GMC Investigations

Self-Referral to the GMC

Doctors are sometimes required to self-refer to the GMC. This could arise from:

- A health condition that may affect patient safety

- Accepting a police caution (anywhere in the world)

- Being criticised by a public inquiry or regulatory body

- Being charged with or convicted of a criminal offence (anywhere in the world)

- An adverse finding by another professional or licensing body

Good Medical Practice obliges doctors to make a self-referral in these circumstances. We have experience in helping doctors to prepare clear, professional self-referral reports, ensuring that any mitigation is effectively presented to help secure the best possible outcome.

When do the GMC investigate?

The GMC will investigate concerns raised where a doctor’s ability to practise safely or public confidence may be at risk. 

The GMC will investigate allegations relating to:

- Misconduct

- Poor performance

- Criminal convictions or cautions

- Health issues that may impact fitness to practise

- Determination by another regulatory

- Insufficient English Language ability.

Early stages of the GMC investigation - GMC Rule 4 letter

The first formal step in many investigations is the GMC’s Rule 4 letter. This letter informs the doctor that a concern has been raised and invites early comments.

While it can be tempting to respond immediately, it's crucial to seek legal advice first. The GMC’s description at this stage is often general and non-specific, making it difficult to respond effectively. In many cases, we advise clients to wait until the full allegations are outlined at the Rule 7 stage before submitting a formal response.

The GMC may also:

Notify your employer of the investigation

Request supporting information from your workplace

Refer the matter to the Interim Orders Tribunal (IOT) if immediate restrictions or suspension are being considered

Read more about Interim Orders Tribunals

The investigation proceeds – GMC Rule 7 letter

As the investigation progresses, the GMC may:

- Interview witnesses

- Review clinical records

- Obtain expert reports

- Assess health, English proficiency, or performance

The GMC will seek to conclude an investigation within 6 months of receipt of the concern. However, in our experience this timescale is often exceeded, particularly if there are ongoing criminal investigations, or evidence that is required from another jurisdiction. 

Eventually the GMC will write a ‘rule 7 letter’ to the doctor, which will set out specific allegations, together with the evidence relied on. This is when the doctor needs to respond to the allegations, setting out their position. It is essential for a doctor to obtain independent legal advice at this stage. A carefully crafted written response will make a significant difference to the outcome. 

It may be that the doctor accepts the allegations, in which case they need to present mitigation in a way which demonstrates insight, remorse and remediation. However, it may be that a doctor denies the allegations, in which case they need to robustly present their case, with as much corroborating evidence as possible. 

What Happens Next? The Case Examiner’s Decision

Following the Rule 7 response, the GMC’s Case Examiners will review the evidence and determine the next steps. They will make one of the following decisions

1) 'No Case To Answer'
The best outcome. The GMC closes the investigation with no further action.

2) Warning
A formal warning may be issued if there was a breach of Good Medical Practice but the risk to patients is not ongoing. Legal advice is essential before accepting a warning, as it becomes part of your record.

3) Agreed Undertakings
Often related to health or performance issues, undertakings are an agreed plan between the doctor and GMC, such as limits on practice or supervision requirements.

4) Referral to the Medical Practitioners Tribunal Service (MPTS) 

More serious or contested cases may be referred for a full Fitness to Practise hearing, especially where dishonesty, sexual misconduct, or serious clinical concerns are alleged. 

Find out more on what happens at an MPTS Fitness to Practise Hearing