Start here: understanding fitness to practise proceedings

Fitness to practise means having the skills, knowledge, health and character to do your job safely and effectively. When a concern is referred to your regulator — the NMC, GMC, GDC, HCPC, GPhC or Social Work England — it investigates whether your fitness to practise is currently impaired. Most referrals end without a hearing or any sanction.

This is the foundation page of the free FtP Navigator, our knowledge hub for regulated professionals facing a referral. Read this page first, then follow the journey stage by stage, starting with screening.

What does fitness to practise mean?

Fitness to practise is your suitability to remain on your professional register without restriction — it is a public-protection test, not a punishment. Every UK health and care regulator exists to protect the public, and its legal framework requires it to protect people’s health, safety and wellbeing, maintain public confidence in the profession, and uphold professional standards. For the NMC, those objectives are set out in the Nursing and Midwifery Order 2001.

Regulators can only investigate allegations on defined grounds. For the NMC these are misconduct, lack of competence, criminal convictions and cautions, health, not having the necessary knowledge of English, determinations by other health or social care regulators, and fraudulent or incorrect register entries. The other regulators use very similar categories.

Crucially, not every mistake or breach of your professional code is a regulatory matter. Regulators say they should act only on serious concerns, and that employers — who are closer to the risk — should usually deal with problems first. A one-off clinical error, where you have reflected, been open and learned from it, will not usually require regulatory action at all.

Who can report you to the NMC, GMC or HCPC?

Anyone can refer a concern about you to your regulator — there is no restriction on who is allowed to report. In practice, referrals commonly come from:

• Your employer, often after (or instead of completing) a local investigation
• Patients, people receiving care and their families
• Colleagues — including a colleague you are in dispute with
• The police, who share information about charges, cautions and convictions
• Other regulators and health or social care organisations, in the UK or abroad, including determinations they have made against you
• The Disclosure and Barring Service (DBS) or Disclosure Scotland, following a barring decision
• You yourself — you must declare criminal charges, cautions and convictions to your regulator, and a genuine self-referral can count in your favour as evidence of insight.

The referral itself is only an allegation. Regulators say their starting point is that most professionals referred to them are normally safe, and they must look at context — staffing, systems, culture, your health and any discrimination or bullying you experienced — before blaming an individual.

What happens when you are referred to your regulator?

Every fitness to practise case follows the same broad journey — referral, screening, investigation, case examiner decision, then (only if necessary) a hearing — and it can end at any stage. The names differ between regulators, but the shape is the same. Here is the journey, mapped to the sections of the FtP Navigator.

Stage	What happens	Your move	Navigator section
1. Referral & screening	The regulator checks whether the concern is serious enough, and within its powers, to investigate. Many cases close here.	Take advice before you respond; diary every deadline.	Screening Coming soon
2. Interim orders (some cases)	If an immediate risk is alleged, a panel can suspend you or impose conditions while the case is ongoing.	Get specialist representation urgently — these hearings come quickly.	Interim orders
3. Investigation	Evidence is gathered from you, your employer, witnesses and records; you are asked context questions.	Engage early; provide context, reflection and evidence of safe practice.	Investigation Coming soon
4. Case examiners	They decide whether there is a “case to answer” — a realistic possibility a panel would find current impairment. They can close the case, give advice, issue a warning, agree undertakings or refer onwards.	Make well-prepared written representations — this is a key exit point.	Case examiners
5. Hearing or meeting	A panel (for the NMC, three people including a registrant) decides facts, impairment and sanction. Some cases resolve by agreement.	Build your evidence of insight and strengthened practice; consider consensual disposal.	Hearing preparation
6. Outcome & resolution	The panel imposes no action or a sanction, from a caution order up to striking off.	Review the decision and your options with a solicitor.	Sanctions & appeals Coming soon

An interim order can be considered at almost any point in the process, not just at the start. For a practical walkthrough of the investigation stage, see our guide on how to survive an NMC, GDC, SWE or GPhC investigation.

What does “impairment” actually mean?

Impairment means your fitness to practise is compromised now — not that you once made a mistake. Because the events are usually months or years old by the time a decision is made, the central question is the risk you pose today. That is why insight and strengthened practice are so important.

Decision makers ask three questions. Can the concern be addressed — for example through training, supervised practice or reflection? Has it been addressed? And is it now highly unlikely that the conduct will be repeated?

Clinical concerns — medication errors, record keeping, an isolated failing — are generally easier to put right. Concerns that go to your professionalism, such as dishonesty, discrimination, sexual misconduct, or abuse of people in your care, are much harder to address and carry far higher risk. If your case involves any of these, get specialist advice from a fitness to practise solicitor before you respond to anything.

What standard of proof applies in fitness to practise cases?

Disputed facts are decided on the balance of probabilities — “more likely than not” — which is a lower bar than the criminal standard of being “sure”. This has real consequences. A regulator can investigate, and prove, conduct that the police dropped or a jury acquitted you of: see Ashraf v General Dental Council [2014] EWHC 2618 (Admin) and Roy v GMC [2023] EWHC 2659 (Admin).

Once facts are proved, impairment and sanction are matters of judgement for the panel, not further “proof”. And be aware that if you fail to give evidence at a final hearing without good reason, the panel may draw an adverse inference against you: R (Kuzmin) v General Medical Council [2019] EWHC 2129 (Admin).

Is fitness to practise the same as being struck off?

No — striking off is the most severe outcome on a ladder of possible results, and most cases never come close to it. Many referrals are closed at screening, after investigation or by case examiners with no finding against you at all.

If a case does reach a panel and impairment is found, the NMC’s sanctions run from least to most severe: no further action; a caution order of one to five years; a conditions of practice order of up to three years; a suspension order of up to twelve months; and, only where nothing less will protect the public, a striking-off order. The panel must choose the least restrictive sanction that achieves public protection.

Remember the regulators’ own stated position: fitness to practise is about keeping people safe, not punishing professionals for past mistakes. Demonstrating openness, insight and learning is the single most powerful thing you can do to influence the outcome.

What should you do first?

Stay calm, say nothing substantive on the record until you have taken advice, and start protecting your position from day one. Early engagement genuinely helps — it lets you give your side, explain the context and show insight — but a rushed, defensive or inconsistent response can follow you all the way to a hearing. Providing materially different accounts later can damage your credibility.

Your first 7 days — checklist

• Read the referral letter and any enclosures carefully, twice; note exactly what is alleged and by whom
• Diary every deadline the regulator has set, and check whether an interim order hearing is listed
• Notify your indemnity insurer, union or defence organisation, and speak to a specialist solicitor before responding
• Do not contact the referrer, the patient or potential witnesses — it can be seen as interference
• Gather your own documents lawfully: contracts, appraisals, training certificates, rotas and correspondence (never remove patient records)
• Start a private, dated reflective note of events while your memory is fresh — but take advice before submitting anything
• Acknowledge the regulator’s correspondence and cooperate; ignoring it can itself become a concern
• Look after your health, and tell your GP if the stress is affecting you — support matters, and health context can be relevant to your case

When you are ready for the next stage of the journey, move on to the screening section of the FtP Navigator (coming soon — in the meantime, our survival guide to NMC, GDC, SWE and GPhC investigations covers the early stages).

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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.