From complaint to final hearing: every stage

From the inside, a fitness to practise case rarely feels like one process. A letter arrives and months pass with little news. Then a bundle of evidence lands with a deadline. Each regulator names its stages differently, but every regulator this guide covers follows the same route. There is a first look at the concern, an investigation and a written response from you. Then comes a decision on the papers and, in a minority of cases, a final hearing. This guide walks that route in order and points you to our fuller guide for each stage.

The route, stage by stage

The first look. Every regulator starts by asking whether it can and should investigate the concern. At the GMC the Registrar makes that initial consideration under rule 4 of the General Medical Council (Fitness to Practise) Rules 2004. The GMC calls this stage triage. The NMC calls it screening, and the GDC calls it initial assessment. At the HCPC a senior decision maker decides whether a concern meets its threshold. The Pharmacy Order 2010 lets the GPhC publish threshold criteria for cases its registrar should not refer. Our guide to what happens when the GMC receives a concern sets out the tests and how many cases end there.
The investigation. If the concern goes further, caseworkers gather the evidence. That means clinical records, witness accounts, information from your employer and sometimes an assessment of your performance or health. The NMC describes investigation as often the longest stage of its process.
The allegations and your reply. When the investigation ends, the regulator puts the allegations and the evidence to you and invites a written reply. Under rule 7 of the GMC's rules, the Registrar sends you the allegation and the documents behind it. You then have 28 days from the date of the letter. The HCPC sends formal allegations with its case investigation report and also allows 28 days. For osteopaths and chiropractors, section 20 of each profession's Act gives you 28 days to send the Investigating Committee your observations, counted from the day the notice of the allegation is sent to you. The other regulators state the period for your reply in the letter that puts the allegations to you, so take the date from that letter. Our guide to writing a Rule 7 response explains what the decision makers look for.
The decision on the papers. Case examiners or a small committee now read the file. They decide whether the case needs a hearing, not whether the allegations are true. At the GMC a medical and a lay case examiner decide. NMC case examiners ask whether there is a realistic possibility that a Fitness to Practise Committee would find you currently impaired. GDC case examiners, one lay and one a dental professional, ask whether there is a real prospect of the allegation being proved and, if it is, a real prospect of a Practice Committee finding your fitness to practise impaired. The GPhC's Investigating Committee decides whether its Fitness to Practise Committee ought to hear the case. An HCPC Investigating Committee Panel meets in private and looks for a realistic prospect of proving the facts, the grounds and current impairment. At the GOC, two case examiners, one lay and one an optometrist or dispensing optician, carry out the Investigation Committee's functions under the GOC's 2013 rules. The Investigating Committees of the GOsC and GCC make the same kind of decision. GMC, NMC and GDC case examiners can close a case, issue a warning or agree undertakings with you. An HCPC panel can only refer the case, close it or send it back for more information.
The final hearing. A doctor's case goes to a medical practitioners tribunal, which the MPTS arranges under section 35C of the Medical Act 1983. Nurses, midwives and nursing associates face the NMC's Fitness to Practise Committee. A dental professional goes before one of the GDC's three Practice Committees, chosen by whether the concern is about conduct, performance or health. Pharmacy professionals and optical professionals each go to their regulator's Fitness to Practise Committee. HCPC registrants face the Conduct and Competence Committee or, in a health case, the Health Committee. Osteopaths and chiropractors face their regulator's Professional Conduct Committee or, in a health case, its Health Committee. At the MPTS and the GDC, the tribunal or committee finds the facts first. It then decides whether your fitness to practise is impaired and only after that turns to sanction. For a doctor, section 35D allows erasure, except in a health or language case, suspension for up to 12 months or conditions for up to three years. Our guide to the MPTS hearing from start to finish follows a doctor's hearing through each stage.
Appeal. A doctor has 28 days to appeal under section 40 of the Medical Act 1983, starting with the date the decision is served. The other regulators also allow 28 days but count the period in their own way, and our guide to appealing a tribunal decision sets out the differences and where to check each rule.

What runs alongside the main route

Two things sit outside that sequence. The first is an interim order, which suspends or restricts your practice while the case continues. A regulator can seek one at any point. Section 41A of the Medical Act 1983 allows an interim order against a doctor for up to 18 months. The GDC says it can refer a case to its Interim Orders Committee at any stage. At the NMC, the Investigating Committee can make an interim order until the Fitness to Practise Committee starts to consider the case. An interim order makes no finding about the allegations, and our guide to interim orders tribunals explains how to prepare.

The second is your employer, which may restrict or exclude you while the regulator investigates. If you are a doctor or dentist employed by an NHS body in England, our guide to exclusion from work sets out your rights under MHPS. Any other employer's power to suspend you sits in your contract and its own policy. For the detail of a single regulator's process, read our guides to the NMC, the GDC and the GPhC.

Where the outcome is decided

Most cases are decided at stages three and four, long before any hearing. In 2025 GMC case examiners closed 309 of 679 cases with no further action and referred 184 to a tribunal, as our Rule 7 guide records. So a reply that answers each allegation with documents gives them a reason to close the case, as does evidence of what you have done since. Evidence of insight and remediation takes months to build. For that reason it should start on the day the concern reaches you, not the week before a deadline.

When you first hear from your regulator, write down what you were told and when. Keep every record unaltered and say nothing of substance until you have taken advice. Then note each deadline in the first letter and plan back from it. Eloquia acts for you from the first letter to the final hearing on a fixed fee for each stage, stated plus VAT and including a specialist barrister. A High Court appeal runs through a regulated law firm we work with, because conducting litigation is a reserved legal activity. Our fees and funding page explains how the staged fees work.

From complaint to final hearing: every stage of a fitness to practise case

The route, stage by stage

What runs alongside the main route

Where the outcome is decided

Sources

Arrange a confidential conversation

The route, stage by stage

What runs alongside the main route

Where the outcome is decided

Sources

Related articles

What happens when the GMC receives a concern about you

Writing a Rule 7 response: what persuades GMC case examiners

The MPTS hearing from start to finish

Arrange a confidential conversation