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

Last updated: 5 May 2026

Quick answer

The General Medical Council (GMC), Nursing and Midwifery Council (NMC), and Health and Care Professions Council (HCPC) all run fitness-to-practise (FtP) panels with similar architecture — investigation, interim orders if needed, full hearing, sanction — but they differ in important details: the legal test for impairment, the standard of proof, the panel composition, the right to representation, and the routes of appeal. The civil standard (balance of probabilities) applies across all three. The hearing structure is broadly the same: facts stage, impairment stage, sanction stage. But the specific tests, the case law, and the practical handling differ. If you are facing FtP proceedings, your starting point is the regulator's procedural rules, the relevant indicative sanctions guidance, and recent appellate case law against that specific regulator — analogies between regulators can mislead.

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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 and Social Work 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.

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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 sits as a panel of three or five, mixing lay members and doctor 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 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 provide funded representation as part of indemnity cover.

Sanctions

The MPTS can:

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

Appeal

The doctor or the GMC can appeal a decision to the High Court under section 40 of the Medical Act 1983. Appellate review is broadly deferential; the court intervenes where the decision is "clearly wrong" or outside the range reasonably open.

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The Nursing and Midwifery Council (NMC)

The NMC regulates nurses, midwives, and (since 2018) nursing associates. FtP cases are heard by the NMC's Fitness to Practise Committee.

Panel composition

A panel of three: usually one lay chair, one registrant member of the same profession (nurse for a nurse, midwife for a midwife), and one lay member.

Procedural rules

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

The legal test

The NMC applies a three-stage approach derived from CHRE v Grant:

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 NMC can refer for review where it considers a sanction insufficient. Appeals are limited to errors of law, factual findings unsupported by evidence, or sanctions outside the reasonable range.

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The Health and Care Professions Council (HCPC)

The HCPC regulates 14 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: one lay chair, one HCPC registrant from the same profession as the registrant under investigation, and one lay member. The HCPC operates a single panel structure across all regulated professions, with profession-specific members rotated in.

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.

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A side-by-side comparison

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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.

The NMC takes remediation seriously but is generally more cautious — it has expressed scepticism in case law about late-stage remediation that appears defensive rather than genuine.

The HCPC sits between the two, with an increasing emphasis on insight as a separate factor.

2. Approach to sexual misconduct

All three regulators treat allegations of sexual misconduct in a professional context very seriously. The presumptive starting point is the most severe sanction available (strike-off / erasure) where the misconduct is established and serious. Departures from that starting point require exceptional circumstances.

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. The GMC has a separate Health Stream within the MPTS process; the NMC and HCPC handle health cases through their main FtP procedure but with case-specific adjustments.

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.

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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. The MPTS uses an electronic bundle system with paginated PDFs. The NMC and HCPC accept paper or electronic bundles, with electronic increasingly preferred.

BundleCreator's Regulatory Law template structures bundles in the order the panel expects:

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

A bundle that takes 4-6 hours to assemble manually is usually finished in around 15 minutes.

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Frequently asked questions

Will my employer be told?

Yes. Each regulator notifies the registrant's employer of any active investigation that progresses to a substantive panel. 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 can be reviewed (and lifted or varied) at six-monthly intervals.

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?

From referral to outcome: 12-30 months is typical. 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 Administrative Court (High Court) within 28 days of the decision. The court applies a deferential standard but does interfere where the panel has misapplied the legal test or imposed a sanction outside the reasonable range. Specialist regulatory counsel is essential for an appeal.

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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
• SRA Disciplinary Tribunal: Defending a Solicitor Against an SRA Referral
• FCA Enforcement Notice: Responding to a Decision Notice and Tribunal Reference