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GMC Stages of Investigation

This factsheet will set out the procedure for the GMC Fitness to Practise process including the potential outcomes at each stage. The main ‘investigation’ phase consists of a Provisional Enquiry, Rule 4 Letter, Rule 7 Letter and if referred to a Medical Practitioners Tribunal (MPT), the stages involved as part of the hearing. 

On receipt of a referral, either as a self-referral or a concern raised by a third party, the GMC will decide whether there are issues which they need to investigate. If the GMC decide the concern is appropriate to investigate and falls within their criteria for taking action, they may decide to undertake a provisional enquiry.

Pre-Investigation Enquiry (called ‘Provisional Enquiries’)

A provisional enquiry is used as an initial, limited review which helps decide whether a full investigation needs to be opened. This is completed to save time, money and reduce anxiety for the doctor concerned. Once a concern has been considered via the provisional enquiry and the GMC decide they do not need to start an investigation, they will send an email confirming no further action will be taken.

If the GMC decide that the concerns raise questions about the doctor’s fitness to practise, they will open a full investigation. This is called the Rule 4 stage.

GMC Rule 4 Letter Stage

The GMC will send the doctor an initial GMC Rule 4 letter which outlines the complaint or concerns raised. The GMC will also disclose the complaint to the doctor’s employer / sponsoring body and make further enquiries to obtain an overview on the doctor’s practice.

The doctor will have an opportunity to respond with their comments on the complaint at this early stage, but it is best to take legal advice before any response is provided, so that appropriate advice can be given about the steps the doctor should take. 

Depending on the nature of the concerns, the investigation can include obtaining further documentary evidence from employers, the complainant or other parties, obtaining witness statements, obtaining expert reports on clinical matters, an assessment of the doctor’s performance, an assessment of the doctor’s health and an assessment of the doctor’s knowledge of the English language.

If at any stage of their investigation, the GMC consider the doctor to be an immediate risk to patients, they can take action to refer them to an Interim Orders Tribunal to stop them from working by suspending them or restricting their practice whilst they continue their investigation.

An Assistant Registrar will make the decision about whether the case should proceed to further investigation.

GMC Rule 7 Letter Stage

If the matter is not resolved at Rule 4 stage, it will proceed to the next stage which is Rule 7 stage. The GMC will send doctors a Rule 7 letter that sets out the evidence and allegations for the doctor to respond to. The doctor is invited to respond in writing, doctors normally have 28 days to respond to the Rule 7 letter. The doctor will need to evidence what they are claiming in their response. 

Once the Rule 7 response has been submitted, the full case is assessed by two Case Examiners (one medical and one non-medical). 

They can either conclude the case with no further action, issue a warning, agree undertakings, or refer the case to an MPT hearing. No case can be concluded or referred to an MPT hearing without agreement by the two case examiners. If they cannot agree, the case is referred to an Investigation Committee for a decision.

Criminal Convictions

Convictions for serious offences are usually referred by an Assistant Registrar straight to an MPT hearing so the Rule 4 and Rule 7 stages detailed above will not always apply. Please also note that the GMC does not usually investigate allegations that are more than five years old, unless it is in the public interest to do so.

Actions following referral to the MPT

Preliminary matters

The MPT hears and determines any preliminary legal arguments. The doctor will be asked to confirm their name, a registration number, and the chair will ask whether the GMC wishes to amend the particulars of the allegation(s) and whether the doctor wishes to make any admissions to the allegations.

Stage one: finding of facts

At this stage the tribunal evaluates all the evidence and relevant documents. The tribunal will then decide if any of the alleged facts are proven on the balance of probabilities. Doctors can also admit to alleged facts at this stage.

If the tribunal decides the allegation is not proved, the hearing ends at this stage.

If the tribunal decides any of the alleged facts are proved, the hearing continues to stage two.

Stage two: impairment

At this stage the tribunal considers if the doctor’s fitness to practise is currently impaired. The tribunal’s decision will be based on the facts found proven and any further relevant evidence presented. 

If the tribunal finds that the doctor is safe to continue working in medicine and treating patients. Then the hearing won’t continue to stage three. The tribunal may decide to place a warning on the doctor’s registration in this case. A warning does not restrict a doctor’s registration or right to continue treating patients.

If the tribunal finds that the doctor’s fitness to practise is impaired, the hearing continues to stage three.

Stage three: sanction

The GMC and doctor’s representatives will put forward to the tribunal what they believe the appropriate sanction should be, if any. Normally at this stage doctor’s representatives also put forward evidence in relation to doctors’ good character.

The Tribunal will decide what sanction to impose and is necessary to protect the public. The tribunal can:

  • end the case with no further action;
  • if appropriate, accept voluntary undertakings offered by the doctor;
  • put conditions on the doctor’s registration (this might mean the doctor is only allowed to do medical work under supervision or restrict him/her to certain areas of practice);
  • suspend the doctor’s name from the medical register so that he/she cannot practise during the period of suspension;
  • erase (remove) the doctor from the medical register so that he/she will not be able to work as a doctor in Great Britain; the GMC’s intention is that erasure should normally be for life.

If it is decided to suspend a doctor or to impose conditions, then the tribunal can order a review hearing to decide whether they can return to unrestricted practice or if a further sanction is necessary.

Review hearings

At a review hearing, a new tribunal decides whether a doctor’s fitness to practise remains impaired. It can impose further sanctions if necessary.


A doctor who is dissatisfied with the outcome of an MPT hearing can, in certain circumstances, appeal the MPT panel’s decision if the decision was wrong, or there was an unjust outcome due to a serious procedural or other irregularity. A doctor has 28 days in which to appeal to the High Court or Court of Session about any decision by an MPT.