Insight and remediation appear at every stage of a GMC case. They feature in the triage decision and in the case examiners' decision at the end of an investigation. They also shape an interim orders tribunal's assessment of risk and a medical practitioners tribunal's finding on impairment. Since 30 May 2025 every GMC decision maker has asked the same three questions about risk. The third is how the doctor has responded to the concern, including insight and remediation. The MPTS guidance that tribunals have applied since 24 November 2025 sets out what each word means. It also explains how tribunals weigh the evidence.
What insight means
According to the MPTS guidance, to show genuine insight you need to show that you understand what happened. You also need to accept how you should have acted differently. Where relevant, that means showing you have considered the allegation and understood what went wrong. It means showing you have grasped the impact or potential impact of your behaviour, performance or health condition. And it means showing empathy for anyone affected, for example by apologising. Insight also involves taking steps to remediate and to identify how you will act differently. It includes seeking support for any health condition. Finally, it covers complying with the professional duty of candour, cooperating with earlier investigations and engaging with the GMC.
The guidance attaches weight to quality and timing. A full acknowledgement of what occurred and what you need to do differently carries more weight than a simple apology. Similarly, a detailed, voluntary self-referral followed by active engagement carries more weight. It counts for more than a limited one made to avoid a referral by someone else. An apology to the right person soon after the events counts for more than one shortly before a decision. Sometimes governance, litigation or the culture of your workplace prevented an earlier apology. In that case the tribunal takes it into account.
You keep the right to defend yourself. The guidance states that a doctor has the right to advance a robust defence. That includes requiring the GMC to prove its case and to call its witnesses. It accepts that an apology may not come until after a witness has given evidence. It also accepts that a doctor whose defence fails cannot always be expected to accept every finding at once. Some evidence of insight is still possible without a full admission.
The guidance also lists what points to a lack of insight. That includes repeating behaviour similar to an earlier concern, minimising its seriousness and blaming others. It also includes being blatantly dishonest with the GMC or the tribunal, which can include knowingly advancing a false case. Failing to comply with a direction to undergo an assessment, or delaying without good reason, is on the same list. In addition, the tribunal must consider differences in culture, faith and communication. These may have affected the way you express insight or frame an apology.
Reflective notes
The MPTS guidance records a limit on what the GMC can ask for. During an investigation the GMC cannot require you to hand over reflective notes produced for your professional development. A tribunal cannot require them either. The GMC or the tribunal can invite you to provide evidence of insight. Whether you do, and in what form, is your decision. If you choose to provide reflective notes, the tribunal can consider them.
What remediation means
Remediation means steps that reduce the risk of the same thing happening again. The guidance says it depends on insight, because you have to recognise a concern before you can address it. There is no set way to demonstrate it. One example the guidance gives is passing an objective assessment. Another is training, supervision, coaching or mentoring relevant to the concern, followed by putting the learning into practice. Evidence of good practice in a similar setting also counts, often from an employer who knows about the allegation. So does treatment for a health condition that now allows you to practise safely.
Objective evidence is likely to carry more weight than your own statements. The guidance names certificates from completed training and records of continuing professional development. It also names reports from supervising clinicians and from your treating practitioner. The time between a course and the hearing matters too, because it affects how far you can show the learning in practice. Some methods, such as trainer-led learning, support this better than others. A statement from your responsible officer can give a factual account of your response and any apology. It can also describe your cooperation with local processes and your current practice. If no statement is available, the tribunal should draw no adverse inference.
How tribunals weigh it
The guidance asks three questions. Is the allegation easily remediable? Has it been remedied, or is it being remedied? Is it highly unlikely to be repeated? Concerns about performance, health and knowledge of English are generally easier to remediate. Concerns are harder to remediate where deliberate, reckless, persistent or repeated behaviour created a high risk of harm. The same applies where they suggest an underlying problem with attitude, or sit at the higher end of seriousness. In those cases insight and remediation carry less weight.
When judging quality, the tribunal asks three things. First, is the remediation relevant, in that it addresses the allegation directly? Second, is it measurable, in that objective evidence shows what you have done? Third, is it effective, in that there is enough information to see how you have applied the learning? Completed steps carry more weight than steps you have started but not finished.
Building the evidence from the start
Begin on the day the concern arrives. List each concern in the allegation. Against each one, note the step you will take and the person who will verify it. Add the document that will prove it. Choose courses that address the specific failing rather than general courses with a broad title. Ask your supervisor to report at intervals, so the tribunal sees learning applied over time. Write your reflective statement in your own words, and address the patient's experience as well as your own. Revise it as the case develops.
Other healthcare professionals
Every regulator's guidance weighs insight and remediation. The HCPC's sanctions policy has sections on insight, remorse, apology and remediation. It treats a lack of either as aggravating. The GDC's guidance lists lack of insight as aggravating. It counts evidence of insight among the factors pointing to a reprimand or conditions. The NMC's library has a guide on insight and strengthened practice. The GCC's sanctions guidance treats regret, apology and insight as mitigation. And the GOC tells its case examiners to consider remediation where the registrant does not dispute the facts. See our pages for each profession.
Eloquia helps you build this evidence in GMC investigations and tribunal hearings, with a specialist barrister from the outset. Each fixed fee includes counsel's work, and we state every fee plus VAT.
Sources
- MPTS, Guidance for tribunals: step 2d, how the doctor has responded to the allegations (insight and remediation)
- Medical Practitioners Tribunal Service, Guidance for MPTS tribunals (published 30 September 2025, in effect from 24 November 2025)
- General Medical Council, New GMC guidance to ensure greater clarity and consistency in handling of fitness to practise concerns (29 May 2025)
- General Medical Council, Deciding the outcome of an investigation (Doctors)
- General Medical Council, Deciding whether to open an investigation (Doctors)
- HCPC: Sanctions policy, 2 March 2026
- GDC: Fitness to Practise, Guidance for the practice committees, version 1.0, 6 January 2026
- NMC: Fitness to practise library
- GCC: Guidance on Sanctions, April 2018
- GOC: Guidance for case examiners, version 2, September 2025
