Fitness to Practise: How GMC, NMC, and HCPC Hearings Differ

What the three regulators have in common

All three:

• Are established and governed by their own constitutive legislation (Medical Act 1983 for the GMC; Nursing and Midwifery Order 2001 for the NMC; Health Professions Order 2001 for the HCPC), with overarching scrutiny by the Professional Standards Authority for Health and Social Care under the National Health Service Reform and Health Care Professions Act 2002
• Apply the civil standard of proof — balance of probabilities — to allegations of fact
• Have a three-stage hearing model: facts found / not found, then impairment, then sanction
• Have appeal routes to the High Court (Administrative Court for England and Wales), with a deferential review standard
• Publish decisions; hearings are in public unless privacy is granted

The big-picture similarities mask important differences in detail. Below are the differences that matter most.

---

The General Medical Council (GMC)

The GMC regulates doctors. FtP cases are heard by the Medical Practitioners Tribunal Service (MPTS), which is operationally separate from the GMC's investigation arm.

Panel composition

A Medical Practitioners Tribunal panel includes both medical and lay members. The panel is independent of the GMC; the GMC presents the case as the regulator and the tribunal decides.

Procedural rules

The General Medical Council (Fitness to Practise) Rules Order of Council 2004 (as amended). Specific procedural directions are published by the MPTS.

The legal test

Section 35C of the Medical Act 1983 sets out the categories of impairment:

• Misconduct
• Deficient professional performance
• Adverse physical or mental health
• A determination by another body
• A conviction or caution
• An English-language ability deficiency

The MPTS applies the test in CHRE v NMC and Grant [2011] EWHC 927 (Admin) at [74] — at the impairment stage, the panel must consider whether the doctor's conduct demonstrates that they are currently impaired, and whether public confidence in the profession demands a finding of impairment even where the doctor has remediated.

Right to representation

A doctor has the right to be represented by counsel, solicitor, or a trade union / defence organisation representative. Most doctors instruct the Medical Defence Union (MDU), Medical Protection Society (MPS), or Medical and Dental Defence Union of Scotland (MDDUS) — all three commonly offer assistance with regulatory proceedings as a discretionary benefit of membership.

Sanctions

The MPTS can:

• Take no further action
• Issue a warning (under section 35D(3))
• Make undertakings
• Impose conditions on registration
• Suspend (up to 12 months at a time)
• Erase from the register

Appeal

The doctor can appeal an erasure, suspension or conditions direction to the High Court under section 40 of the Medical Act 1983; the GMC can appeal under section 40A. The appeal succeeds if the decision was wrong or unjust because of a serious procedural or other irregularity (CPR 52.21(3)).

---

The Nursing and Midwifery Council (NMC)

The NMC regulates nurses, midwives, and nursing associates. FtP cases are heard by the NMC's Fitness to Practise Committee.

Panel composition

A panel of three, including at least one registrant and one non-registrant member; the chair may count as either. Where three is not reasonably practicable, a panel of two may sit, and it need not include a registrant (Nursing and Midwifery Council (Practice Committees) (Constitution) Rules 2008, r.6(10)–(11)).

Procedural rules

The Nursing and Midwifery Council (Fitness to Practise) Rules 2004 (as amended).

The legal test

The NMC applies a three-stage approach, and at the impairment stage it follows CHRE v NMC and Grant [2011] EWHC 927 (Admin) at [74]:

1. Did the registrant act in such a way that the events occurred as alleged? (facts)
2. Do the proven facts amount to impairment of fitness to practise? (impairment)
3. What sanction, if any, is appropriate? (sanction)

The NMC is particularly active on misconduct related to honesty and integrity. Falsifying records, lying to colleagues, and concealment in a clinical setting attract strong responses even where direct patient harm is not established.

Right to representation

A registrant can be represented by counsel, solicitor, the Royal College of Nursing, the Royal College of Midwives, or a trade union representative. The RCN and RCM have professional regulation teams.

Sanctions

The Fitness to Practise Committee can:

• Take no further action
• Issue a caution order (1-5 years)
• Impose conditions of practice (up to 3 years)
• Suspend (up to 12 months at a time)
• Strike off

The NMC also operates an Interim Order regime for cases where the committee considers immediate restrictions necessary while the substantive case proceeds.

Appeal

A registrant can appeal to the High Court under article 38 of the Nursing and Midwifery Order 2001. The Professional Standards Authority, not the NMC, can refer a decision it considers not sufficient to protect the public to the High Court (NHS Reform and Health Care Professions Act 2002 s.29). The appeal is by way of re-hearing (PD 52D para 19.1(2)) and succeeds if the decision was wrong or unjust because of a serious procedural or other irregularity (CPR 52.21(3)).

---

The Health and Care Professions Council (HCPC)

The HCPC regulates 15 professions including paramedics, occupational therapists, physiotherapists, radiographers, dietitians, biomedical scientists, and others. (Social workers in England transferred to Social Work England in December 2019; social workers in Wales, Scotland and Northern Ireland are regulated by their respective country bodies, not the HCPC.) FtP cases are heard by HCPC FtP panels.

Panel composition

A panel of three, including at least one registrant from the same part of the register as the registrant concerned and one lay member; the chair may count as either (Health Professions Council (Practice Committees and Miscellaneous Amendments) Rules 2009).

Procedural rules

The Health Professions Order 2001 (as amended) and the Health Professions Council (Conduct and Competence Committee) (Procedure) Rules.

The legal test

The HCPC applies a similar three-stage test to the NMC: facts, impairment, sanction. The substantive law on impairment is the same — CHRE v Grant. The HCPC's practical case law tends to track NMC cases on similar issues.

Right to representation

A registrant can be represented by counsel, solicitor, or a professional body representative (BAOT, CSP, SoR, etc.). Some professional bodies fund representation; others do not — depends on the registrant's level of engagement and the body's policy.

Sanctions

The HCPC can:

• Take no further action
• Issue a caution (1-5 years)
• Impose conditions of practice
• Suspend
• Strike off

Appeal

A registrant can appeal to the High Court under article 38 of the Health Professions Order 2001.

---

A side-by-side comparison

---

Common themes — and what differs in practice

Despite the architectural similarities, three areas of practical difference matter for any registrant facing FtP.

1. Approach to remediation

The GMC and MPTS place significant weight on demonstrated remediation — courses completed, supervision undertaken, evidence of insight, written reflection. A doctor who remediates effectively can sometimes avoid impairment findings even where misconduct is admitted.

All three regulators treat insight and remediation as central to impairment and sanction; the weight they carry depends on the facts.

2. Approach to sexual misconduct

All three regulators treat allegations of sexual misconduct in a professional context very seriously. Serious sexual misconduct is treated as among the most serious concerns and is often incompatible with continued registration; see your regulator's sanctions guidance.

3. Approach to mental health and ill-health

Where impairment is rooted in the registrant's own ill-health rather than misconduct, all three regulators have specific procedures. Where a GMC tribunal considers the doctor's physical or mental health, it sits in private unless it considers a public hearing appropriate (GMC (Fitness to Practise) Rules 2004 r.41(3)(b) and (6)); the NMC and HCPC also have health procedures and health committees.

A registrant whose case is in the health stream should not be cross-examined in the same way as a misconduct case. Take specialist advice if the case-management is being approached as a misconduct case when it should be a health case.

---

Bundle preparation for FtP hearings

A typical FtP bundle contains:

• Section A: Notice of Hearing, Allegations document, registrant's response
• Section B: Witness statements (registrant, lay witnesses, professional witnesses)
• Section C: Clinical or workplace records relied on
• Section D: Expert reports (occasionally)
• Section E: Character references
• Section F: Health evidence (if relevant)
• Section G: Insight and remediation evidence (CPD, supervision letters, written reflection)
• Section H: Previous regulatory history (if any)

Each regulator has specific bundle conventions; follow the directions in your case.

BundleCreator's Regulatory Law template is designed to produce an organised, indexed bundle quickly, with:

• Hyperlinked index
• Pagination throughout (Bates A1, A2 / B1, B2 etc., or Arabic at panel preference)
• OCR for searchability
• Section bookmarks

---

Frequently asked questions

Will my employer be told?

Usually, and often early. The GMC must notify employers of an investigation as soon as reasonably practicable (Medical Act 1983 s.35B(1)); other regulators commonly contact employers during the investigation. The notification triggers internal HR processes and, in NHS settings, the Maintaining High Professional Standards framework.

Can I keep working?

Usually yes during investigation, unless an Interim Order is imposed. Interim Orders restrict practice while the substantive case proceeds — they require evidence that public protection or public confidence demands restriction, not just that there is a serious allegation. Interim orders last up to 18 months; the first review is within 6 months; later reviews are at least every 6 months (GMC: Medical Act 1983 s.41A(2); NMC art 31(6)) or every 3 months (HPO art 31(6)); extensions are by application to the High Court.

What if the allegation is criminal?

A criminal conviction or caution is itself a category of impairment for all three regulators. The FtP process can be paused while criminal proceedings run, then resume to consider the impairment and sanction implications. Always co-ordinate criminal-defence and regulatory strategy from day one.

How long does it take?

It depends on the regulator and the case. Cases involving complex disclosure, expert evidence, or vulnerable witnesses can take longer. Cases admitted at an early stage can resolve faster.

What about the public register?

Each regulator publishes the outcome of FtP proceedings on the public register. Cautions and conditions are visible for the duration of the order; suspensions are visible during the suspension; erasures/strike-offs are permanent unless the registrant successfully applies for restoration.

Can I appeal?

Yes — to the High Court within 28 days of service of notice of the decision. The appeal succeeds if the decision was wrong or unjust because of a serious procedural or other irregularity (CPR 52.21(3)). Specialist regulatory counsel is essential for an appeal.

---

Further reading

• General Medical Council — Fitness to Practise
• Nursing and Midwifery Council — Fitness to Practise
• Health and Care Professions Council — Concerns Process
• Medical Practitioners Tribunal Service
• Solicitors Disciplinary Tribunal: Defending a Solicitor Against an SRA Referral
• FCA Enforcement Notice: Responding to a Decision Notice and Tribunal Reference