A medical practitioners tribunal may erase your name, suspend you or place conditions on your registration. If it does, you have a statutory right of appeal under section 40 of the Medical Act 1983. The right is unqualified. But the time limit is short. The court also applies settled principles about when it will interfere with a tribunal's decision. This guide shows how to appeal an MPTS tribunal decision. It covers the route, the deadline and what an appeal has to show.
Which decisions you can appeal
Section 40(1) covers a tribunal direction for erasure, suspension or conditional registration, and a direction varying conditions. It also covers a decision suspending indefinitely your right to apply for restoration. In addition, section 40(1A) covers certain refusals to restore a name to the register. A warning is not on that list. The MPTS explains that a doctor can challenge other decisions, a warning for example, by judicial review. That is a separate procedure with its own tests.
The 28 day limit
Section 40(4) requires the appeal to be brought before the end of the period of 28 days beginning with the date on which notification of the decision was served on you. Because the period begins with the date of service, that day counts as the first of the 28. Work out the last day as soon as the decision letter arrives. Then put it in your diary with a margin and treat it as fixed.
In England and Wales the appeal goes to the High Court of Justice. In Scotland it goes to the Court of Session, and in Northern Ireland to the High Court of Justice. The MPTS says which court applies depends on your registered address. In England and Wales, the Civil Procedure Rules govern appeals.
What happens to the sanction while you appeal
The GMC's guide for doctors deals with this. A tribunal's decision, it states, does not take effect until the appeal period expires or the appeal is complete. An appeal therefore holds off a suspension or erasure that the tribunal has not made immediate. Where the tribunal has made an immediate order under section 38, the position differs. That order stays in force until the substantive direction takes effect or the court determines the appeal. So you remain restricted while the appeal runs.
What the court looks for
Rule 52.21(3) of the Civil Procedure Rules sets the test. It provides that the appeal court will allow an appeal where the decision below was wrong. It will also allow one where the decision was unjust because of a serious procedural or other irregularity. Practice Direction 52D, paragraph 19.1, provides that an appeal under section 40 is by way of rehearing. Written evidence supports it, with oral evidence only if the court orders it.
In Sastry v General Medical Council [2021] EWCA Civ 623, the Court of Appeal drew the principles together. The court's jurisdiction is appellate, not supervisory. It is entitled to substitute its own decision for the tribunal's. Nor will it defer to the tribunal's judgment more than the circumstances warrant. On sanction, it asks whether the sanction was appropriate and necessary in the public interest or was excessive and disproportionate. The Court of Appeal also distinguished a doctor's appeal from the GMC's. A section 40 appeal is a rehearing, so the court forms its own view on sanction. In doing so it gives the tribunal's expertise the respect the circumstances warrant. By contrast, the more restrained approach of Bawa-Garba v General Medical Council [2018] EWCA Civ 1879 applies to the GMC's own appeals under section 40A. Those appeals proceed by way of review.
An appeal therefore needs to identify a specific error. It can argue that the tribunal misdirected itself on the law. For example, it may have erred on the test for dishonesty or the meaning of impairment. An appeal can also argue that a finding of fact had no proper basis in the evidence, or that the hearing was unfair. Further grounds are inadequate reasons, and a sanction that was disproportionate or departed from the tribunal's guidance without explanation. Disagreement with the outcome, without more, is not a ground.
What the court can do
Under section 40(7) the court can dismiss the appeal or allow it and quash the direction. Instead, it can substitute any direction the tribunal had power to give. Or it can remit the case to the MPTS for a tribunal to decide it again in accordance with the court's directions. In addition, it can make an order for costs. The GMC may appear as respondent, and for costs purposes it counts as a party. So an unsuccessful appeal carries the risk of an order to pay the GMC's costs on top of your own.
Appeals the other way
The doctor is not the only party who can go to court. Since 31 December 2015 the GMC has had its own power to appeal, under section 40A. It may appeal a tribunal decision it considers insufficient to protect the public. The Professional Standards Authority can also refer a decision to the court. According to the GMC's guide, the Authority has 40 days to refer a decision following the end of the doctor's 28 day appeal period. The GMC's 2025 report records ten GMC appeals in progress during 2025, of which the court allowed three and dismissed one. Six remained outstanding. The report also states that around seven in ten of its concluded appeals since 2016 have produced a successful outcome for the GMC. A tribunal may suspend you rather than erase your name. If so, do not treat the decision as final until those periods have passed.
Starting an appeal
The other healthcare regulators also allow 28 days, but each counts the period in its own way: the NMC and the HCPC from the date notice of the order is served, the GPhC from the date the written notice of reasons was sent. Check the rule on our pages for each profession.
A High Court appeal is litigation in the full sense. Eloquia conducts that work alongside a regulated law firm, as part of our work on GMC cases and MPTS hearings. We stay involved so that the knowledge built up in your case carries through. A specialist barrister is part of the team from the outset. Our fixed fee for an appeal includes counsel's work, and we state it plus VAT.
Whoever acts for you, the first steps are the same. First, obtain the tribunal's full written determination and the transcripts of the hearing. Next, identify each error you say the tribunal made. Then take advice on the merits and on the costs risk well inside the 28 days. Grounds of appeal should name the error and show why it matters to the outcome, rather than repeat the arguments the tribunal rejected.
Sources
- Medical Act 1983, section 40 (legislation.gov.uk)
- Medical Act 1983, section 40A (legislation.gov.uk)
- Medical Act 1983, section 38 (legislation.gov.uk)
- MPTS, How a hearing works for doctors: appeals
- General Medical Council, Our fitness to practise processes: a guide for doctors (published October 2014, updated January 2025)
- Civil Procedure Rules, Part 52, rule 52.21 (Ministry of Justice)
- Sastry v General Medical Council [2021] EWCA Civ 623 (The National Archives, Find Case Law)
- General Medical Council, Concerns about fitness to practise: Annual statistical report 2025 (published 30 July 2026)
- Civil Procedure Rules, Practice Direction 52D, paragraph 19.1 (Ministry of Justice)
- Medical Act 1983, Schedule 4, paragraph 10 (legislation.gov.uk)
- Nursing and Midwifery Order 2001, article 29 (orders and appeals)
- Health Professions Order 2001, article 29 (orders and appeals)
- Pharmacy Order 2010, article 58 (appeals)
