Probity · Dishonesty allegations

Dishonesty Allegations and Fitness to Practise: How Regulators Assess Honesty

How a dishonesty allegation is built, who has to prove what, how panels decide what was in your mind, the difference between dishonest, misleading and mistaken, what makes dishonesty more or less serious, and how to respond. Based on NMC, HCPTS and MPTS decision-making guidance.

How charges are drafted State of mind evidence Seriousness factors

Short answer: when a regulator alleges dishonesty, it must say so clearly in the charges and prove it on the balance of probabilities. Panels apply the two-stage Ivey test. First, what did you actually know or believe? Because no one can see inside your head, this is decided by inference from all the evidence: documents, timing, what you were told, workplace practice, your explanations and your character. Second, was your conduct dishonest by the standards of ordinary decent people? Your own standards of honesty do not matter at that stage. If dishonesty is found, its seriousness depends on factors such as whether it was persistent, covered up, for personal gain or connected to patient care.

Key takeaways

Read your charges carefully. NMC guidance says a panel cannot find dishonesty unless it is clearly alleged.
The regulator must prove dishonesty. You do not have to prove you were honest.
The first question, about your knowledge and belief, is where most dishonesty cases are won or lost.
Good character can support your credibility on what you believed, even though testimonials count for little at sanction in dishonesty cases.
A criminal conviction is treated as proof of the facts, and accepting a caution is an admission.
A breach of the duty of candour can be just as serious as dishonesty, even without a dishonesty finding.

This article goes deeper than our pillar guide to probity in healthcare, which introduces the Ivey test, and our real probity case files. Here, the focus is on how a dishonesty allegation actually works, step by step.

How a dishonesty allegation is built

Fitness to practise allegations are set out as numbered charges, sometimes called particulars. A dishonesty allegation usually has three linked parts:

1 · The act

What you are said to have done. For example, that you recorded an observation at a certain time.

2 · Knowledge

What you are said to have known. For example, that you knew the observation had not been carried out.

3 · Dishonesty

That, as a result, your conduct was dishonest.

Each part must be proved separately. A panel may find the act proved, but not the knowledge, and therefore not dishonesty.

Dishonesty must be clearly alleged NMC guidance on dishonesty charges says that dishonesty must be explicitly alleged. Wording such as “misleading”, or vaguer language, is not enough. Without a clear dishonesty charge, a panel cannot find dishonesty or take it into account at sanction. When you receive your charges, check exactly which allegations include dishonesty. It shapes your whole response.

Who has to prove what

The burden is on the regulator. It must prove each charge. You do not have to prove you were honest.
The standard is the civil one. The HCPTS practice note on state of mind confirms facts are decided on the balance of probabilities, meaning more likely than not.
State of mind is proved by inference. The same practice note says a person’s state of mind can only be proved by inference or deduction from the surrounding evidence. There is rarely a document that says “I did this dishonestly”.

The Ivey test in practice

Our probity guide explains the two stages of the Ivey test. Here is how panels actually apply each one, using HCPTS and NMC decision-making guidance.

Stage 1: what did you actually know or believe?

The HCPTS practice note says panels must examine all the evidence and circumstances, including the facts, the history, the registrant’s explanation and any evidence of character. When assessing knowledge or belief, panels consider evidence such as:

Type of evidence	The question it helps answer
What you said, and what you were told	Did you have the information that made the conduct wrong?
The information available to you	Could you have known, and did you?
Workplace expectations and practice	Was there a policy or common practice that shaped your belief?
Your understanding of the context	How did the situation look to you at the time?
Documents and timing	Does the sequence of events fit your account?
The credibility of your later accounts	Have your explanations been consistent?
Your character	Does your history make your account of your belief more credible?

This is why genuine belief matters so much. In Kirschner v GDC, one of our probity case files, a dishonesty finding was quashed because the committee’s conclusions about what the dentist believed did not hold together.

Real case · Court of Appeal

Raychaudhuri v GMC [2018] EWCA Civ 2027

The facts. A paediatrician partly completed the examination section of a patient assessment form before he had seen the child, and was then evasive when a consultant asked him about it.

What happened. The Medical Practitioners Tribunal found the conduct wrong but not dishonest. The GMC appealed, and the High Court substituted a finding of dishonesty. The doctor then appealed to the Court of Appeal.

The outcome. The Court of Appeal quashed the dishonesty finding and restored the tribunal’s decision. It found the tribunal had properly weighed the context: the doctor had explained honestly to others what he had done, and his evasiveness with the consultant was described as venial and comparatively trivial. The court stressed that a tribunal’s assessment of the facts deserves great weight.

The lesson: Stage 1 looks at the whole picture. Evidence that you were open with others at the time can be decisive in showing what you really knew and intended.

Stage 2: was it dishonest by ordinary standards?

Once a panel has decided what you knew or believed, it asks whether your conduct, on that basis, was dishonest by the standards of ordinary decent people. The HCPTS practice note says the test is purely objective and your own standards of honesty are irrelevant. NMC guidance adds a useful nuance: your own view of whether you were dishonest is irrelevant to the finding, but can be relevant to seriousness.

Character evidence: useful at one stage, limited at another The HCPTS practice note says good character and testimonials can support the credibility of your account of what you knew or believed. That makes them relevant when the facts are being decided. At sanction, however, the MPTS’s 2025 guidance says references and testimonials have limited, if any, relevance in dishonesty cases. Gather character evidence with that difference in mind. Our guide to testimonials and remediation evidence explains how to get it right.

Dishonest, misleading, mistaken, or not candid?

These words are often used loosely, but they mean different things in fitness to practise, and the difference can decide your case.

Mistake or negligence

Unintentional

An error made without intending to deceive, such as a wrong date written in good faith. Can still be misconduct, but is not dishonesty.

Misleading

Inaccurate effect

Information that gives a false impression. NMC guidance says a charge of “misleading” is not the same as a charge of dishonesty.

Failure of candour

Not open

Not being open when something goes wrong, for example staying silent out of fear. NMC guidance says this can happen without dishonesty, but is among the most serious categories of concern.

Dishonest

Deliberate, by ordinary standards

Conduct that, given what you knew or believed, ordinary decent people would regard as dishonest.

A worked example: same act, different state of mind

The same action can lead to very different findings depending on what the person knew and believed. This hypothetical example shows how.

Hypothetical · Version A

Late entry, honest belief

A nurse writes up a patient’s observations at the end of a busy shift and enters the times they were taken, based on her rough notes. The ward routinely writes up observations this way. She does not mark the entries as late.

Likely analysis: the panel may find poor record keeping, and possibly misconduct. But if it accepts she believed this was accepted practice and the observations were genuinely taken, it is unlikely to find dishonesty.

Hypothetical · Version B

Entries for checks not done

A nurse fills in a set of observations she knows she did not carry out, because she ran out of time, and backdates them so the chart looks complete.

Likely analysis: she knew the checks were not done. Ordinary decent people would regard recording checks that did not happen as dishonest. A dishonesty finding is likely, and it is aggravated because others rely on the record.

When there are criminal proceedings: convictions and cautions

Some dishonesty allegations, such as theft or fraud, also involve the police or the courts. This changes how the regulatory case works. The HCPTS practice note on convictions and cautions, updated in September 2024, sets out the approach panels take, which reflects how most regulators work.

A conviction proves the facts. A certified copy of the conviction is admissible as proof of the conviction and of the findings of fact on which it was based.
The panel will not re-try the case. The practice note says panels must be careful not to “go behind” a conviction and re-try the criminal case. You cannot use the fitness to practise hearing to argue you were wrongly convicted.
Accepting a caution is an admission. A caution can only be given where the person unequivocally admits the offence. Accepting a caution for a dishonesty offence therefore means admitting it, with regulatory consequences.
The sentence is not the measure of seriousness. Panels are told the sentence is not a definitive guide to how serious an offence is. A lenient sentence may reflect the expectation that the regulator will act.

Before accepting a caution or pleading guilty Take advice from someone who understands both the criminal and the regulatory consequences. A decision that seems sensible in the police station can have lasting effects on your registration. You will also usually need to report a caution, charge or conviction to your regulator, as explained in our guide to self-referral.

What makes dishonesty more or less serious

Not all dishonesty is treated the same. MPTS guidance and NMC decision-making guidance point to the factors that matter most.

Points towards greater seriousness

Aggravating features

Persistent dishonesty, or dishonesty that was covered up, which MPTS sanctions guidance says is likely to result in erasure
Conduct that was repeated, premeditated, or an abuse of power
A breach of the duty of candour
A connection to patient care, records or professional practice
A pattern, rather than an isolated incident

Can point towards less seriousness

Mitigating context

An isolated incident
Private conduct: NMC guidance says a single incident in private life is unlikely to be misconduct unless part of a pattern
Early recognition and remediation, before any consequences
No risk to the public

Two further points from MPTS sanctions guidance are worth knowing. It lists examples of dishonesty that include defrauding an employer, falsifying or improperly amending patient records, providing false references, giving inaccurate or misleading information on a CV, and not taking reasonable steps to make sure statements in formal documents are accurate. And it says dishonesty outside clinical duties can be particularly serious, because it undermines public trust in the profession.

Probity course

Probity for Healthcare Professionals

Honesty in records, declarations, CVs and finances, the Ivey test and the duty of candour, assessed and certificated for your CPD or remediation portfolio.

View the course

Completing a course does not change or predict any regulator’s decision. Courses are educational and support your own reflection and development.

Responding to a dishonesty allegation

Dishonesty allegations carry the highest stakes, so your approach should be careful and advised from the start.

Get specialist advice immediately. Dishonesty allegations need experienced representation. Our guide to your first steps after a concern covers who to contact.
Read the charges closely. Identify exactly which allegations include dishonesty, and what knowledge you are said to have had.
Gather evidence of what you believed at the time. Contemporaneous notes, emails, policies, training records and evidence of workplace practice can all matter at Stage 1.
Be consistent and accurate. Panels assess the credibility of your later accounts. Any new inaccuracy can be treated as further evidence against you.
Gather character evidence for the facts stage. It can support the credibility of your account of your belief.
If you accept dishonesty, say so early and fully. Early, genuine acceptance, with insight into why it matters, is relevant to seriousness and sanction.
If you dispute it, reflect anyway. You can show insight into why honesty matters without accepting facts you dispute. See our guide on reflecting when you dispute the facts.

Frequently asked questions

How do regulators decide if someone was dishonest?

They apply the Ivey test. First, they decide what the person actually knew or believed about the facts. Second, they decide whether the conduct was dishonest by the standards of ordinary decent people.

Who has to prove dishonesty?

The regulator. It must prove the allegation on the balance of probabilities. You do not have to prove you were honest.

How can a panel know what I was thinking?

It cannot see it directly, so it decides by inference from the surrounding evidence, including documents, timing, what you were told, workplace practice, your explanations and your character.

Is “misleading” the same as “dishonest”?

No. NMC guidance says a charge must clearly allege dishonesty. A charge of misleading conduct, or vaguer wording, does not allow a panel to find dishonesty.

Does it matter if I did not think I was being dishonest?

Not for the finding itself. The second stage is objective, so your own standards of honesty are irrelevant. But NMC guidance says your view can be relevant to how serious the dishonesty is.

Do character references help in a dishonesty case?

They can support the credibility of your account of what you believed when facts are decided. At sanction, MPTS guidance says testimonials have limited, if any, relevance in dishonesty cases.

Is dishonesty always followed by striking off?

Not always, but often. MPTS sanctions guidance says persistent or covered-up dishonesty is likely to result in erasure. Isolated incidents, private conduct and early recognition can point towards less serious outcomes.

Can failing to be open be as serious as dishonesty?

Yes. NMC guidance says a breach of the duty of candour is among the most serious categories of concern, even where there is no dishonesty.

Can I challenge a criminal conviction at my fitness to practise hearing?

No. HCPTS guidance says panels must not go behind a conviction or re-try the criminal case. A certified conviction is accepted as proof of the conviction and the facts it was based on.

Does accepting a police caution count as admitting dishonesty?

A caution can only be given where you unequivocally admit the offence, so accepting one for a dishonesty offence is an admission. Take advice on the regulatory consequences before accepting.

Can a dishonesty finding be overturned on appeal?

Yes. In Raychaudhuri v GMC (2018), the Court of Appeal restored a tribunal’s finding that a doctor was not dishonest, after the High Court had substituted a dishonesty finding. Courts give great weight to the tribunal’s assessment of the facts.