Health and Fitness to Practise: When a Health Condition Becomes a Regulatory Concern
When regulators act on health and when they do not, the three ways health appears in a case, how health is investigated, the outcomes available and their legal limits, how health is weighed against conduct, and the support available while a case is open.
Reviewed October 2026 against GMC, MPTS, NMC, HCPC, GDC and GPhC guidance, legislation and data
Short answer: UK health regulators do not take action simply because a professional has a physical or mental health condition. They act where a condition is not being managed and creates a risk to patients, or where health is part of a wider concern. Health-only cases are usually resolved through agreed undertakings rather than a hearing, and the law limits removal from the register on health grounds alone. Where health is raised as an explanation for misconduct, panels look for cogent evidence linking the two, and it rarely outweighs serious or deliberate conduct. Throughout, the evidence that matters most is that you are seeking and following treatment and understand how your health could affect your practice.
Key takeaways
- Most professionals with a health condition never need to tell their regulator about it. What matters is managing it safely.
- Health can appear in three ways: as the concern itself, as an explanation for conduct, or as something affecting your ability to take part in the process.
- Regulators may ask for a health assessment and, with your consent, information from your GP or occupational health.
- At the GMC, GDC and GPhC, removal is not available where the only ground is health. At the NMC and HCPC, striking off for health alone needs at least two years of continuous suspension or conditions first.
- Health can explain conduct, but courts have held that it carries less weight where conduct was deliberate, repeated or harmful.
Whether you need to report a health condition is covered in our guide to self-referral. Privacy at hearings and the publication of health information are covered in our guides to hearings and outcomes. This guide focuses on how health is treated within the process itself.
A health condition is not a finding of impairment
Every regulator draws the same distinction: between having a condition and being unable to practise safely because of it.
"A self-referral doesn't need to be made about your health condition if: there are no concerns about your conduct, and there is no risk relating to the clinical care you provide"
"There are very few circumstances where we decide that a nurse, midwife or nursing associate who has (or used to have) a health condition, but is currently able to practise safely without any risk to patients, is impaired on the basis of public confidence in the professions alone."
"Health concerns that require formal intervention by the HCPC arise where the registrant fails to demonstrate that they are managing their health issues in a way that avoids any detrimental impact to service users."
NMC screening guidance adds that the NMC "will not leave the fact that the nurse, midwife or nursing associate has a health condition to speak for itself". It looks for specific examples of how the condition causes risk to patients.
Three ways health appears in a case
As the concern itself
"Adverse physical or mental health" is a statutory ground of impairment in its own right. The question is about risk, not blame. NMC guidance says the concern focuses on "the way in which the health condition causes risks, rather than about the nurse, midwife or nursing associate's personal culpability".
As an explanation for conduct
Where there is a concern about behaviour or performance, a health condition may explain it. GMC guidance from November 2025 says decision makers need "cogent evidence that the doctor's health condition is linked to the concern" (para 12).
As a barrier to taking part
A condition can make it harder to engage with an investigation or hearing. Regulators can adjust the process. In 2024 to 2025, the NMC used its intermediary service in 7 cases and made 16 referrals to an independent advocacy service.
How health is investigated
Health assessments
For mental health, the GMC normally appoints "two health examiners, who are normally general psychiatrists". Physical health may involve a basic examination or a specialist referral. Where the concern relates to drugs or alcohol, "you will usually be asked to provide a testing sample". Assessments are mainly remote, but testing needs UK attendance. After a health self-referral, the GMC aims to write to you within 7 days.
Records and expert examination
After seeking your agreement, the NMC gathers information "from their GP, occupational health professional, or a specialist or consultant", and may ask for "a medical examination with an expert doctor, or testing, or sometimes both" (INV-2). If you do not co-operate, it will consider whether to add a separate concern about that, unless the non-cooperation stems from the condition itself.
Outcomes in health cases, and their legal limits
The GMC's 2025 fitness to practise report states that "cases that relate solely to a professional's health will never result in erasure and are usually managed without the need for a tribunal". In practice, many health cases close with agreed undertakings, which might include treatment, testing, occupational health supervision or limits on certain work. Our guide to warnings and undertakings explains how undertakings work.
| Regulator | Removal for health alone | Source |
|---|---|---|
| GMC | Not available. Erasure is available only if another ground of impairment is also found | MPTS sanctions guidance, November 2025 |
| NMC | Only after at least two years of continuous suspension or conditions immediately before the decision | Nursing and Midwifery Order 2001, art 29(6) |
| HCPC | Not an option for the Health Committee unless the registrant has been continuously suspended or under conditions for at least two years | HCPTS practice note on health allegations, para 6(c) |
| GDC | Not available. Erasure cannot be directed where a dentist's fitness to practise is impaired solely on health grounds | Dentists Act 1984, s27B(7) |
| GPhC | Not available. Removal cannot be directed where fitness to practise is impaired solely by adverse physical or mental health | Pharmacy Order 2010, art 54(7) |
The MPTS health banding
Since November 2025, MPTS tribunals use sanctions bandings by case type. For health cases, the suggested ranges are:
Health hearings are usually held in private. The HCPTS practice note says a panel is justified in hearing health cases in private "to protect the registrant's privacy, unless there are compelling public interest grounds for not doing so" (para 9).
When health is offered as an explanation
Health is often raised alongside misconduct, especially dishonesty or behaviour out of character. GMC guidance says a condition "may explain or provide a reason for a concern about their behaviour or performance" (para 1), but case examiners still consider whether the concern separately poses a current risk requiring action. Three recent judgments show how courts approach this.
Adil v General Medical Council [2023] EWCA Civ 1261
The facts. A surgeon posted videos in 2020 denying the existence of COVID-19 and promoting conspiracy theories, using his medical credentials. The tribunal found he had experienced a mental health condition in early 2020, and treated it as a partial explanation.
The outcome. The Court of Appeal dismissed his appeal. The period of illness "did not negate the seriousness of the failings", and was "not the whole story" (para 78).
The lesson: health can reduce culpability, but where conduct causes wider harm, it rarely changes the outcome on its own.
Sun v General Medical Council [2023] EWHC 1515 (Admin)
The facts. A surgical trainee was found to have committed research misconduct and dishonesty over 16 months, including false declarations and false allegations against colleagues. Four consultant psychiatrists gave evidence about her mental health at the time, and she had recovered by the hearing.
The outcome. Erasure was upheld. The court accepted that mental health is "part of the balancing exercise", but said its weight "will inevitably be less than" factors such as how long the conduct lasted, whether it was repeated and the harm it caused (para 49). She knew what she said was false.
The lesson: a condition that affected judgment can mitigate. A condition that did not change what you knew to be true carries much less weight in a dishonesty case.
Professional Standards Authority v Social Work England and JS [2023] EWHC 926 (Admin)
The facts. A social worker with a mental health diagnosis attended a home visit under the influence of alcohol and was later barred by the DBS. The case was brought on health and barring grounds only, and a panel imposed a two-year suspension.
The outcome. The PSA appealed. The court found a "serious procedural irregularity" because the regulator "should have included" allegations of misconduct (para 66). The panel had never made findings about the conduct itself. The decision was quashed and sent back for a fresh hearing.
The lesson: the health route is not a substitute for examining conduct. Where there is both a health condition and serious conduct, both are likely to be considered.
What insight into your health looks like
NMC guidance says regulatory action is often not needed where a professional "has demonstrated good insight into the extent and effect of their condition" and "is taking appropriate steps to access treatment and is positively engaging with health professionals". In practice, that evidence tends to look like this:
- Engagement with treatment. Reports from your treating clinician confirming diagnosis, treatment and progress.
- Occupational health involvement. Advice from occupational health on fitness for work and any adjustments, and evidence you are following it.
- Objective testing, where relevant. In cases involving alcohol or drugs, consistent test results over time carry real weight.
- A plan for relapse. What you would notice, who you would tell and what you would stop doing if your health deteriorated.
- Honest reflection. A written account of how the condition affected, or could affect, your practice. Our reflective practice course can help you structure it.
- Workplace support. Confirmation from your employer of supervision, adjusted duties or a phased return.
For how panels assess insight more broadly, see our guide to demonstrating insight.
Looking after yourself during the process
Fitness to practise processes are stressful, and regulators now publish data on deaths, from all causes, during their processes so they can learn from them. The figures below include natural causes as well as other causes.
Following an independent review, the GMC appointed Professor Louis Appleby as an independent mental health adviser and says it has implemented all his recommendations to reduce the impact of its processes. Free, confidential support is available:
GMC Doctor Support Service
Run by the BMA for the GMC, free and "completely independent from the GMC". Confidential emotional support from another doctor, who can also accompany you at a hearing. You do not need to be a BMA member.
NMC Careline
Confidential emotional and practical support for nurses, midwives and nursing associates going through fitness to practise.
If you are struggling now
You can talk to Samaritans at any time, free, on 116 123. If you feel unsafe, contact your GP, NHS 111 or emergency services.
Frequently asked questions
Do I have to tell my regulator about a health condition?
Usually not, if there are no concerns about your conduct or clinical care and you are seeking and following treatment and managing any risk. You may need to tell them if the condition could affect your practice and is not being managed.
Can I be struck off because of my health?
Not for health alone at the GMC, GDC or GPhC, where removal is unavailable unless another ground is also found. At the NMC and HCPC, striking off on health grounds alone is only possible after at least two years of continuous suspension or conditions.
Will I have to see a doctor chosen by the regulator?
You may be asked to. The GMC uses health examiners, normally two general psychiatrists for mental health concerns, and the NMC may ask for a medical examination with an expert doctor.
Can the regulator see my medical records?
The NMC says it gathers information from your GP, occupational health or specialist after seeking your agreement. If you do not co-operate, it may consider a separate concern about that.
Will my health condition be made public?
Health hearings are usually held in private, and regulators generally do not publish confidential health information. Our guides to hearings and outcomes explain the details for each regulator.
Can my health explain a mistake or misconduct?
It can, if there is cogent evidence linking the condition to the concern. But courts have held that it carries less weight where conduct was deliberate, repeated or caused harm.
Where can I get support during an investigation?
Doctors can use the free, confidential GMC Doctor Support Service run by the BMA. The NMC offers a confidential Careline. Samaritans are available any time on 116 123.
Primary sources
19 official documents and judgments
- GMC: Information for doctors considering self-referral about a health condition
- GMC: Supplementary guidance on assessing the impact of a doctor's health (November 2025)
- GMC: Health assessments, what the assessment involves
- GMC: Concerns about fitness to practise, annual statistical report 2025
- GMC: Doctors who have died while under investigation or monitoring, 2022 to 2024
- GMC: Doctor Support Service
- MPTS: Guidance for medical practitioners tribunal hearings, sanction (November 2025)
- NMC: Health allegations (FTP-2d)
- NMC: Investigating health concerns (INV-2)
- NMC: Regulatory concerns in health cases (SCR-2b)
- NMC: Annual Fitness to Practise Report 2024 to 2025
- Nursing and Midwifery Order 2001, article 29
- Dentists Act 1984, section 27B
- Pharmacy Order 2010, article 54
- HCPTS: Practice note, health allegations (February 2025)
- GDC: Report on causes of death during fitness to practise investigations (November 2024)
- Adil v General Medical Council [2023] EWCA Civ 1261, National Archives
- Sun v General Medical Council [2023] EWHC 1515 (Admin), National Archives
- PSA v Social Work England and JS [2023] EWHC 926 (Admin), National Archives