Probity in Healthcare: Complete UK Guide to Honesty and Professional Integrity
What probity means for UK health and care professionals, what each regulator’s standards require, the eight areas where probity concerns arise, how dishonesty is judged in law, and why regulators treat it as one of the most serious concerns of all.
Short answer: probity means being honest and trustworthy and acting with integrity. For UK health and care professionals, it covers far more than not lying to patients. It includes accurate records, truthful CVs and declarations, honest financial dealings, managing conflicts of interest, honest research and responsible communication. Every UK regulator builds it into its standards. Dishonesty is judged using the test set by the Supreme Court in Ivey, and the MPTS’s latest guidance places it at the high end of seriousness. That is why even a small lapse can become a career-threatening case, especially if it is followed by a dishonest response.
Key takeaways
- Probity applies to your whole professional life, and sometimes your personal life too.
- Good medical practice 2024, the NMC Code and every other UK standard require honesty and integrity.
- Under the Ivey test, you can be found dishonest even if you did not realise ordinary people would see your conduct that way.
- The MPTS’s 2025 guidance says testimonials have limited, if any, relevance to sanction in dishonesty cases, and insight may have less impact.
- Real cases show dishonesty in personal finances, not just clinical work, can end a career.
- Most probity cases are preventable with simple, consistent habits.
What probity means
Probity is the quality of being honest, trustworthy and acting with integrity. In healthcare, it is the foundation of the trust that lets patients share sensitive information, accept advice and allow treatment. It also underpins the trust that employers, colleagues, insurers, researchers and regulators place in you.
Three ideas help explain why probity is wider than it first looks:
Honesty
Not lying, but also not misleading: no omissions, exaggerations or half-truths in what you say, write or sign.
Integrity
Doing the right thing when no one is checking, and not using your professional position for personal advantage.
Openness
Telling the people who need to know, such as your regulator or employer, promptly and accurately, even when it is uncomfortable.
Probity is closely linked to, but not the same as, the duty of candour. Candour is about being open with patients when something has gone wrong with their care. Probity covers honesty and integrity across everything you do as a professional.
Related courseDuty of Candour: openness when things go wrong→What each regulator’s standards say
Every UK health and care regulator makes honesty and integrity a core standard. The wording differs, but the expectation is the same.
| Regulator | Where probity appears | What it requires, in summary |
|---|---|---|
| GMC | Good medical practice 2024, Domain 4 | Conduct that justifies public trust (para 81); honesty about experience, qualifications and role (82); honesty in financial dealings (84); honest, accurate communications (88 to 89); declaring and managing conflicts of interest (94 to 96); reporting cautions, charges and other findings (99). |
| NMC | The Code, sections 20 to 23 | Act with honesty and integrity at all times (20.2); refuse all but the most trivial gifts (21.1); never ask for or accept loans from people in your care (21.2); act with honesty in financial dealings (21.3); tell the NMC and employers about cautions, charges and discipline (23.2 to 23.4). |
| HCPC | Standards of conduct, performance and ethics, standard 9: be honest and trustworthy | Conduct that justifies public trust (9.1); honesty about experience, qualifications and skills (9.2); accurate promotional activity (9.3); declaring conflicts of interest (9.4); telling the HCPC immediately about cautions, charges, convictions, other regulators’ findings, or employer suspension, restriction or dismissal (9.5); cooperating with investigations (9.6). |
| GDC | Standards for the Dental Team | A standard to be honest and act with integrity, alongside maintaining patients’ confidence in you and the profession. |
| GPhC | Standards for pharmacy professionals | A standard to behave in a professional manner, which includes being honest and trustworthy. |
Social workers, optometrists, osteopaths, chiropractors and pharmacists in Northern Ireland are held to the same principle in their own standards. Our regulator pages link to each set of standards.
The eight areas where probity concerns arise
Probity concerns rarely start with a dramatic act of fraud. Most grow out of everyday professional tasks. These are the eight areas where they most often arise.
Records and documentation
Inaccurate entries, notes written to look contemporaneous when they were not, or records changed after a concern is raised.
Record Keeping course →CVs, applications and qualifications
Overstating experience, qualifications or roles. GMC para 82 requires honesty about experience, qualifications and current role.
Probity course →Declarations to regulators and employers
Not declaring cautions, charges, convictions, restrictions or health matters when required, or answering registration questions inaccurately.
Probity course →Financial dealings
Timesheets, expenses, private fees, insurance reports and claims. GMC para 84 and NMC Code 21.3 require honesty in all financial dealings.
Financial Integrity course →Sick leave and other work
Working elsewhere while on sick leave from one employer, without telling them. The Krishnan case below arose from exactly this.
Probity course →Conflicts of interest and gifts
Letting personal interests affect referrals or prescribing, accepting gifts or hospitality, or not declaring an interest. See GMC paras 94 to 96 and NMC Code 21.1.
Financial Integrity course →Research and audit
Fabricating or manipulating data, misrepresenting results or failing to follow research governance. GMC para 85 requires integrity in research.
Professional Ethics course →Communications and social media
Misleading public statements, advertising or online content. GMC paras 89 to 90 and NMC Code 20.10 and 21.4 apply.
Social Media course →Probity at appraisal and revalidation
Probity is not only tested when something goes wrong. It is built into the routine checks that keep you on the register.
GMC probity statement
As part of revalidation, doctors make a probity statement at appraisal. GMC guidance says it covers having appropriate insurance or indemnity, declaring and managing conflicts of interest, giving information that is not false or misleading, and not deliberately leaving out relevant information. Doctors also make a health statement and reflect on significant events and complaints.
NMC revalidation declarations
Every three years, nurses, midwives and nursing associates confirm their health and character and their professional indemnity arrangements as part of revalidation. These are formal declarations, so they must be accurate and complete.
Because these are signed declarations, an inaccurate answer can itself become a probity concern. Treat every appraisal and revalidation form with the same care as a statement to your regulator.
How dishonesty is judged: the Ivey test
When a regulator alleges dishonesty, the panel must decide whether you were dishonest using the legal test set by the Supreme Court in Ivey v Genting Casinos in 2017. The MPTS issued a circular to its tribunals confirming that this test applies. It has two stages:
What did you actually know or believe about the facts at the time? This is subjective. Your genuine belief matters, even if it was unreasonable, although the more unreasonable it is, the less likely a panel is to accept it was genuinely held.
Given what you knew or believed, was your conduct dishonest by the objective standards of ordinary decent people? There is no requirement that you realised your conduct was dishonest by those standards.
This replaced the older Ghosh test, which also asked whether the person realised that ordinary people would regard their conduct as dishonest. Under Ivey, that second, subjective question no longer applies. In practical terms, “I didn’t think it was dishonest” is not a defence if, on what you knew, ordinary decent people would see it as dishonest.
GMC v Krishnan [2017] EWHC 2892 (Admin)
The facts. A GP did locum work through an agency while on sick leave from his main employer, without telling that employer.
The tribunal. The Medical Practitioners Tribunal found misconduct but decided he was not dishonest, applying the older Ghosh test. It found his fitness to practise was not impaired and issued a warning.
The court. The Ivey judgment was handed down during the proceedings. The High Court held that the tribunal had applied the wrong test, quashed its findings on dishonesty and impairment, and sent the case back to the tribunal to reconsider under Ivey.
The lesson: what matters is how your conduct looks to ordinary decent people, given what you knew. Working elsewhere while signed off sick, without telling your employer, is a classic way for a probity concern to arise.
Why regulators treat probity so seriously
Clinical errors can often be put right with training and supervision. Dishonesty goes to trust itself, which is much harder to rebuild. The MPTS’s Guidance for MPTS tribunals, in effect since 24 November 2025, is clear about this:
- High seriousness. The guidance says the nature of the departure in dishonesty concerns may place them at the high end of seriousness, and that even a single incident can have a significant harmful impact.
- Aggravating features. It notes seriousness increases where conduct was repeated, premeditated, persistent or an abuse of power.
- Insight may count for less. In higher-seriousness cases, evidence of insight and remediation may have less impact, and action may be needed even where a doctor has shown insight.
- Testimonials. References and testimonials have limited, if any, relevance to sanction in dishonesty cases.
- Sanctions. Where the risk is medium or high, the guidance requires consideration of suspension or erasure.
The MPTS’s sanctions guidance adds that evidence of clinical competence cannot mitigate serious or persistent dishonesty. In other words, being an excellent clinician does not offset a serious honesty concern.
GMC v Hayat [2018] EWCA Civ 2796
The facts. A doctor made an insurance claim stating he had suffered a heart attack while in Pakistan. Medical evidence suggested this was unlikely, the insurer declined the claim, and the matter was referred to the GMC and the police.
The tribunal. The Medical Practitioners Tribunal found that he had fraudulently claimed to have had a heart attack and made a false insurance claim. It erased him from the medical register.
The appeals. The High Court sent the case back for reconsideration. The GMC appealed, and the Court of Appeal allowed its appeal, finding the tribunal had properly exercised its discretion. The erasure stood.
The lesson: the dishonesty here was about a personal insurance claim, not patient care, yet it ended the doctor’s registration. Probity covers your financial and personal dealings, not just your clinical work.
Related courseFinancial Integrity: honesty in claims, fees and financial dealings→Probity for Healthcare Professionals
Honesty in records, declarations, finances, research and communication, with the standards behind each, assessed and certificated for your CPD or remediation portfolio.
Completing a course does not change or predict any regulator’s decision. Courses are educational and support your own reflection and development.
The second-concern trap
Many of the most serious probity cases did not start as probity cases. They started as something smaller, and became serious because of the response. The pattern is familiar to anyone who reads tribunal decisions:
- A small concernA missed entry, a clinical error or an unpaid fee.
- A dishonest responseAdding to the record later as if it were made at the time, giving an inaccurate account, or not declaring when required.
- A probity caseThe original concern may have been minor, but dishonesty now sits at the high end of seriousness.
MPTS sanctions guidance also lists dishonesty during a hearing as an indicator that a professional lacks insight. The safest course is always to tell the truth early, take advice, and correct any record openly and properly. Our guide to responding to a fitness to practise concern covers disclosure duties in detail.
Everyday habits that protect your probity
- Write records at the time, and clearly date and attribute any later addition.
- Keep your CV factual. Describe roles, dates and qualifications exactly. If in doubt, understate.
- Read declarations carefully before signing, including registration and revalidation forms, and answer them fully.
- Check timesheets, expenses and claims before submitting, and keep evidence.
- Tell your employer before doing other work while off sick, and follow your contract.
- Declare interests and decline gifts or hospitality that could appear to influence you.
- Be accurate online, including in profiles, advertising and comments about your work.
- Self-report promptly when your standards require it.
Grey areas: everyday situations that test probity
Most probity decisions are not about obvious fraud. They are small judgement calls made under pressure. These situations come up again and again. The safer approach in each case follows the principles in Good medical practice and the NMC Code.
| Situation | Where the risk lies | Safer approach |
|---|---|---|
| A grateful patient offers a gift | Gifts can create, or appear to create, an obligation. The NMC Code says to refuse all but the most trivial gifts, favours or hospitality. | Decline anything more than trivial. Follow your employer’s gifts policy and record what you accept. |
| You are asked for a reference for a colleague | An over-generous reference can mislead an employer about patient safety. | Be honest and fair. Include known concerns that are relevant, and stick to what you know first-hand. |
| You notice an error in a record you wrote last week | Correcting it as if the original said something else can look like falsification. | Add a clearly dated and signed correction. Never overwrite or remove the original entry. |
| A friend asks you to sign a form or certificate | Signing something you cannot verify means vouching for information that may be untrue. | Only sign documents whose contents you know to be accurate, and within your role. |
| A company offers to sponsor a course or meal | Sponsorship can influence prescribing or purchasing, or appear to. GMC paras 94 to 96 require you to manage conflicts of interest. | Check your employer’s policy, declare it, and decline if it could affect, or seem to affect, your decisions. |
| You are signed off sick but feel well enough for a locum shift | Working elsewhere without telling your employer can be seen as dishonest, as in Krishnan. | Speak to your employer and occupational health first, and follow your contract. |
| A registration or revalidation form asks about past cautions | Leaving something out, even something minor, can become a more serious concern than the original matter. | Read every question carefully, answer fully, and take advice if you are unsure whether something must be declared. |
| You post about your work or a treatment on social media | Overstated claims, undeclared interests or patient information can breach probity and confidentiality. | Be accurate, declare interests, and never share identifiable patient information. |
A useful self-check before any of these decisions: would you be comfortable explaining exactly what you did, and why, to your regulator, your employer and the patient?
Related courseProfessional Ethics: making sound judgement calls under pressure→If a probity concern is raised about you
Probity concerns are among the hardest to address, but how you respond still matters greatly, including for sanction and any later review.
- Get advice before responding, and never alter records or contact witnesses.
- Be scrupulously honest in every response. Any further inaccuracy will compound the concern.
- Reflect on why honesty matters in your role, not only on the facts. Insight into the impact on public trust is central. See our reflective account guide.
- Choose learning that targets probity, not clinical skills, and record how it has changed what you do.
- Be realistic. For serious or persistent dishonesty, remediation may have less impact. Our guides to the limits of remediation and remediation evidence explain why.
A hypothetical example
A physiotherapist’s job application. Applying for a senior post, a physiotherapist lists a postgraduate certificate she had started but not completed, and describes a band 6 rotation as a band 7 role. The new employer checks and refers her to the HCPC.
Under the Ivey test, the panel would first decide what she actually believed when she wrote the application. It would then decide whether, on that basis, ordinary decent people would regard the entries as dishonest. Her clinical skills are not in question. The concern is about trust, so the remediation that matters is insight into why accurate applications matter to patients and employers, probity-focused learning, and a record of honest conduct since.
Related courseProbity: honesty in applications and declarations→Frequently asked questions
What does probity mean in healthcare?
Probity means being honest, trustworthy and acting with integrity. In healthcare it covers records, CVs and applications, declarations, financial dealings, conflicts of interest, research and communication, in and out of work.
What is the test for dishonesty in fitness to practise cases?
The test from Ivey v Genting Casinos (2017). A panel first decides what you actually knew or believed about the facts, then whether your conduct was dishonest by the standards of ordinary decent people. You do not need to have realised it was dishonest by those standards.
Is a probity concern always dishonesty?
No. Some probity concerns involve failures of integrity or openness, such as an undeclared conflict of interest, without a finding of dishonesty. But a dishonesty allegation is the most serious type of probity concern.
Can a probity concern arise from my personal life?
Yes. Dishonesty outside work, such as financial fraud or a criminal offence involving dishonesty, can raise questions about whether you can be trusted as a professional. In GMC v Hayat, a false personal insurance claim led to erasure.
Do testimonials help in a dishonesty case?
Much less than in other cases. The MPTS’s 2025 guidance says references and testimonials have limited, if any, relevance to sanction in dishonesty cases.
Can you be struck off for dishonesty?
Yes. Serious or persistent dishonesty can lead to erasure or striking off. MPTS guidance says that where risk is medium or high, suspension or erasure must be considered, and that clinical competence cannot mitigate serious or persistent dishonesty.
Is working while on sick leave a probity issue?
It can be, if you do other work while signed off from your main employer without telling them. The GMC v Krishnan case arose from this situation.
How can I protect myself from probity concerns?
Keep accurate, contemporaneous records; describe your experience exactly; read declarations carefully; check claims and timesheets; declare interests; be accurate online; and self-report promptly when required.
Do I make a probity declaration at appraisal?
Doctors make a probity statement as part of revalidation, covering indemnity, conflicts of interest, and honest, complete information. Nurses and midwives confirm their health and character and their indemnity arrangements at NMC revalidation. These are formal declarations and must be accurate.
Primary sources
- GMC: Good medical practice 2024, Domain 4: Trust and professionalism
- NMC: The Code, read online
- MPTS: Guidance for MPTS tribunals (in effect from 24 November 2025)
- MPTS: Sanctions guidance (February 2024)
- MPTS: Appeals circular on Ivey v Genting Casinos [2017] UKSC 67
- GMC v Krishnan [2017] EWHC 2892 (Admin), National Archives
- GMC v Hayat [2018] EWCA Civ 2796, National Archives
- HCPC: Standards of conduct, performance and ethics
- GMC: Guidance on supporting information for revalidation
- NMC: Revalidation requirements