Sexual Boundaries and Sexual Misconduct: What UK Regulators Expect and What Happens After a Concern

Sexual boundaries are the clearest line in healthcare: a sexual or improper emotional relationship with a patient, and sexual behaviour towards a colleague, breach the standards of every UK regulator. This guide explains what counts as sexual misconduct, what the GMC, NMC, GDC, GPhC and HCPC say, how an allegation is investigated, and what helps. Our Professional Boundaries for Clinicians course is £79 (£50 with Bulk Buy 10), 2 CPD hours, online, and CPD certified by The CPD Certification Service (provider no. 13197).

What are sexual boundaries in healthcare?

A patient trusts a healthcare professional with their body, their history and their worries, at a time when they may be unwell or anxious. Sexual boundaries are the limits that keep that trust safe: no sexual contact, no sexual comments or messages, no examinations without a clinical reason and consent, and no relationship that uses the trust or the information gained in practice.

The power in the relationship sits with the professional. That is why a patient’s agreement does not make a sexual relationship acceptable, and why regulators treat a breach of sexual boundaries as one of the gravest concerns they receive. The Professional Standards Authority (then the Council for Healthcare Regulatory Excellence) set out these responsibilities for every regulated profession in its 2008 guidance on clear sexual boundaries between healthcare professionals and patients.

What counts as sexual misconduct?

The NMC’s fitness to practise guidance describes sexual misconduct as "unwelcome behaviour of a sexual nature". It can be physical, verbal, visual or online, and it can be a single incident or a pattern. Sexual harassment is included, and it is judged by its effect on the other person, even where that effect was not intended.

For doctors, Good medical practice paragraph 57 says acting in a sexual way "can include – but isn't limited to – verbal or written comments, displaying or sharing images, as well as unwelcome physical contact." In practice, the concerns regulators investigate include:

• A sexual or romantic relationship with a patientWhether the patient agreed or not, and whether it began during care or soon after.
• Sexual comments, messages or imagesRemarks about a patient’s body, flirting, messages on a personal phone or social media, sharing or requesting images.
• Touch that is not needed for careUnwelcome physical contact, an examination without a clinical reason, or an intimate examination without consent or without the offer of a chaperone.
• Behaviour towards a colleagueSexual comments, advances, contact or images at work, and using a senior position to pursue a relationship with a junior colleague or a student.
• Conduct outside workThe NMC guidance says sexual misconduct outside practice "could indicate deep-seated attitudinal issues which could put the public at risk".

What does each UK regulator say?

What about former patients and people close to a patient?

The GMC’s guidance Maintaining personal and professional boundaries says doctors "must not pursue a sexual or improper emotional relationship with a current patient" (paragraph 9) and must not use a professional relationship to pursue a personal relationship with someone close to a patient (paragraph 11). For a former patient, paragraph 12 lists what you must consider: how long ago the professional relationship ended, its nature, the patient’s vulnerability, whether you care for other members of their family, whether the patient’s decisions are influenced by the past relationship, and "whether you would be (or could be seen to be) abusing your professional position". Paragraph 17 is clear: "you must not pursue a personal relationship with a former patient who is still vulnerable."

The NMC Code makes the same point in 20.6, which names people "who have been in your care in the past", their families and carers. Where the care involved mental health, psychotherapy or a long period of dependence, the risk that a later relationship uses the past trust is greatest.

Is sexual misconduct towards a colleague treated the same way?

Yes. Regulators look at conduct towards colleagues, students and staff as well as patients. Good medical practice paragraph 57 says doctors "must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress." The GMC’s boundaries guidance accepts that consensual relationships between colleagues are a private matter, while asking you to keep professional boundaries and to take care where there is a large difference in power, such as a supervisor and a trainee. The HCPC’s standard 1.12 names colleagues alongside service users and carers.

A concern about a colleague can reach the regulator from the colleague, a manager, an employer’s investigation or a student’s placement report. See a GMC referral by a colleague and an employer referral to the GMC.

How do chaperones protect a patient and a clinician?

An intimate examination needs a clinical reason, an explanation in plain words, the patient’s consent for that examination, privacy while they undress, and the offer of a chaperone. The GMC’s guidance Intimate examinations and chaperones says "you should, wherever possible, offer the patient the option of having a chaperone who can act as an impartial observer" (paragraph 16), that "You should not assume that the patient doesn't want a chaperone" (paragraph 21), and that a relative or friend is not a suitable chaperone in the ordinary case (paragraph 20).

Record the offer, the patient’s answer, the chaperone’s name if one was present, and what was examined. Stop if the patient asks you to stop. A regulator can also make a chaperone requirement part of an interim order or conditions after an allegation.

What happens after an allegation of sexual misconduct?

The concern reaches the regulator from a patient, a colleague, an employer or the police. The regulator assesses it and decides whether to investigate. Because of the risk to the public, an allegation of sexual misconduct is a case where the regulator considers an interim order: a tribunal or panel can suspend your registration or impose conditions, such as a chaperone for every examination, while the investigation continues. See interim orders explained.

At the end of the investigation, case examiners or a committee decide whether to close the case, issue a warning, agree undertakings, or refer it to a hearing. At a hearing, the panel decides the facts, whether they amount to misconduct, whether your fitness to practise is impaired, and the sanction. Our Professional Misconduct hub explains each step for every UK regulator.

The MPTS Sanctions guidance is clear about the gravity of these cases. Pursuing a sexual or improper emotional relationship with a vulnerable patient "is an aggravating factor that increases the gravity of the concern" (paragraph 146), and erasure is likely to be appropriate where a doctor has abused their professional position and the conduct involves predatory behaviour, a vulnerable patient or a criminal offence (paragraph 148). The NMC says sexual misconduct towards people receiving care or colleagues "poses a significant risk to the quality of care people receive."

For the GMC process in detail, see a GMC sexual misconduct investigation and how the GMC investigates boundary violations.

What to do: five steps after a concern is raised

1. Get advice the same day. Contact your defence organisation, union or legal representative before you reply to your regulator or your employer. Do not contact the patient or the colleague who raised the concern.
2. Keep to the facts. Write down what happened, when, who was present and what you recorded, while it is clear in your mind. Keep your notes, rotas and messages.
3. Put safeguards in place now. Use a chaperone for every intimate examination, keep contact with patients to work channels, and agree any limits on your practice with your employer.
4. Start remediation that matches the concern. A course on professional boundaries, with notes after each section, shows that you are addressing the standard in question.
5. Write a reflection that shows insight. What happened, which standard it fell short of, the effect on the other person and on trust, and what you have changed. See how to demonstrate insight and how to write a reflective statement.

A professional boundaries course for a concern or for CPD

Our course covers sexual boundaries within the wider subject of professional boundaries with a patient or a colleague, and ends with insight, reflection and remediation. It serves a professional responding to an allegation of misconduct, and a professional planning CPD for revalidation or renewal.

The course is written for every UK healthcare regulator. 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

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.

This guide is part of our Professional Boundaries hub, which links every Probity & Ethics guide and course on boundaries with a patient or a colleague.

Frequently asked questions