Appeals and restoration: challenging the decision and getting back on the register

An adverse fitness to practise decision is not necessarily the end. You can appeal a final panel decision to the court, but only within 28 days of being notified — a deadline the courts enforce strictly. If you have been struck off, you can apply for restoration to the register once five years have passed. This page explains both routes.

This is part of the free FtP Navigator knowledge hub. If your case ended in a suspension or conditions of practice order rather than a strike-off, start with our guide to review hearings instead — a review, not an appeal, is usually the right route back.

How do I appeal a fitness to practise decision?

You appeal a final fitness to practise decision to the court, not back to your regulator. Taking the NMC as the worked example on this page, a nurse, midwife or nursing associate appeals a final substantive order to the High Court in England and Wales, the High Court of Justice in Northern Ireland, or the Court of Session in Scotland, under Articles 29(10) and 38 of the Nursing and Midwifery Order 2001.

There is a narrower, separate route for register entries. An order removing you from the register — or amending it — because an entry was fraudulently procured or incorrectly made is appealed to the county court, or in Scotland to a sheriff, under Articles 26(13) and 38(1)(b) of the Order.

The other healthcare regulators operate on the same broad model of a statutory appeal to the court on a tight deadline. Doctors should read our expert guide to appealing a GMC fitness to practise decision for the GMC-specific position.

How long do I have to appeal?

You have 28 days to appeal a final committee decision, or a decision made on review, and that period starts the day after the date on the letter informing you of the outcome. Note that it runs from the date on the decision letter — not from the day you actually read it — so the clock may already be running before the letter reaches you.

If the last of the 28 days falls when the court office is closed, such as a weekend or bank holiday, the next working day is treated as the last day of the appeal period. Do not plan around that margin; treat day 28 as your absolute deadline.

The court can extend time only where there are exceptional circumstances, following R (Adesina & Ors) v Nursing and Midwifery Council [2013] EWCA Civ 818. In practice, extensions are rare — a late appeal is usually a lost appeal, which is why the first seven days after the decision matter so much.

Your first 7 days after an adverse decision — checklist

• Day 1: Diarise the appeal deadline — 28 days from the day after the date on the decision letter, not from when you read it.
• Days 1–2: Obtain the panel’s full written determination and keep every page of the decision letter and its envelope.
• Days 1–3: Take specialist legal advice on the realistic merits of an appeal — before spending money on court fees.
• Days 2–4: Request the hearing transcript or your notes of the hearing, and gather the key exhibits.
• Days 3–5: Check whether any interim order applies to you pending appeal, and what it permits.
• Days 4–6: Notify your insurer, defence organisation or union — many have their own notification deadlines.
• Day 7: Decide in principle: appeal, accept and plan for a future review or restoration, or seek a second opinion.

What are the grounds for appeal?

In broad terms, the court will interfere with a panel’s decision where it was wrong, or where it was unjust because of a serious procedural irregularity in the proceedings. An appeal is not a rehearing of your whole case in front of a fresh panel — the court reviews what the panel did and why.

Arguments that tend to have realistic prospects include errors of law, findings no reasonable panel could have reached on the evidence, clearly disproportionate sanctions, and genuine procedural unfairness. Arguments that rarely succeed include simple disagreement with the outcome, re-arguing evidence the panel heard and rejected, and points that were never raised at the hearing.

An honest merits assessment before you issue is essential. A specialist fitness to practise appeal solicitor can tell you within a short review of the determination whether your strongest points are appeal points at all — or whether your energy is better spent preparing for a review or restoration.

Can I keep working while I appeal?

Whether you can keep working during an appeal depends on the order made against you and on any interim order the regulator has in place. If you appeal the outcome of a final hearing, you may be placed on an interim order until the appeal is determined — the NMC’s guidance on interim orders after sanction, and on early reviews of a substantive order following an appeal, deals with exactly this situation.

An interim order pending appeal can suspend you or restrict your practice even while the substantive order is under challenge. So never assume that lodging an appeal lets you carry on as before — check the precise terms of every order that applies to you, and get advice before accepting any shift or role that might breach them.

What is a PSA referral?

The Professional Standards Authority (PSA) routinely reviews every final fitness to practise decision of the health and social care regulators, and can appeal a decision it considers insufficient for the protection of the public under section 29 of the National Health Service Reform and Health Care Professions Act 2002. This means a lenient outcome is not always final — the PSA can ask the court to substitute something tougher.

The PSA has 40 days to appeal, beginning on the last day of your own 28-day appeal period. Where you have no right of appeal, it has 56 days from the day after the date on your outcome letter. A regulator can also refer a panel’s decision to the PSA itself where it considers the decision insufficient to protect the public, maintain public confidence or uphold proper professional standards.

Appeal, review or restoration — which applies to you?

The right route depends on what order was made and how much time has passed: appeals challenge the decision itself, reviews deal with existing suspension or conditions orders, and restoration is the route back after a strike-off.

	Appeal	Review	Restoration
What it challenges	Says the panel’s decision was wrong or unjust	Doesn’t challenge the decision — looks at whether an order is still needed	Doesn’t reopen the strike-off — asks whether you are now fit to return
Who decides	The court (High Court, High Court of Justice NI, or Court of Session)	A panel of the regulator’s Fitness to Practise Committee	A panel of the regulator’s Fitness to Practise Committee
When	Within 28 days of notification of the decision	Before a suspension or conditions order expires (see our reviews guide)	Only after 5 years from the striking-off order taking effect
Typically right for you if	There is a real error of law, fact or procedure	You accept the findings and want the order lifted or eased	You were struck off and can show you are now a fit and proper person

How do I get restored to the register after being struck off?

If you have been struck off, you must apply for restoration to the register — and under Article 33 of the Nursing and Midwifery Order 2001 you can only apply once five years have passed since the striking-off order came into force. Only one application is considered in any 12-month period, so a premature or under-prepared application costs you at least a year.

A panel of the Fitness to Practise Committee decides your application. Crucially, a restoration hearing is not an appeal against the original striking-off order: the panel will not reassess the findings of fact, and attacking the original decision is one of the most common ways applicants fail.

Be warned about repeat applications. If a panel refuses a second or subsequent application, it may suspend your right to apply again altogether, and you can only ask the Registrar to review that direction after three years.

What does a restoration panel look for?

The panel must decide whether, looking at the circumstances that led to the striking-off order, you are now a fit and proper person to practise — judged against the regulator’s overarching objective of public protection, as the Court of Appeal confirmed in General Medical Council v Chandra [2018] EWCA Civ 1898. The factors it weighs include your insight into and remediation of the original concerns, the time elapsed, your employment history since removal, your efforts to keep your practice up to date, and whether you could practise safely in future.

The panel must also consider public confidence. As General Medical Council v Nooh [2017] EWHC 2948 (Admin) recognises, strike-off cases sit on a spectrum: some were only just serious enough for erasure, while others are so grave it is difficult to see how the professional could ever be restored.

You must also satisfy the practical requirements for restoration. For the NMC these include meeting return to practice standards, evidencing health and character requirements, and meeting the English language requirements. Any “unresolved concerns” — matters that surfaced before or after the strike-off, such as a later conviction — will be put to you with the supporting evidence, and it is for the regulator to prove them on the balance of probabilities.

How do you build a strong restoration application?

A strong restoration application is built around evidence, not assertion — the panel hears the case background from the regulator’s presenter first, then it is your responsibility to present the evidence supporting restoration, including any medical evidence if your case involved health. Under Rule 25 of the NMC’s Fitness to Practise Rules 2004, the panel then deliberates in private and announces a reasoned decision in public.

If the panel is satisfied, it can grant restoration outright, grant it subject to you satisfying return to practice standards (a return to practice course or test of competence), grant it with a conditions of practice order taking effect when you rejoin the register, or combine the two. Conditions at this stage exist to support your safe return after time away — if your practice still presents the risks that led to the strike-off, the panel must refuse.

Start early, ideally a year or more before you apply: courses, testimonials, work records and reflective evidence take time to assemble. Our detailed guide to NMC restoration and getting back on the register walks through the evidence panels find persuasive.

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This page is general information, not legal advice. No liability is accepted for reliance on it. Rules and guidance change — always check the current position or take specialist advice.