MPTS Interim Orders Tribunal: What Happens on the Day
Being referred to an Interim Orders Tribunal usually means a hearing within days, on a video call, deciding whether you can keep practising while the GMC investigates. This guide walks through the hearing from the notice to the written decision: the bundle, who sits on the tribunal, each stage in order, what to say and what not to, how the November 2025 guidance treats different types of concern, what is published afterwards, reviews, a 2025 court case about a hearing that went ahead without the doctor, and where to get help.
Reviewed October 2026 against MPTS guidance for interim orders tribunals (in effect 24 November 2025), the MPTS resource for doctors on IOT hearings, GMC guidance on interim orders (June 2025) and the GMC annual statistical report 2025
Short answer: An Interim Orders Tribunal (IOT) is a three-member Medical Practitioners Tribunal Service panel that decides whether your registration should be restricted while the GMC investigates. Hearings are usually held in private on Microsoft Teams, with at least seven days' notice. The GMC's lawyer speaks first, then you or your representative, then the tribunal decides in private and announces the result the same day. Whether the allegations are true is left for later stages. It can make no order, impose interim conditions or suspend you, for up to 18 months. In 2025, 229 of 350 IOT decisions were conditions, 55 were suspensions and 66 were no order.
Key takeaways
- Tell the MPTS straight away whether you will attend and who will represent you, and keep your contact details up to date.
- Your submissions should be about risk and the right order, not about proving the allegations wrong.
- The tribunal cannot accept undertakings. If you think conditions are enough, say which ones and why.
- Orders take effect immediately. Only the outcome is published, never the reasons, and health information is not published.
- Every order is reviewed within six months, and you can apply to a court to end or change it.
This guide is about the hearing itself. The legal test for interim orders, how they compare across regulators, pay during suspension and court challenges are covered in our guide to interim and substantive suspension.
What an Interim Orders Tribunal is
The GMC can refer you to an IOT at any point during an investigation if it believes your registration may need to be restricted to protect the public, in the wider public interest, or in your own interests. The hearing is run by the Medical Practitioners Tribunal Service (MPTS), which is part of the GMC but operationally separate from its investigation teams.
A risk decision
It asks whether an order is needed while the case continues, and if so, the least restrictive order that manages the risk. It weighs that against the effect an order would have on you.
Decide the facts
The tribunal makes no findings of fact and does not decide impairment. It considers how much weight the information can bear. Witness evidence is not usually heard.
How IOT hearings end: five years of data
IOT outcomes, 2025. Source: GMC annual statistical report 2025, table 3a (350 outcomes).
| Year | Conditions | Suspension | No order | Total |
|---|---|---|---|---|
| 2025 | 229 | 55 | 66 | 350 |
| 2024 | 213 | 52 | 59 | 324 |
| 2023 | 173 | 29 | 37 | 239 |
| 2022 | 184 | 34 | 54 | 272 |
| 2021 | 217 | 35 | 56 | 308 |
Source: GMC annual statistical report 2025, table 3a. The GMC described the share of suspensions in 2025 as broadly stable.
In each of the last five years, interim conditions have been the most common outcome, and in every one of those years more hearings ended with no order than with suspension. Interim suspension is real, but it is not the default.
Before the hearing
The GMC writes to tell you about the referral and the reasons for it. Its letter includes the IOT hearing bundle: the documents the GMC will put before the tribunal. The MPTS then sends a Notice of Hearing with the date and time, your right to attend and be represented, and the warning that the hearing can go ahead without you.
- Call your defence organisation the same day. Notice is usually at least seven days, and can be shorter in exceptional cases.
- Reply to the MPTS. Email the interim hearings team to confirm whether you will attend, whether you will be represented and by whom, and any reasonable adjustments you need.
- Read the bundle for risk. Note what the GMC says the risk is and in which part of your practice. Raise questions about the bundle with your GMC contact.
- Send your own documents early. Material outside the bundle should go to the MPTS without delay. If you send a large bundle, highlight the key pages. Redact patient information.
- Test the technology. Teams details arrive before the hearing, and a test call can be arranged.
- Only ask to postpone if you must. Use form P2, as early as possible, with reasons and evidence. A legally qualified case manager decides, and postponements are limited and usually very short.
Who will be on the call
Three tribunal members
Appointed and trained by the MPTS. At least one is a doctor and at least one is a lay member. One chairs.
Legally qualified chair
Most IOTs have a chair who is an experienced lawyer and advises on law and procedure.
Legal assessor
If the chair is not legally qualified, a lawyer advises the tribunal but takes no part in the decision.
GMC representative
A lawyer instructed by the GMC, who presents the case for an order.
Tribunal clerk and assistant
MPTS staff who run the hearing and keep you updated in the waiting area.
You and your supporters
Your representative, and a friend or family member for moral support, who is not heard unless the chair allows it.
The hearing, stage by stage
- 1
Join early
Be ready at least 30 minutes before the start. You wait in a virtual waiting area, and start times can slip because hearing lengths vary.
- 2
Opening
The chair introduces the tribunal and asks you to confirm your full name and GMC reference number.
- 3
The GMC's submissions
The GMC's lawyer explains why an order is said to be necessary and what type. Take notes of points you need to answer.
- 4
Your submissions
You or your representative respond, limited to whether an order is necessary and, if so, which one. The tribunal may ask you questions.
- 5
Private deliberation
Everyone else leaves while the tribunal decides "in camera" and writes its determination.
- 6
The decision
You are called back, the chair announces the outcome, and the written determination is shared. If you did not attend, it is sent to you.
Either side can apply to adjourn once the hearing has started. The tribunal hears both sides, decides in private and either continues or adjourns to a set date.
What to say, and what not to
The November 2025 MPTS guidance sets out three steps: is the test met, is an order necessary, and what order is proportionate. Your submissions should follow the same path.
- Explaining why the risk is lower than it appears, with evidence
- Completed learning or remediation, which carries more weight than plans
- Objective evidence, such as assessment results or expert reports
- Specific conditions you could work under, if you accept an order may be needed
- How a suspension would affect your ability to work and keep your skills up to date
- Referring the tribunal to page numbers in the bundle
- Arguing at length that the allegations are untrue
- Offering undertakings, which the tribunal cannot accept
- Criticising the person who raised the concern
- Emotional language or interrupting the GMC's lawyer
- Relying on an employer's refusal to support conditions to argue for no order
- Unchecked submissions drafted with AI: accuracy remains your responsibility
If your employer has already restricted your work, say so, but be realistic about its weight. GMC guidance says local measures are a suitable alternative to an order only if they cover your entire practice, in every place you work, and would still apply if you changed role.
If you prefer not to speak, or cannot attend, you can send written submissions in advance. The MPTS suggests typed documents in a large font, with headings and numbered points. Insight is relevant too: its "nature, quality and timing" affects how much weight it carries, as our guide to insight in fitness to practise explains.
Related coursePatient safety: showing a tribunal how risk is now managed→How the 2025 guidance treats different concerns
The MPTS guidance that came into effect on 24 November 2025 gives tribunals specific guidance by type of concern. It does not decide any case, but it shows where a tribunal is likely to start.
| Type of concern | What the guidance says |
|---|---|
| Clinical concerns | Conditions are often proportionate. Suspension is generally for the higher end of seriousness. |
| Health | Conditions are often proportionate. Suspension is likely only where judgement is impaired, insight is lacking or earlier restrictions were not followed. |
| Insufficient English | Conditions may be proportionate, possibly with increased supervision. |
| Sexual misconduct | Chaperone conditions may suit isolated, lower-end incidents, but are unlikely to work for a pattern of predatory behaviour. |
| Dishonesty | Suspension is likely to be considered where an order is necessary, but may be disproportionate for lower-end matters outside practice. |
| Violent or abusive behaviour | Suspension is likely where an order is needed. Conditions may suit isolated behaviour or behaviour linked to a health condition. |
| Discrimination | Unlawful discrimination usually means suspension should be considered. |
| Criminal matters | The stage of the proceedings matters. Suspension should be considered where the offence is serious. |
| Freedom of expression | Conditions are often proportionate, and must be workable and enforceable. |
Source: MPTS, Guidance for MPTS tribunals, section 2: interim orders tribunal hearings (in effect 24 November 2025), part A.
Conditions must be appropriate, workable and measurable, and are usually drawn from the MPTS conditions bank. Workability is judged against the risk, not against whether one particular employer can support them.
Related courseChaperones and professional boundaries→The three possible outcomes
| Outcome | Effect | Your licence |
|---|---|---|
| No order | You continue to practise without restriction while the investigation continues | Unchanged |
| Interim conditions | Immediate restrictions or requirements, such as supervision or limits on certain work | Kept |
| Interim suspension | You cannot practise until the order ends, is revoked or is changed | Automatically withdrawn |
An order can last up to 18 months. Its length reflects how long the GMC reasonably needs to finish the investigation, including any assessments and listing a final hearing. Conditions can justify a longer period than suspension, because they let you keep working.
How to comply with conditions and build a compliance record is covered in our guide to conditions of practice.
After the hearing: what is published and who is told
MPTS website
A notice of conditions or suspension appears on the recent decisions page and is removed after six weeks.
Medical register
Active orders appear on the register. If you are erased while an order is in force, that is published for a year.
What stays private
The discussion and reasons are not published, and neither is health information or health-only conditions.
Others told
Your responsible officer is told of any restrictions. Overseas regulators may be told if you qualified or are registered abroad.
The written determination explains the outcome, next steps and your right to apply to the court to revoke or vary the order. Keep it: you will need it for your employer, your appraisal and every review.
Reviews: your next chance
An order must be reviewed within six months and then at least every six months, and within three months if conditions are replaced by suspension or the reverse, or after a court extension. You can ask for an early review once three months have passed since the last one. Our suspension guide compares review timings across regulators. Three points are specific to the MPTS:
- The review is not a re-run. The reviewing tribunal does not reconsider the original decision. Without new information, the order is usually maintained. New information matters if it affects seriousness or the likelihood of repetition.
- Reviews on the papers. If you and the GMC agree the outcome, a review can take place without a hearing. Take advice before agreeing, and stay ready to attend until you are told the hearing is cancelled.
- Breaches are judged carefully. A breach must be proved on the balance of probabilities. The tribunal looks at whether it was a one-off, whether patients were harmed, whether it was wilful, and your insight.
A 2025 case: the hearing that went ahead without the doctor
V v General Medical Council [2025] CSOH 114
What happened. A GP learned of his IOT hearing only the day before, while on holiday. His representative's request to postpone was refused, the representative withdrew, and on 18 August 2025 the tribunal went ahead in his absence and imposed a 15-month interim suspension. The GMC relied on similar allegations from 11 people. An early review was refused, and he asked the Court of Session to end the order under section 41A(10) of the Medical Act 1983, arguing that conditions such as a chaperone, recording or audit could manage the risk.
The outcome. On 5 December 2025 Lady Tait refused the petition. The court decides afresh, with "no starting assumption" in favour of the tribunal's order, and it was satisfied for itself that suspension was necessary and that 15 months was proportionate. On the proposed chaperone, she said that "A chaperone would not be in a position to gainsay the petitioner's clinical judgment nor to intervene."
The lesson: hearings can and do go ahead without you. Keep your contact details current with the GMC and MPTS, tell them if you will be away, and have a defence organisation ready to act. And proposed conditions must answer the actual risk, not just be the least restrictive option available.
Other real outcomes are collected in our fitness to practise case studies.
Help before and on the day
Who can speak for you
A lawyer through your defence organisation or one you instruct, a member of a recognised professional organisation, a lay person the tribunal approves, or yourself. The MPTS strongly advises legal representation. A McKenzie friend can help with notes and papers but cannot speak for you.
Practical and emotional help
The MPTS support service helps with process and signposting, but cannot discuss your case. Its Hearing Information Line, run by law student volunteers, explains how hearings work. The BMA's Doctor Support Service gives confidential peer support and, with enough notice, a supporter can be with you at the hearing.
Free or low-cost legal help may be available through Advocate, Citizens Advice or LawWorks. For your own health, NHS Practitioner Health supports doctors in England, and Samaritans is free on 116 123. If the GMC is also asking for your response to the allegations, our guide to the GMC Rule 7 letter explains that separate step.
Frequently asked questions
What is an Interim Orders Tribunal?
A three-member MPTS tribunal that decides whether a doctor's registration should be restricted, by conditions or suspension, while the GMC investigates a concern.
How much notice will I get of an IOT hearing?
Usually at least seven days. It can be shorter in exceptional cases, so contact your defence organisation as soon as the GMC writes to you.
Can I keep working before the hearing?
Yes. A referral alone does not restrict your registration. Restrictions start only if the tribunal makes an order, and then take effect immediately. Your employer may still apply its own local measures.
Are IOT hearings in person?
They are currently held virtually on Microsoft Teams. You can ask for a test call before the hearing.
Are IOT hearings public?
No. They are held in private, although you can ask for a public hearing.
Will I have to give evidence?
Witness evidence is not usually heard. The tribunal may ask you questions after your submissions.
Does the IOT decide whether the allegations are true?
No. It makes no findings of fact. It decides whether an order is needed to manage risk while the investigation continues.
Can I offer undertakings at an IOT?
No. The tribunal cannot accept undertakings. You can propose specific conditions instead.
What happens if I do not attend?
The hearing can go ahead without you if you were properly notified. The decision is then sent to you. You can send written submissions in advance.
How long can an interim order last?
Up to 18 months. The GMC can ask a court to extend it by up to 12 months at a time.
Will my interim order be published?
The outcome is published on the MPTS website for six weeks and active orders appear on the register. The reasons and any health information are not published.
How often is an interim order reviewed?
Within six months and then at least every six months. You can ask for an earlier review once three months have passed since the last one.
Can I challenge an interim order in court?
Yes. You can apply to the High Court, or the Court of Session in Scotland, to revoke or vary it under section 41A(10) of the Medical Act 1983. The court decides afresh whether the order is necessary.
Primary sources
7 official documents and judgments
- MPTS: Guidance for MPTS tribunals, section 2, interim orders tribunal hearings (in effect 24 November 2025)
- MPTS: Resource for doctors, interim orders tribunal hearings
- MPTS: Interim orders tribunals, how they work
- GMC: Decisions on interim orders (June 2025)
- GMC: Interim orders tribunals, information for responsible officers
- GMC: Concerns about fitness to practise, annual statistical report 2025
- V v General Medical Council [2025] CSOH 114
