Investigation outcomes · Warnings and undertakings

Warnings and Undertakings in Fitness to Practise: What Happens Next

The test for a warning at the GMC, NMC and GDC, how often each outcome is used, your options when one is proposed, what undertakings involve and when they are offered, how to decide whether to agree, and what follows once the case closes.

Reviewed October 2026 against GMC, NMC, GDC, HCPC and GPhC guidance and data

The test for a warning Your options Agree or go to a hearing?

Short answer: a warning and undertakings are both ways of ending an investigation without a full hearing. A warning is given where your conduct or performance fell significantly below the expected standard but there is no need to restrict your practice. It does not limit your work, but it is published for a period and can be disclosed to employers afterwards. Undertakings are commitments you agree to, such as supervision, training or limits on your practice, which are used where there is a realistic prospect of a finding of impairment but agreed restrictions are enough to protect the public. You can usually decline either and ask for a hearing instead, but that decision has consequences and should be made with advice.

Key takeaways

A warning is not a finding of impairment, but it is a formal record that matters in any future case.
Warnings are common: 110 of 679 GMC case examiner decisions in 2025.
Undertakings need your agreement. At the NMC, if you do not agree within 28 days, the case is referred for a hearing.
Breaching undertakings is treated as a sign of continuing risk.
Neither outcome is necessarily final. New information can reopen a closed case.

Our guide to writing your response explains how to influence these decisions, and our guide to outcomes sets out how long each stays on the register. This guide is about what these two outcomes mean, and what to do when one is proposed or agreed.

How often warnings and undertakings are used

GMC case examiner decisions, 2025

Warnings110 · 16%

Undertakings60 · 9%

of 679 decisions. 309 closed with no action and 184 were referred to a tribunal.

NMC case examiner decisions, 2024 to 2025

Warnings74 · 6%

Undertakings116 · 10%

of 1,171 decisions. 321 closed with no further action and 658 were referred for a hearing or meeting.

GDC case examiner decisions, 2024

Warnings13%

Advice15%

of 515 decisions. 62% were closed and 38% referred to a practice committee.

Sources: GMC fitness to practise data 2025; NMC Annual Fitness to Practise Report 2024 to 2025; GDC Fitness to Practise Statistical Report 2024. The GDC report does not give a separate 2024 figure for undertakings.

Advice, warnings, undertakings and conditions compared

These four outcomes are often confused. The differences matter for your work, your record and your choices.

Outcome	Who decides	Restricts practice?	Published?	Needs your agreement?
Advice	Case examiners	No	Not published at the GDC; not routinely published at the GMC	No
Warning	Case examiners or the GMC Investigation Committee	No	Yes, for a set period	No, but it can be challenged
Undertakings	Agreed with case examiners	Usually, in agreed ways	Yes, while in force, except health details	Yes
Conditions	A panel or tribunal after a hearing	Yes	Yes, while in effect	No, they are imposed

Advice is the lightest outcome. The NMC gave advice in only 2 of 1,171 case examiner decisions in 2024 to 2025, while the GDC closed 15% of its 2024 decisions with advice. Conditions are explained in our guide to conditions of practice.

The test for a warning

A warning sits between closing a case and taking action on your registration. Each regulator frames the test slightly differently.

Regulator	When a warning is appropriate
GMC Decision on whether a warning is required, January 2026, para 11	Where there is evidence that the doctor's behaviour or performance "has fallen significantly below the professional standards expected to a degree warranting a formal regulatory response, but restrictive action on the doctor's registration is not required".
NMC Warnings, CAS-2b, January 2026	Where the concerns pose a risk to public safety, public confidence or professional standards, but there is no realistic possibility of a finding that fitness to practise is currently impaired. A warning indicates conduct that fell significantly below the standards in the Code.
GDC Disclosure and publication policy	Case examiners can close a case with a warning, which is ordinarily issued for up to 24 months and published on the online register.

GMC guidance says a warning will often be appropriate where a case involving sexual misconduct, dishonesty or clinical concerns has "just fallen short" of meeting the realistic prospect test, and may be appropriate for a conviction or caution for a less serious offence, such as one-off drink or drug driving. NMC guidance gives examples including medication administration failures where the professional showed strong reflective insight and safe practice since, and unprofessional communication followed by improved behaviour.

What decision-makers weigh

GMC guidance lists factors including whether the incident was isolated or repeated, whether there is relevant fitness to practise history, and the doctor's level of insight, including a genuine expression of regret or apology. That last factor is one you can influence, through the reflection and evidence in your response. Our guide to demonstrating insight explains how.

When a warning is proposed: your options

GMC

Accept, or ask for a hearing

If case examiners consider a warning appropriate, a doctor can ask for an oral hearing before the Investigation Committee instead of accepting it. The Committee can conclude the case with no further action, issue a warning, or, if new information emerges, refer the case to a tribunal. Hearings follow guidance in effect from January 2026.

NMC

Ask for a review

Warnings are published seven days after notification. A warning can be reviewed if the decision may be materially flawed or there is new information that may have led to a different decision, and the Registrar decides a review is in the public interest or necessary to prevent injustice.

Think before you challenge Asking for a hearing or a review is your right, and can be the correct choice where the facts are wrong. But a hearing is public, takes time, and the outcome is not guaranteed to be better. Take advice on the strength of the evidence before deciding.

How the HCPC and GPhC differ

HCPC

No warnings at the investigation stage

The HCPC's Investigating Committee Panel decides only whether there is a case to answer, and there is no process to appeal its decision. Instead of agreed undertakings, a case can end by consent, without a contested hearing, where you admit the allegation in full and there is no public interest in a full hearing. Consent outcomes can include a caution, conditions, suspension or voluntary removal. In 2024 to 2025, 22 HCPTS cases concluded by consent.

GPhC

A right to refuse the warning

The GPhC's Investigating Committee can impose a warning where there is a real prospect of proving the facts but the case does not need to go to the Fitness to Practise Committee. It is published on the register for 12 months. GPhC guidance from April 2025 says a professional has the right to ask to be referred to the Fitness to Practise Committee instead, and if asked, the Investigating Committee must refer.

A closed case is not always closed

Real case · High Court · 2019

R (Bramhall) v General Medical Council [2019] EWHC 3525 (Admin)

The facts. A liver transplant surgeon marked his initials on patients' transplanted livers on several occasions. In February 2017, GMC case examiners gave him a warning. He was later convicted of common assault, having pleaded guilty. The GMC then reviewed the warning, referred the misconduct allegation back to case examiners, and referred the convictions to a tribunal.

The outcome. The surgeon challenged all three decisions by judicial review. The High Court dismissed the challenge, finding the decisions rational and lawful. The convictions were genuinely new information that had not been available when the warning was given.

The lesson: a warning closes a case on the information available at the time. If significant new information emerges later, such as a conviction, the regulator can revisit it.

What undertakings are

Undertakings are commitments you agree to, instead of the case going to a hearing. They can include restrictions, supervision, training, health monitoring or reporting requirements, and they work in practice much like conditions of practice.

GMC

Strict eligibility

GMC guidance says undertakings may only be agreed where the doctor's fitness to practise appears to be impaired, undertakings would provide sufficient protection to the public, and there is no possibility of erasure if the matter went to a tribunal. They are agreed, not imposed.

NMC

28 days to decide

Case examiners send recommended undertakings, and you have 28 days to say whether you agree. If you do not confirm agreement by the date given, the concerns are referred for a hearing. The NMC will consider amendments that make them workable, provided they still protect the public.

The NMC publishes a statement of regulatory concern with the undertakings in most cases, but does not publish details that could identify a health condition or other sensitive information. The GMC and GDC publish undertakings while they are in force.

Agree to undertakings, or go to a hearing?

This is one of the most important decisions in the process. There is no universally right answer, but these are the questions to work through with your adviser.

Points in favour of agreeing

The case ends without a public hearing and its uncertainty
You can keep practising, within the undertakings
You may be able to negotiate workable wording
Compliance builds evidence of safe practice

Points to weigh carefully

Undertakings are published while in force, except health details
They must be workable for you and your employer
Breaching them is treated as a sign of continuing risk
If you genuinely dispute the facts, a hearing is where they are tested

Living with undertakings

Once agreed, undertakings are monitored in much the same way as conditions: reports from supervisors and workplaces, notifications of new posts, and regular updates. GMC guidance from November 2025 says a breach of undertakings "is likely to suggest that the doctor continues to pose a current and ongoing risk", and that the GMC may refer the case to case examiners or to a tribunal depending on the breach. Our conditions guide includes a compliance log you can use for undertakings too.

After the case closes

Check the register. Make sure what is published is accurate.
Keep the decision letter. You may need to explain it in job applications, revalidation or appraisal.
Expect it to be disclosed. The GMC usually discloses historical warnings to current employers who ask, even after publication ends, and the NMC keeps a record of sanctions that may be disclosed to employers on request.
Keep learning. GMC guidance lists relevant fitness to practise history as a factor in future decisions, so a sustained record of safe practice matters.
Answer declarations honestly. Our guide to declarations explains why.

Frequently asked questions

Is a warning a finding that my fitness to practise is impaired?

No. A warning is given where the realistic prospect test for impairment is not met, but conduct or performance fell significantly below the expected standard.

Does a warning stop me working?

No. A warning does not restrict your practice, but it is published for a period and may be disclosed to employers.

How long is a warning published?

At the GMC, one year on the doctor details page and a further year on the history page. At the NMC, 12 months. At the GDC, usually up to 24 months.

Can I refuse a GMC warning?

You can ask for an oral hearing before the Investigation Committee instead of accepting it. The Committee can close the case, issue a warning or, if new information emerges, refer it to a tribunal.

Can I challenge an NMC warning?

An NMC warning can be reviewed if the decision may be materially flawed or there is new information, and the Registrar decides a review is in the public interest or necessary to prevent injustice.

What happens if I do not agree to undertakings?

At the NMC, if you do not confirm agreement within the time given, usually 28 days, the case is referred for a hearing. At the GMC, refusal usually leads to referral to a tribunal.

Can undertakings be changed?

The NMC says case examiners will consider amendments that make undertakings workable, as long as they still protect the public. Raise any practical problems before agreeing.

Does the HCPC give warnings?

Not at the investigation stage. The HCPC's Investigating Committee Panel decides only whether there is a case to answer. A case can instead end by consent if you admit the allegation in full.

Can a pharmacist refuse a GPhC warning?

Yes. GPhC guidance says a professional can ask to be referred to the Fitness to Practise Committee instead of receiving a warning from the Investigating Committee, and the Committee must refer if asked.

Can a closed case be reopened?

Yes, if significant new information emerges. In R (Bramhall) v GMC, a warning was reviewed after the doctor's later conviction, and the High Court upheld the GMC's decisions.

Primary sources

15 official documents and judgments