Fitness to practise · Your first steps

How to Respond to a Fitness to Practise Concern: Your First Steps

You have just learned that a concern has been raised with your regulator. This guide covers the first few weeks: who to call, who you must tell, what to send first, what to keep, and what to avoid, based on what regulators themselves say.

First 14 days, step by step Disclosure duties explained Where to get help

Short answer: do not reply straight away. Read the letter carefully, note every deadline, and contact your defence organisation, union or professional body first. Return any information the regulator says you must provide, such as your personal details and employers, on time. Check whether your professional standards require you to tell employers or other organisations, and do so in writing. Keep every document, start a private timeline while events are fresh, and look after your health. Leave your full account of events until you have advice, and in most cases until you have seen the evidence.

Key takeaways

The first few weeks set the tone for everything after, but rushing usually does more harm than waiting a few days for advice.
The NMC asks for a first response within 14 days of its letter. Your personal details and employer contacts are required. A full account is optional at that point.
Good medical practice and the NMC Code both set out things you must tell your regulator or employers. Missing them can create a separate concern about honesty.
Early, well-judged information can help. The NMC says it can mean faster decisions and sometimes no full investigation.
Some events must be self-reported, and an interim order hearing needs urgent action. Both are covered below.
Leaving the register is not a simple way out. Regulators have their own rules for this.

The first 14 days, phase by phase

Every case is different, but the early weeks usually follow a similar shape. Use this as a working plan, adjusted to the deadlines in your own letter.

Day 0 to 2
Pause, read, and get advice
- Read the whole letter twice. Note which regulator, which stage, what is alleged, and every date.
- Do not reply, call the complainant or post about it.
- Contact your defence organisation, indemnity provider, union or professional body. Ask what they cover and who your adviser will be.
- If you feel overwhelmed, use a support line today. The services are listed below.
Day 3 to 7
Secure the facts and meet your duties
- Write a private timeline of what happened, with dates, names and what you remember. Share it only with your adviser.
- List the documents that matter, such as records, rotas, emails and policies, and ask your adviser how to obtain copies properly.
- Check what you must disclose, and to whom, under your standards. Disclose in writing and keep a copy.
Day 7 to 14
Send what is required, on time
- Return any form the regulator says is required, such as the NMC’s personal details form and employer contacts.
- With your adviser, decide whether to send early context now or wait for the evidence.
- If you have a representative, send the regulator your written consent for them to act for you.
Weeks 2 to 6
Start building your picture
- Begin honest, written reflection on the concern, separate from your account of the facts. Our reflective account guide shows how.
- Identify learning that targets the concern, and keep evidence that you completed it.
- Think about who could give a reference later, and tell them about the concern.

The first letter, regulator by regulator

The first contact looks different depending on who regulates you. Knowing what to expect helps you tell what is being asked of you now.

Regulator	What usually happens first
GMC	Concerns are triaged first. The GMC may make short provisional enquiries for easily obtained information. When a full investigation opens, an investigation officer usually emails to arrange a phone call, and your current employers and responsible officer are told.
NMC	You have 14 days from the letter to return the personal details form and employer contacts. Early context, reflection and evidence of steps taken are welcomed but not required at this point.
HCPC	A case manager gathers information, which can include contacting your employer. You receive the formal allegations later, with 28 days to respond.
GDC	An initial assessment decision is usually made within five working days. If the case opens, you are asked for your comments and relevant documents.
GPhC	A dedicated case officer investigates and is your main contact. The GPhC says it gives updates about every two months.

Who to call first

Most UK health and care professionals have access to free advice or representation through a defence organisation, indemnity provider, union or professional body. Many do not realise this until they check. The RCN, for example, asks members to contact it as soon as possible after hearing from the NMC, and before replying.

Profession	Where people commonly get help
Doctors	Medical defence organisations such as the MPS, MDU or MDDUS, and the BMA
Nurses and midwives	The RCN, the RCM, Unison and other unions
Dentists and dental care professionals	Dental defence organisations and the BDA
Pharmacists	The Pharmacists’ Defence Association and your indemnity provider
Allied health professionals	Your professional body or union, such as the CSP for physiotherapists
Optometrists	The Association of Optometrists
Social workers	BASW and your union

If you are not a member of any of these, a specialist regulatory solicitor can advise. Ask about costs at the start. Whoever you use, give them the full letter and every deadline.

Who you may need to tell

This is where many professionals get into difficulty. Disclosure duties come from your professional standards, your contract and, sometimes, the regulator’s own letter. Failing to disclose when you should can become a probity concern in its own right, which is often more serious than the original issue.

Standard	What it requires, in summary
Good medical practice 2024, para 99 (GMC)	Tell the GMC without delay if you accept a caution, are charged with or found guilty of a criminal offence, are criticised by an official inquiry, or another professional body makes a finding against your registration.
Good medical practice 2024, para 100 (GMC)	If an organisation suspends you or restricts your practice, tell, without delay, every organisation you do medical work for and any patients you see independently.
Good medical practice 2024, para 98 (GMC)	Cooperate with formal inquiries, patient safety investigations and complaints procedures, and be open and honest.
The NMC Code, 23.2	Tell the NMC and any employers, as soon as you can, about any caution or charge, or criminal finding, other than protected ones.
The NMC Code, 23.3	Tell any employers you work for if your practice has been restricted or conditions have been imposed.

Other regulators have similar duties in their own standards, including the HCPC, GDC and GPhC. Read yours, check your contract, and ask your adviser. A good rule is to disclose in writing, keep a copy, and stick to the facts.

Why early disclosure usually helps The RCN points out that the NMC is likely to contact your employer anyway. Telling your employer yourself, in writing, shows openness, avoids any suggestion of concealment, and makes it more likely your manager will support you and later give a reference that carries weight.

Should you self-refer?

Sometimes the first step is yours, not the regulator’s. Professional standards require you to tell your regulator about certain events yourself. The NMC sets out a clear list, which reflects the approach of most regulators.

You must tell the NMC

Self-refer

A caution, or a charge for an offence
A criminal conviction, other than a protected one
A conditional discharge
Discipline by any regulatory or licensing body, including outside health and care

Usually no need to self-refer

Not required

Parking, public transport or fixed penalty fines
Civil matters unrelated to practice, such as county court judgments
Protected cautions or convictions
Health conditions managed well without affecting practice
Complaints already being dealt with locally by your employer

Doctors have similar duties under paragraph 99 of Good medical practice, set out above. If you are unsure whether something needs to be reported, ask your adviser promptly. A late self-referral is far better than none, and failing to report can itself become a probity concern.

When your employer is investigating too

Many regulatory concerns start with, or run alongside, a local investigation by an employer. The two processes are separate, but they affect each other.

Different questions. Your employer asks whether its policies or your contract were breached. Your regulator asks whether your fitness to practise is impaired.
Information travels. Regulators often ask employers for their investigation reports and statements. What you say locally may be read by your regulator, so be accurate and consistent in both.
Local frameworks. For doctors employed in the NHS in England, local handling of concerns usually follows the Maintaining High Professional Standards framework. Other professions follow their employer’s disciplinary and capability policies.
Liaison. The GMC runs an Employer Liaison Service, which works with responsible officers on when concerns should be referred.

Tell your adviser about both processes from the start, so your responses stay consistent and your representation covers both where possible.

If you are told about an interim order hearing

Occasionally, the first serious step is notice of an interim order hearing. This happens only where the regulator believes there may be a risk that needs managing while the case is investigated. It is not a finding that the allegations are true, but it is urgent.

Feature	MPTS (doctors)	NMC (nurses and midwives)
Who decides	A tribunal of three, including at least one registrant and one lay member	An interim orders panel
Public or private	Private by default, though the doctor can ask for a public hearing	Check your notice; health matters are generally heard in private
Possible orders	Interim conditions or interim suspension, for up to 18 months	Interim conditions or interim suspension, for up to 18 months at a time
Reviews	First review within six months, then at intervals of no more than six months	Reviewed every six months; extensions only by the High Court or Court of Session

What usually helps at short notice:

Contact your adviser immediately and ask whether they can represent you at the hearing.
Gather evidence of current safeguards, such as confirmation from your employer of supervision, a change of duties or other measures already in place.
Think about workable conditions. Panels must consider whether conditions would be enough before suspension. Proposals your employer can support may help.
Provide current health evidence if health is part of the concern.

Your first reply to the regulator

The first letter is not always a request for your full account. It is important to separate what the regulator requires now from what it invites.

The NMC’s 14-day response

When the NMC opens a case, it gives you 14 days from the date of its letter to respond. You must complete the personal details form and give your employer contact details. A substantive response is not mandatory at that point. However, the NMC says early information can help it decide faster, can provide context, and in some cases can mean a full investigation is not needed.

The NMC suggests an early response can include:

your current employment, and any steps your employer has taken to manage risk;
context about the incident or incidents;
steps you have already taken to address the concerns, such as courses or extra training; and
evidence of reflection and insight.

Send now, or wait for the evidence?

Often sensible to send early

Facts that help and do not hurt

Required forms and employer details. Your current role and any supervision or support in place. Objective context, such as staffing levels on the shift. Learning or support you have already started.

Usually wait for advice and evidence

Your detailed account

A full description of disputed events, admissions or denials of specific allegations, and anything about other people’s conduct. You will normally get the evidence and a formal chance to respond later, as our guide to the investigation stage explains.

Other regulators work differently. The GMC, for example, may make short provisional enquiries first, and gives doctors 28 days to respond once the allegations and evidence are sent. Whatever your regulator, never miss a stated deadline. If you need more time, ask in writing before the deadline expires.

Not sure where to start?

Our Dealing with a Complaint or Investigation course explains each stage of the process, your duties and how to build a clear, honest record of your learning from the start.

View the course

Protecting the evidence, including your own

Investigations are decided on documents. The habits you set in the first weeks decide what you will have to work with later.

Keep everything. Save letters, emails and texts about the matter in one folder. Do not delete anything.
Never alter or add to records after the event. If a genuine correction is needed, follow your employer’s process, and make it clearly dated and attributed. Changing records to look better is a serious probity issue in its own right. Our Record Keeping course covers how to correct records properly.
Write your private timeline now. Memory fades quickly. Your adviser can tell you how to keep it so it stays private.
Obtain documents properly. Ask your employer or adviser for records you need. Do not access patient records you have no clinical reason to view.
Note who was there. Record names and roles of colleagues who may remember events, but do not discuss the case with possible witnesses.

Do’s and don’ts in the early weeks

Get advice before writing anything substantive
Meet every deadline, or ask for more time in writing
Disclose to employers where your standards require it
Keep working within any conditions or restrictions exactly
Start honest reflection early
Use the support services available to you

Don’t

Contact the person who raised the concern about the case
Post about the case or the people involved on social media
Alter, tidy up or add to records after the event
Send an angry, defensive or blaming reply
Ignore letters in the hope it goes away
Resign or try to leave the register without advice

Can you resign or leave the register to end it?

Many professionals consider this in the first shock. It rarely works the way people expect.

Resigning from your job does not stop a regulator’s investigation. The regulator is concerned with your registration, not your employment.
Leaving the register is not usually automatic while a case is open. The NMC, for example, offers a formal route called agreed removal. It is only available where the concerns are not so serious that they could lead to striking off, and you must show you do not intend to practise. A record is kept, and it is taken into account if you apply to rejoin.
Other regulators have their own rules, and some do not allow voluntary removal while proceedings are under way.

This is a significant, long-term decision. Take advice before considering it.

Looking after yourself

Fitness to practise processes are known to be stressful, and regulators have introduced support because of it. These services are free and confidential:

NMC Careline

Independent emotional support for nurses, midwives and nursing associates in the NMC’s process. Available 24 hours a day, every day, on 0800 587 7396.

Doctor Support Service

Confidential emotional support from fellow doctors, run for the GMC by the BMA Wellbeing Support Service.

NHS Practitioner Health

A free, confidential NHS mental health and addiction service for health professionals in England, by self-referral.

Samaritans

Round-the-clock emotional support for anyone, on 116 123.

Scotland and Wales have their own services for health professionals, and many unions and defence bodies offer counselling. If you ever feel unable to keep yourself safe, contact NHS 111, your GP or emergency services.

What a real case shows about early action

Real case · High Court

Cohen v General Medical Council [2008] EWHC 581 (Admin)

The facts. A consultant anaesthetist failed to discuss a patient’s recent stroke before surgery, did not document the consultation, kept inadequate anaesthetic records, and did not properly assess neurological symptoms after the operation. A fitness to practise panel found serious shortcomings, found his fitness to practise impaired and imposed conditions.

What changed. By the time of the hearing, there was evidence that he had substantially improved his practice. A colleague described his later work and record keeping in strongly positive terms, and he had a long career and supportive references.

The outcome. On appeal, the High Court held that the panel had not properly considered that the failings were easily remediable, had in fact been remedied, and were highly unlikely to be repeated. The court found his fitness to practise was not impaired and replaced the conditions with a warning.

The lesson: evidence of genuine, sustained improvement can make a real difference, which is why starting early matters. Our remediation guide explains how to build that evidence. It also shows why records and clinical practice concerns are generally easier to address than concerns about honesty or attitude.

A hypothetical example

Hypothetical example

A midwife’s first two weeks. A community midwife receives an NMC letter about a home visit where a family says she missed signs that a newborn was unwell. Her first instinct is to email a long explanation that night. Instead, she calls the RCM the next morning and is assigned an adviser.

Over the following days, she writes a private timeline, lists the records and messages from that visit, and tells her manager about the referral in writing. She returns the NMC’s personal details form and employer contacts within 14 days. On advice, her early response is short and factual: her current role, the extra supervision her employer has put in place, and the neonatal assessment refresher she has booked. Her full account waits until she has seen the evidence.

None of this decides her case. It means the NMC has accurate early information, her employer is on side, and nothing she has done has created a second concern.

Frequently asked questions

How long do I have to respond to an NMC letter?

The NMC gives 14 days from the date of its letter. You must return the personal details form and your employer contact details. A substantive response is not mandatory at that point, though the NMC says early information can help.

Should I respond to the regulator myself?

You can, but it is usually wise to get advice first from your defence organisation, union or professional body. They can help you decide what to send now and what to leave until you have seen the evidence.

Do I have to tell my employer about a fitness to practise concern?

It depends on your standards, your contract and the stage of the case. The NMC Code and Good medical practice both require you to tell employers about certain things, such as restrictions, charges and cautions. The regulator may contact your employer itself. Early, written disclosure is usually the safest course.

Can I contact the person who complained?

You should not contact the person who raised the concern about the case, or try to influence witnesses. It can look like pressure and may become a concern in itself.

Should I start a course straight away?

Learning that targets the concern can help, and the NMC lists completed courses among the steps it finds useful. Choose learning that relates directly to the issue, keep the certificate, and pair it with honest reflection on how you have changed your practice.

Will the concern stop me working?

Usually not at this stage. You can normally keep working unless an interim order restricts or suspends you, or your employer takes its own action.

Can I leave the register to avoid the process?

Not simply. Regulators have their own rules. The NMC’s agreed removal route, for example, is only available where the concerns are not so serious that they could lead to striking off, and a record is kept if you later apply to rejoin.

Where can I get emotional support?

Nurses, midwives and nursing associates can call the NMC Careline on 0800 587 7396, any time. Doctors can use the Doctor Support Service. NHS Practitioner Health supports health professionals in England, and Samaritans are available on 116 123.

Do I need to self-refer to my regulator?

For some events, yes. The NMC, for example, requires you to tell it about cautions, charges, non-protected convictions, conditional discharges and discipline by other regulatory or licensing bodies. Doctors have similar duties under Good medical practice. Parking fines and locally handled complaints usually do not need self-referral.

What should I do if I am called to an interim order hearing?

Contact your adviser straight away and ask about representation. Gather evidence of current safeguards, such as supervision your employer has put in place, and think about conditions that would manage any risk. An interim order is not a finding that the allegations are true.