HCPC Fitness to Practise: Complete Guide for Health and Care Professionals
How the Health and Care Professions Council handles concerns about its 15 professions: the legal grounds, the threshold test, the Investigating Committee's "realistic prospect" test, hearings at the HCPTS, the latest figures by profession and stage, the sanctions policy in force from March 2026, fairness and performance findings, and free support.
Reviewed October 2026 against the Health Professions Order 2001, HCPC policies and fitness to practise data, HCPTS practice notes, and the PSA's 2025-26 performance review
Short answer: HCPC fitness to practise is the process the Health and Care Professions Council uses to decide whether someone in one of its 15 professions, such as a paramedic, physiotherapist or practitioner psychologist, can practise safely without restriction. In 2024-25 it received 2,409 concerns about a register of 356,104, and fewer than 1% of registrants had a concern raised. Concerns must pass a triage and threshold test before investigation. An Investigating Committee Panel then decides, on the papers, whether there is a "realistic prospect" of proving impairment, and only those cases go to a final hearing run by the Health and Care Professions Tribunal Service (HCPTS).
Key takeaways
- Paramedics, practitioner psychologists and physiotherapists account for over half of all concerns.
- Self-referral is the largest known source of concerns, ahead of employers and the public.
- Only about a third of cases considered by the Investigating Committee were found to have a case to answer in 2024-25.
- A revised sanctions policy has applied since 2 March 2026, with clearer guidance on discrimination, boundaries and sexually motivated misconduct.
- The PSA found avoidable or unexplained significant delays in about 40% of cases it audited, so expect the process to take time.
This guide covers the HCPC only. For how all UK regulators compare, see our complete guide to fitness to practise in the UK.
Who the HCPC regulates
- Arts therapists
- Biomedical scientists
- Chiropodists and podiatrists
- Clinical scientists
- Dietitians
- Hearing aid dispensers
- Occupational therapists
- Operating department practitioners
- Orthoptists
- Paramedics
- Physiotherapists
- Practitioner psychologists
- Prosthetists and orthotists
- Radiographers
- Speech and language therapists
Each profession has protected titles, so only registrants can use them. Social workers are not regulated by the HCPC: in England they are regulated by Social Work England, and in Scotland, Wales and Northern Ireland by their own care councils.
The legal grounds
Under article 22(1) of the Health Professions Order 2001, an allegation must say your fitness to practise is impaired because of one of these grounds, or that your register entry was "fraudulently procured or incorrectly made".
Unlike the GMC and NMC, the HCPC's legislation has no separate ground for lack of knowledge of English. As at other regulators, the HCPC can act on conduct outside the UK or before you were registered (article 22(3)).
The numbers
The HCPC's fitness to practise annual report for 2024-25 is the latest full year published. In June 2026, the HCPC said concerns had risen by 41% over the past year, so demand is now considerably higher than the figures below.
| Stage | 2024-25 | What it shows |
|---|---|---|
| Concerns received | 2,409 | Up from 2,226; 2,044 met triage |
| Closed before the Investigating Committee | 949 | Including 591 that did not meet the threshold policy |
| Investigating Committee decisions | 711 | 252 case to answer, 244 no case to answer, 215 adjourned |
| Interim orders | 203 | Granted from 239 applications |
| Final hearings concluded | 215 | 59 striking-off orders |
| Register | 356,104 | At 31 March 2025 |
Source: HCPC Fitness to Practise Annual Report 2024-25.
Who raised concerns
The source was not known for 1,222 concerns, mostly ones that did not pass triage.
The high number of self-referrals reflects the HCPC's standards, which require registrants to tell it promptly about matters such as cautions, charges and convictions, and restrictions imposed elsewhere. When you must self-refer is covered in our guide to self-referral.
Which professions are referred most
In 2024-25, paramedics had the most concerns (503, 20.9%), followed by practitioner psychologists (397, 16.5%) and physiotherapists (360, 14.9%). Paramedics and practitioner psychologists also had the highest rates, at about 11 concerns per 1,000 registrants a year. The full breakdown for 2023-24, the latest published by profession, shows the pattern.
| Profession | Concerns meeting triage, 2023-24 |
|---|---|
| Paramedic | 516 |
| Practitioner psychologist | 330 |
| Physiotherapist | 269 |
| Occupational therapist | 191 |
| Radiographer | 163 |
| Biomedical scientist | 113 |
| Chiropodist or podiatrist | 83 |
| Operating department practitioner | 82 |
| Speech and language therapist | 49 |
| Dietitian | 43 |
| Hearing aid dispenser | 42 |
| Arts therapist | 29 |
| Clinical scientist | 17 |
| Prosthetist or orthotist | 6 |
| Orthoptist | 4 |
Source: HCPC concerns data summary, 2023-24 (1,953 concerns that met triage). Larger professions naturally have more concerns, so counts are not rates.
Final hearing outcomes, 2024-25
Twenty cases were resolved by consensual disposal, where the registrant and the HCPC agree an outcome that a panel approves, including 13 removals by consent. You can appeal a final decision of the Conduct and Competence Committee or Health Committee to the High Court, or the equivalent court in Scotland or Northern Ireland, under article 38. No appeal against an HCPC final decision was upheld in 2024-25. What each outcome means is in our guide to fitness to practise outcomes.
How an HCPC case moves
- 1
Triage
The HCPC checks that the concern is about a registrant and within its remit. Concerns only about customer service, employment or fees are outside it.
- 2
Threshold
The HCPC asks whether the concern amounts to an allegation that your fitness to practise "may be impaired" on one of the statutory grounds, using ten factors set out below.
- 3
Investigation and your response
The HCPC gathers evidence and sends you a case investigation report with the allegations and papers. "The registrant will have 28 days to respond to the allegations." Our guide to writing your response explains how.
- 4
Investigating Committee Panel
A panel decides on the papers whether there is a case to answer. The HCPC aims for this within 33 weeks of receiving the concern.
- 5
Interim order, if needed
At any stage, a panel can impose interim conditions or suspension if there may be a risk. HCPC interim orders are reviewed within 6 months and then every 3 months. In 2024-25, 203 were granted from 239 applications. See our guide to interim and substantive suspension.
- 6
Final hearing at the HCPTS
A Conduct and Competence Committee or Health Committee panel decides the facts, the statutory ground, impairment and sanction. See our guide to fitness to practise hearings.
The threshold test: ten factors
The HCPC's threshold policy (updated July 2025) lists the questions it considers before investigating.
Paraphrased from the HCPC Threshold policy for fitness to practise investigations.
The policy also lists types of concern it treats as serious, "including but not limited to":
- Dishonesty
- Failure to raise concerns
- Failure to work in partnership
- Discrimination
- Serious breaches of professional boundaries
- Abuse of position, especially involving a vulnerable person
- Sexual or sexually motivated conduct
- Sexual abuse of children or indecent images of children
- Serious convictions, cautions and community sentences
- Serious violence
- Serious or reckless errors that caused, or could cause, harm
Factor 8 matters: the policy says that where remediation shows improvements are embedded, you may no longer present a risk and the threshold may not be met, unless the original concern was potentially serious. It also says concerns about incidents more than five years old may not be capable of meeting the threshold, though each case is judged on its merits. Starting remediation early can make a real difference here.
The "realistic prospect" test
The HCPTS practice note on case to answer (November 2023) says the Investigating Committee Panel asks whether there is a "realistic prospect" that the HCPC can prove at a hearing that your fitness to practise is impaired. It is a "limited, paper-based, exercise" and the panel must not make findings of fact. You do not have to provide evidence, but anything you send must be considered. In 2024-25, panels found a case to answer in 252 of 711 decisions, and 215 were adjourned.
Two points differ from other regulators. The Investigating Committee Panel cannot issue a warning or agree undertakings: it only decides whether there is a case to answer, as explained in our guide to warnings and undertakings. And there is no process to appeal its decision. If a case is closed before the panel, the HCPC shares the closure decision with you, the person who raised the concern and your employer.
What happens to you at each stage
| Stage | What usually happens | What you can do |
|---|---|---|
| Triage and threshold | The HCPC checks remit and applies the ten threshold factors. If it closes the case, the decision is shared with you, the person who raised it and your employer. | If asked for information, respond accurately and show any remediation already done. |
| Investigation | A case investigation report sets out the allegations and evidence, with the papers gathered. | You have 28 days to respond. Take advice from your professional body or union first. |
| Investigating Committee Panel | A paper decision on whether there is a realistic prospect of proving impairment. No warnings or undertakings at this stage. | Your written response is all the panel sees from you, so make it complete. |
| Final hearing | An HCPTS panel decides facts, the statutory ground, impairment and sanction, or approves a consensual disposal. | Attend, be represented and give evidence, or explore consensual disposal with the HCPC. |
Sanctions and the policy from 2 March 2026
Under article 29(5) of the Health Professions Order, a Conduct and Competence Committee or Health Committee that finds impairment can impose:
Caution order
Shown on the register for between one and five years.
Conditions
For up to three years.
Suspension
For up to one year, usually reviewed before it ends.
Striking-off
No application to return for five years (article 33).
A revised HCPC sanctions policy has guided panels since 2 March 2026, after a public consultation launched in May 2025. The HCPC says it adds clarity and consistency, particularly on discrimination, breaches of professional boundaries and sexually motivated misconduct, and aligns with HCPTS practice notes and recent case law. The HCPTS practice note on professional boundaries, and how panels judge those cases, is covered in our guide to professional boundaries.
Striking off is limited for health and competence. Under article 29(6) of the Health Professions Order, a striking-off order cannot be made for lack of competence or health alone unless you have been continuously suspended or under conditions for at least two years. If you are struck off, you cannot apply for restoration for five years, as explained in our guide to how long remediation takes.
Performance and fairness
PSA review 2025-26
The Professional Standards Authority's review, published on 30 June 2026, found the HCPC met 16 of 18 standards. It did not meet standard 15 on timeliness or standard 18 on keeping people informed and supported. The PSA "identified avoidable and/or unexplained significant delays in approximately 40% of cases" it reviewed, and said the open caseload had increased.
Who receives concerns
The HCPC's analysis of 2023-24 found men had concern rates 2.3 to 2.6 times higher than women of the same age. Among UK-trained registrants, the rate was 7.0 per 1,000 for Black registrants and 4.9 for White registrants. Rates for internationally trained registrants were similar to UK-trained overall (5.2 and 5.4).
The same analysis found 69.6% of concerns about Black registrants met the threshold, compared with 43.3% for White registrants, while differences at the Investigating Committee stage were not statistically significant. The HCPC cautions that "disproportionality shown in our data should not automatically be seen as unfairness", and that small numbers make some figures unstable. If you think bias or a poor working environment played a part, say so in your response with evidence.
The concerns that most often lead to action
Dishonesty and records
Including false entries in records to cover a mistake. A paramedic struck off in 2026 had dishonestly recorded giving a controlled drug he had not given; see Hough in our case studies.
Working in partnership and judgement
"Failure to work in partnership" and serious or reckless errors are listed as serious concerns in the threshold policy.
Boundaries and sexual conduct
Now addressed in more detail in the 2026 sanctions policy. See our guide to professional boundaries.
Discrimination
Listed as a serious concern, and a focus of the revised sanctions policy.
Convictions and self-referral
Self-referrals are the largest known source of HCPC concerns. Not declaring is usually worse than the matter itself. See our guide to failure to disclose.
Insight and denial
Panels look for understanding of future risk, not just remorse. Maintaining a flat denial after findings are made makes insight hard to show. See our guide to insight.
The standards your case is measured against
HCPC cases are judged against the standards of conduct, performance and ethics, revised with effect from 1 September 2024, and the standards of proficiency for your profession.
| Area | Where the HCPC sets the standard | Our guide |
|---|---|---|
| Boundaries | Standards 1.8 to 1.12 | Professional boundaries |
| Openness after mistakes | Standard 8, be open when things go wrong | Duty of candour |
| Honesty | Standard 9, be honest and trustworthy | Probity in healthcare |
| Records | Standard 10, keep records of your work | Records and probity |
| Conflicts and gifts | Standard 9.4 | Conflicts of interest |
| Health | Standard 6, manage risk, including your own health | Health and fitness to practise |
Support during an HCPC case
FTP registrant support service
Free emotional and practical support from CiC, an independent wellbeing provider, 24 hours a day, every day of the year. CiC does not tell the HCPC or anyone else that you have used it. Freephone 0800 587 7396, or email assist@cicwellbeing.com.
Your professional body or union
Contact your professional body, union or indemnity provider as soon as you hear from the HCPC, and before you reply. Many HCPC professions have professional bodies that offer advice to members facing fitness to practise.
If you are struggling, you can contact Samaritans at any time on 116 123.
If you have just heard from the HCPC
- Note the deadline. You usually have 28 days to respond to the case investigation report.
- Get advice from your professional body, union or indemnity provider before replying.
- Keep to any interim order and tell employers where required.
- Do not change any records connected to the concern.
- Start remediation now, because it is one of the threshold factors and is considered at every stage.
- Reflect in writing. Our guide to reflective accounts explains how.
Real HCPC and HCPTS decisions are summarised in our fitness to practise case studies, and evidence that helps at each stage in our guide to evidence of remediation.
Frequently asked questions
How many HCPC registrants are struck off each year?
In 2024-25, 59 striking-off orders were made at 215 concluded final hearings, on a register of 356,104.
Which professions get the most HCPC concerns?
Paramedics, practitioner psychologists and physiotherapists. In 2024-25 they accounted for 20.9%, 16.5% and 14.9% of concerns.
What is the HCPC threshold test?
Whether a concern, and the information gathered about it, amounts to an allegation that your fitness to practise may be impaired on one of the statutory grounds, judged using ten factors including risk, honesty, patterns and remediation.
What does "case to answer" mean at the HCPC?
That an Investigating Committee Panel has found a realistic prospect of proving at a hearing that your fitness to practise is impaired. It is decided on the papers, without findings of fact.
How long does an HCPC investigation take?
The HCPC aims for the Investigating Committee to consider a case within 33 weeks of the concern, but the PSA found significant delays in about 40% of cases it reviewed in 2025-26.
Can I agree an outcome with the HCPC instead of a hearing?
Sometimes. Consensual disposal lets you and the HCPC agree an outcome, such as a caution or removal by consent, which a panel must approve. There were 20 in 2024-25.
What sanctions can an HCPC panel impose?
A caution order for one to five years, conditions for up to three years, suspension for up to one year, or a striking-off order.
Can I keep working during an HCPC investigation?
Yes, unless a panel imposes an interim order suspending you or placing conditions on your practice.
Will my employer be told?
If a case is closed before the Investigating Committee, the HCPC shares the closure decision with your employer. Employers are often involved earlier as a source of information.
Can the HCPC give me a warning instead of a hearing?
Not at the investigation stage. The Investigating Committee Panel only decides whether there is a case to answer. Outcomes such as a caution are made by a final hearing panel, or agreed through consensual disposal.
Does the HCPC regulate social workers?
No. Social workers in England are regulated by Social Work England, and in the rest of the UK by their national care councils.
Is there free support for HCPC registrants under investigation?
Yes. The FTP registrant support service from CiC offers free, independent emotional support 24 hours a day on 0800 587 7396.
Primary sources
15 official documents and laws
- HCPC: Fitness to Practise Annual Report 2024-25
- HCPC: Concerns data summary, 2023-24
- HCPC: Fitness to practise data, supplementary analysis 2023-24
- HCPC: Threshold policy for fitness to practise investigations (July 2025)
- HCPC: Investigating concerns fact sheet
- HCPTS: Practice note, case to answer (November 2023)
- HCPC: Revised sanctions policy (February 2026)
- HCPC: HCPC meets 16 of 18 PSA standards (June 2026)
- PSA: Periodic review of the HCPC 2025-26
- HCPC: FTP registrant support service
- HCPC: Revised standards of conduct, performance and ethics now in effect (2024)
- Health Professions Order 2001, article 22
- Health Professions Order 2001, article 33 (restoration)
- Health Professions Order 2001, article 38 (appeals)
- Health Professions Order 2001, article 29
