How to Deal with a Fitness to Practise Complaint: What to Do in the First 30 Days

The fitness to practise course for a complaint or investigation is How to Deal with a Complaint or Investigation: £79 (£50 with Bulk Buy 10), 2 CPD hours, online, CPD certified by The CPD Certification Service (provider no. 13197), with a dated certificate for the regulator and for your CPD record. For the later stages there is a course for each: the Module on Insight, Module on Reflection and Module on Remediation (£49 each, 1.5 CPD hours) once the case examiners or a committee are looking at insight, and How to Ensure a Similar Mistake or Misconduct Will Not Be Repeated (£79 (£50 with Bulk Buy 10), 2 CPD hours) before a hearing. A fitness to practise complaint reaches you as a letter or an email from your regulator, and the first 30 days set the course of what follows. This guide explains how to deal with a fitness to practise complaint as a UK healthcare professional: what each regulator does first, the deadlines to respond, what to gather and send, and what to avoid. It covers the GMC, NMC, GDC, GPhC and HCPC. It is written by Dr Shehzad Iqbal, a GMC-registered GP.

What is a fitness to practise complaint?

Being fit to practise means having the skills, knowledge, health and character to practise safely and effectively. A fitness to practise complaint is a concern, raised with your regulator, that your fitness to practise may be impaired. The grounds are set in each regulator’s law and include misconduct, deficient professional performance, a criminal conviction or caution, adverse physical or mental health, and not having the necessary knowledge of English.

The complaint can come from a patient or a relative, a colleague, your employer or responsible officer, the police, another regulator, or the regulator itself after a media report. Not every complaint becomes an investigation. Each regulator first asks whether the concern, if true, would raise a question about your fitness to practise. Our guide to what fitness to practise means explains the grounds in more detail.

What happens first?

The first stage has a different name with each regulator (triage, screening, initial assessment), but it asks the same question: does the concern meet the threshold for an investigation? At this stage:

• the regulator reads the complaint and may make preliminary enquiries with the person who raised it, your employer or others;
• a concern that does not meet the threshold is closed, and you may not hear about it until it is closed, or at all;
• a concern that does meet it is opened as an investigation, and the regulator writes to tell you; and
• where a concern points to a serious and immediate risk, the regulator can refer you to an interim orders committee or tribunal at any stage.

Some concerns go straight to the decision makers. The HCPC, for example, sends concerns about serious violence, sexual offences, or serious or sustained dishonesty from triage straight to its Investigating Committee.

How does each regulator handle a complaint?

• Doctors (GMC). The GMC triages the concern, then makes a provisional enquiry, a limited first enquiry to decide whether to open a full investigation. When it opens one, it tells the doctor and asks for the employer’s details, and it asks the employer, through the responsible officer, whether they have other concerns. Two case examiners, one medical and one non-medical, then decide the case. See our guides to a GMC referral and the GMC investigation step by step.
• Nurses, midwives and nursing associates (NMC). At screening the NMC asks whether it has a concern in writing about someone on its register, and whether there is evidence of an ongoing risk to public safety, public confidence or professional standards that could need regulatory action. It also considers evidence of strengthened practice provided at screening. An investigation follows, then case examiners decide whether there is a case to answer. See an NMC referral and the NMC investigation process.
• Dental team (GDC). The GDC tells you why it is looking into the issues and may ask for more details. Once it has the information, including clinical advice, it closes the case or refers it to two case examiners, one lay and one dental professional. The GDC states that around a third of cases raised with it are referred to case examiners, and that you can continue working in your current role while it investigates. See a GDC referral.
• Pharmacists and pharmacy technicians (GPhC). After an investigation that finds the allegations meet its threshold criteria, the GPhC refers the case to its Investigating Committee. The committee meets in private, does not hear oral evidence from you, and reads your written representation. See the GPhC fitness to practise stages.
• HCPC professions. The HCPC triages the concern, makes an initial investigation (it tells the registrant unless there is a reason to delay, and may contact the employer), then applies its threshold. Where the threshold is met it drafts the allegations and refers them to the Investigating Committee. See the HCPC fitness to practise stages.

How long do you have to respond?

Read your letter first: it gives the date that applies to you. The figures each regulator publishes are:

A response is optional with each regulator, but a decision is then made without your account. If you need more time, ask before the deadline, in writing, and give the reason.

What to do in the first 30 days

1. Days 1 to 2: get advice. Contact your defence organisation, indemnifier, union or legal representative and send them the letter. Do not reply to the regulator, the person who complained or your employer about the facts before you have spoken to them.
2. Days 1 to 7: read the letter closely. Note what the concern is, which standard it relates to, the deadline, the name of your caseworker, and whether the regulator has asked for your employer’s details or for documents.
3. Days 3 to 14: gather the facts. Collect the records, rotas, emails, messages and policies that relate to the concern, and write down what happened and what you knew at the time while it is clear in your mind. Keep this note for your adviser.
4. Days 7 to 21: start remediation. Choose a course that matches the concern, take it, and keep notes after each section. Speak to your appraiser, supervisor or a mentor about what you can change in your practice now.
5. Days 14 to 28: write your reflection. What happened, which part of your regulator’s standards it fell short of, the effect on the patient, colleagues and trust, and what you now do differently, with the evidence for each point. See how to write a reflective statement.
6. Before the deadline: send your response. Agree the final wording with your adviser, check every date and fact against the documents, and send it with the evidence before the date in your letter.

What should your response contain?

• An accurate account of what happened, in date order, that matches the records. Where you accept a fact, say so plainly.
• Insight: an understanding of why the concern matters, its effect on the patient and on trust in your profession, and what you would do differently. Our guide to how to demonstrate insight explains what decision makers look for.
• Remediation: the steps you have taken that match the concern, with certificates, notes and dates. See how to demonstrate remediation.
• Testimonials from people who know about the concern and have seen your practice since, such as a clinical lead, a supervisor or a colleague.
• Context that is relevant and accurate: workload, staffing, systems or health, set out as facts and not as a reason to blame others.

What should you avoid?

• Contacting the patient or the person who raised the concern about the complaint.
• Changing, adding to or deleting a record after the event. A note added later must be dated and marked as a later entry.
• Blaming colleagues, the patient or the system in place of explaining what you did and why.
• Answering in a hurry. A second inaccuracy in a response makes the first concern more serious.
• Missing a deadline without asking for more time.
• Posting about the case on social media, or discussing it with colleagues who may be witnesses.

What can happen after the investigation?

The decision makers (case examiners at the GMC, NMC and GDC; an investigating committee at the GPhC and HCPC) decide whether there is a case to answer, or a realistic prospect of a finding that your fitness to practise is impaired. The outcomes are similar across the regulators:

• Close the case with no further action.
• Advice about your future practice.
• A warning, which for doctors appears on the register for a set time.
• Undertakings: commitments you agree to, such as supervision, a course or a practice audit.
• Referral to a hearing before a panel or tribunal, which decides the facts, whether fitness to practise is impaired and what sanction, if any, to impose. See how to prepare for a fitness to practise hearing.

An interim order is separate. It can be made at any stage to restrict practice while the case continues, and it is not a finding against you. See the interim orders tribunal.

Courses that help with a complaint

Start with the course on how to respond, then a course on the subject of the concern. Each course is online and self-paced, with immediate access and a dated certificate, and Probity & Ethics courses are CPD accredited through The CPD Certification Service (provider no. 13197). They serve a professional responding to a complaint, and a professional planning CPD.

Related courses

Any 3 courses for £200, 5 for £300, 10 for £500. Unsure where to start? Book a free call or use which course do I need.

Courses by subject: Probity for Healthcare Professionals, Professional Boundaries for Clinicians, Professionalism in Documentation, Ensuring Clinical Competence and Patient Safety and Ensuring Effective Communication as Healthcare Professionals.

See the courses for your profession:

• DoctorsGMC
• Nurses and midwivesNMC
• Dental teamGDC
• PharmacistsGPhC
• HCPC professionsHCPC
• Optometrists and dispensing opticiansGOC
• ChiropractorsGCC
• OsteopathsGOsC
• Social workersSocial Work England

This guide is part of our Professional Misconduct hub.

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