputed facts before you respond.

What should I include with my response?

Testimonials that mention the concern, certificates for targeted learning, reflective pieces, audit or feedback results, appraisal records and any documents supporting your account.

Can I change my medical records before responding?

No. Never alter or add to a record after a concern is raised. It can turn a clinical concern into an allegation of dishonesty.

What can case examiners decide?

No further action, advice, a warning, undertakings or referral to a Medical Practitioners Tribunal. In 2025 they made 679 decisions, 309 of them no further action.

Can I refuse a GMC warning?

Yes. If you dispute the facts or ask for a hearing, the case goes to an oral hearing before the Investigation Committee, which can take no action, give a warning or refer the case to a tribunal.

How long does a GMC warning last?

A GMC warning is shown on the medical register for two years.

What are GMC undertakings?

Agreed restrictions or requirements on your practice. They must be appropriate, workable and measurable, and are not offered where there is a realistic prospect of erasure. You have 28 days to agree.

Can the GMC add new allegations after the Rule 7 letter?

It can expand an existing allegation. In Rudling v GMC (2018), the High Court allowed dishonesty allegations about a record to be added without a new Rule 7 letter.

Is there support for doctors who receive a Rule 7 letter?

Yes. The Doctor Support Service, commissioned by the GMC and run by the BMA, offers confidential emotional support on 020 7383 6707. Your defence organisation provides legal advice.

Primary sources

9 official documents, laws and judgments