Overview of consultation

The Medical Protection Society (MPS) welcomes the opportunity to respond to the Department of Health and Social Care’s (DHSC) consultation on reforming the General Medical Council (GMC) legislative framework.

The draft General Medical Council Order 2026 (the ‘draft Order’) represents a significant shift in how medical regulation could operate. We support the overall objective of creating a more modern, proportionate and flexible regulatory framework. However, we believe several important amendments to the draft Order are needed to safeguard that the system delivers regulation that is fair, efficient and compassionate

As the world’s leading protection organisation for doctors, dentists and healthcare professionals with 350,000 members practising across nine global regions, our views draw on MPS’s unparalleled experience supporting members through every stage of the regulatory process.

MPS response

Commencement

Question: The DHSC need to ensure that the commencement of the General Medical Council Order 2026 is managed in a safe and effective way that mitigates the risks of a regulatory gap during this transition.

A ‘coming into force date’ mechanism has been included for parts 2 to 10 of the draft order. However, we have not specified a date for when parts 2 to 10 come into force as per article 2(2)(b) of the draft order. Article 2(2)(b) relates to the coming into force of the majority of the provisions within the draft order.

Although a coming into force date for the General Medical Council Order 2026 would provide clarity, there would be advantages in allowing flexibility regarding when provisions are activated, in particular for areas involving transition of cases from the old framework to the new. This could be achieved by specifying dates in tertiary legislation - for example, to be made through a Privy Council Order.

Do you agree or disagree that a specific ‘coming into force’ date should be included in article 2(2)(b) of the final General Medical Council Order 2026?

• Agree

Please explain your answer:

We agree that the advantages that would come with allowing flexibility in terms of when many of the provisions within the draft GMC Order are activated would outweigh the benefits that come with providing a coming into force date.

We believe that doctors already subject to active fitness to practise proceedings should complete those proceedings under the existing framework. Access to any new processes should be strictly on an opt-in basis for the registrant. We believe the Department of Health and Social Care should make it explicit to the GMC that this is its intention and the GMC should also commit to this.

Governance

Question: Separate to annual report requirements relating to equality and diversity, the draft order contains the following for GMC relating to equality, diversity and inclusion:

• a duty to ensure that, in the exercise of its functions, it applies good practice in relation to equality and diversity
• where it considers that an improvement may be required, a duty to take such steps as it considers appropriate to make that improvement
• a duty to have regard to any current or future principles set by PSA regarding equality, diversity and inclusion

Do you agree or disagree with the inclusion of these requirements in the order?

• Neither agree nor disagree

Please explain your answer:

We support the inclusion of a duty requiring the GMC to apply good practice in relation to equality and diversity in the exercise of its functions. The regulator holds significant power and influence, and it should be expected to promote fairness and consistency in these areas.

We also support the principle that the GMC should take steps to drive improvements when it considers this may be required in relation to equality, diversity and inclusion. We have, for example, supported the work it has done to reduce disproportionate referrals of ethnic minority and International Medical Graduate (IMG) doctors by employers to the GMC.

We do however have concerns that a mandate to take “such steps as it considers appropriate” gives the GMC wide latitude, with limited external constraint. We consider important that their powers in this area should be expressed linked to their statutory purpose and that any steps they take in relation to this duty are transparent, openly communicated, evidence-based, proportionate, and shaped by engagement with stakeholders.

We do not believe it is necessary to place a statutory obligation on the GMC to have regard to PSA principles, particularly given the importance of maintaining a clear distinction between the binding legal duties placed on the GMC compared to the advisory guidance that is produced by the PSA. It is important that any principles issued by the PSA remain advisory in nature and does not, in practice, assume quasi-legislative force without appropriate scrutiny.

We are also not persuaded that the PSA, as currently constituted, is best placed to develop comprehensive principles on equality, diversity and inclusion for regulators. This is because the PSA’s statutory remit remains primarily focused on the protection of the public, with limited explicit recognition of the impact of regulatory processes on healthcare professionals.

While the PSA has an oversight role in promoting consistency, its statutory functions do not require it to take a genuinely balanced view of regulatory effectiveness that gives equal weight to practitioner experience and outcomes. Effective EDI principles, however, depend on precisely this balance, particularly where issues of disparity arise within fitness to practise processes.

There is therefore a real risk that PSA-led principles would reflect a narrow, system-level perspective, without sufficient regard to how regulatory processes operate in practice or their cumulative impact on registrants. This could lead to frameworks that are insufficiently grounded in operational reality and of limited practical value to regulators.

We advise that as part of the government’s approach to regulatory reform it should revisit this framing of the PSA’s statutory purpose so that ensuring that fairness, proportionality, and the minimisation of adverse effects on registrants are given proper weight, rather than remaining secondary considerations.

We also advise against introducing a statutory requirement for regulators to have regard to PSA-issued EDI principles unless and until the PSA’s remit and functions are substantively realigned. Without such reform, there is a significant risk that any such link would lack both balance and credibility.

Question: Parts 2 to 4 of the draft order relate to GMC’s governance and operating functions. This includes provisions relating to:

• delegation of exercise of functions
• disclosure of information
• guidance
• annual reports
• fee setting and other financial requirements
• default powers of the Privy Council

The provisions in these sections aim to improve the efficiency of GMC’s administrative functions, reducing bureaucracy.

Do you agree or disagree that the provisions set out in parts 2 to 4 of the draft order enable GMC to carry out its governance and operating framework functions appropriately?

• Neither agree nor disagree

Please explain your answer:

We support the ambition to enable a more efficient and streamlined governance and operating framework for the GMC. It is however important to ensure efficiency gains must not come at the expense of fairness, transparency, or accountability. The effectiveness of these provisions will therefore depend on the strength of the safeguards underpinning delegation, information-sharing, and financial decision-making, as well as continued and effective engagement with stakeholders.

Question: Schedule 1 of the draft order includes provisions to enable GMC and MTS to effectively operate. It outlines how the GMC board may operate under the order, how committees may function and how adjudicatory bodies such as appeal panels may operate. It also puts a duty on GMC to appoint a registrar and case examiner or case examiners to exercise certain functions on behalf of GMC. In addition, the Privy Council must, by order, make further provision as to the constitution of the regulator.

Do you agree or disagree that the powers and duties in schedule 1 on constitution of the regulator are sufficient to enable GMC and MTS to carry out their functions appropriately and proportionately?

• Disagree

Please explain your answer:

We have concerns regarding the provisions of Schedule 1, Part 1 relating to the composition of the GMC’s governing body. We support appropriate lay representation within professional regulation and recognise the value of a balanced membership. However, we believe it is essential that the governing body of the profession’s regulator retains a strong core of professional expertise and that medical practitioners should comprise a substantial proportion of the board.

The draft Order permits a governing body of up to 14 members and requires a minimum number of registrant members, which differs from the current framework which broadly provides for parity between lay and professional members.

In our view, legislation should continue to ensure an equal balance between registrant and lay representation amongst non-executive members, and also that within the registrant cohort the overwhelming majority should be medical practitioners, reflecting the fact that the GMC register is itself overwhelmingly comprised of doctors.

Maintaining strong medical representation is important not only for ensuring that the governing body has the necessary clinical expertise to support high-quality decision-making, but also for sustaining the confidence of the profession in its regulator. A model which does not secure this balance risks weakening both the effectiveness and legitimacy of the GMC’s governance arrangements.

Question: The draft order proposes that the Privy Council’s default powers continue to apply (they are currently contained in section 50 of the Medical Act 1983). These are powers which the Privy Council may use if it feels that GMC has failed to carry out its regulatory functions. In relation to GMC’s rule-making powers in the draft order, the Privy Council will no longer be required to approve new rules or rule changes made by GMC under the draft order. However, should any future rules be deemed to require Privy Council approval, such approval will be put in place.

Do you agree or disagree that the powers and duties in the draft order in relation to the Privy Council are sufficient to support GMC to carry out its functions appropriately?

• Neither agree nor disagree

Please explain your answer:

It is important to ensure that appropriate checks and balances are in place regarding how the GMC exercises its rule-making powers. This should include robust and meaningful consultation with stakeholders, including medical defence organisations.

We recognise the benefits of removing the routine requirement for Privy Council approval, given that this mechanism has had limited material impact in practice. We also support the consultation’s suggestion that Privy Council approval may still be sought where appropriate. However, it is unclear how such decisions would be made in practice, including what criteria or process would determine when escalation is required.

Without greater clarity, there is a risk that rules with significant implications may proceed without sufficient external scrutiny. To strengthen safeguards, a formal mechanism could be introduced allowing stakeholders to request Privy Council involvement in cases where additional oversight would be beneficial.

PSA evidence gathering

Question: The draft order, as per a recommendation of the Mann Review, provides for a consequential amendment to be made to the National Health Service Reform and Health Care Professions Act 2002 to allow PSA to have a power to compel information from GMC.

Do you agree or disagree that the draft order provides PSA with sufficient and proportionate evidence-gathering powers?

• Agree

Please explain your answer:

We support the proposed power for the PSA to compel the provision of information from the GMC where this is necessary to exercise its statutory oversight functions.

Effective oversight is reliant on the PSA having timely access to information required to assess regulatory decision-making, identify systematic issues and maintain public confidence. Previous reliance on voluntary disclosure created the potential for delays, inconsistency and inadvertent barriers to scrutiny.

The proposed power outlined in the draft Order appears both proportionate and appropriately targeted. It is limited to information required for the PSA’s statutory functions and provides a clear mechanism for obtaining material where voluntary disclosure is insufficient. This strikes an appropriate balance between supporting effective oversight and avoiding unnecessary regulatory burden.

We also believe that the proposed power will lead to greater transparency and accountability across the regulatory system. As the independent oversight body, the PSA should be equipped with the appropriate tools to scrutinise the performance of the GMC effectively to provide assurance to patients, the public and registrants that regulatory processes are operating fairly and consistently.

Education and training

Question: The draft order sets out that GMC can approve overseas undergraduate, foundation and postgraduate education and training programmes.

Do you agree or disagree that GMC should be able to approve overseas undergraduate, foundation and postgraduate education and training programmes? This does not mean that people who take part in such overseas programmes would be given priority for places on the UK foundation programme or for speciality training in the UK, subject to a few limited exceptions in the Medical Training (Prioritisation) Act 2026. 

• Neither agree nor disagree

Please explain your answer:

As a medical defence organisation, we do not have a formal role in the provision of undergraduate, foundation and postgraduate education and training programmes, and have focused our response to this consultation to questions where we have direct expertise.

Question: Part 5 of the draft order relates to GMC’s education and training functions. This includes provisions relating to:

• standards in connection with practising as a regulated professional
• approval of education and training, an examination or assessment or a qualification
• supply and production of information and evidence
• criminal offences
• certification of completion of a course
• other related powers

Our proposed changes aim to enable GMC to undertake more flexible and swifter education and training functions.

Do you agree or disagree that the powers and duties set out in the draft order enable GMC to carry out its education and training functions sufficiently and proportionately?

• Neither agree nor disagree

Please explain your answer:

As a medical defence organisation, we do not have a formal role in the provision of undergraduate, foundation and postgraduate education and training programmes, and have focused our response to this consultation to questions where we have direct expertise.

Postgraduate Medical Education and Training Order of Council 2010

Question: As a consequence of modernising GMC’s register and legislative framework, many of the current provisions contained within the Postgraduate Medical Education and Training Order of Council 2010 (‘the PMET Order’) will become obsolete.

The draft order therefore proposes that the PMET Order is revoked, including the list of recognised specialties currently contained in the schedule to the PMET Order, and the Privy Council is given a power to specify categories of speciality in practice in the UK in an order of council.

Question: Do you agree or disagree that the PMET Order should be revoked and the categories of speciality in practice should be set out in a new order of council?

• Neither agree nor disagree

Please explain your answer:

As a medical defence organisation, we do not have a formal role in the provision of undergraduate, foundation and postgraduate education and training programmes, and have focused our response to this consultation to questions where we have direct expertise.

Registration

Question: The draft order provides that medical practitioners may be able to be registered despite having a complete restriction on registration. This means they will be registered as a medical practitioner but not allowed to practise. A medical practitioner may choose to have a complete restriction on their registration, or a complete restriction could be, for example, the result of failing to complete periodic assessment.

Do you agree or disagree that doctors should be able to be registered with a complete restriction on registration?

• Disagree

Please explain your answer:

We have a number of concerns regarding the proposed approach to registration in relation to restrictions and enhancements.

The proposal to remove the licence to practise and replace it with a system based on the presence or absence of a ‘complete restriction’ represents a significant shift in how practice rights are defined. The current system provides a clear and well-established signal that holding a licence to practise indicates that a doctor is permitted to undertake clinical practice, while its absence indicates the opposite. We are concerned that if all doctors are ‘registered’ – but the ability to practise is inferred from whether a restriction applies or not - this could reduce clarity for patients, employers, and practitioners, and may lead to misunderstanding about who is authorised to practise.

We are concerned about the potential impact this could have on public understanding and confidence. The proposed terminology of ‘restrictions’ and ‘enhancements’ may be less intuitive to patients unless supported by clear, accessible explanations. There is a risk that the register becomes harder to interpret, undermining its function as a transparent source of assurance for the public. In particular, describing a doctor as being registered with restrictions could be misunderstood as indicating that those restrictions are a result of a fitness to practise process. This risks creating confusion about a doctor’s regulatory status and could lead to negative implications about the nature of any restrictions.

If these changes are to be made, very careful implementation and transition will be required. Moving from the current system to a new model based on restrictions and enhancements carries inherent risks, including misunderstanding, misclassification, and inconsistency. These risks could have direct consequences for patient safety and medico‑legal exposure if not effectively managed.

Instead, the proposal risks generating avoidable uncertainty regarding a doctor’s ability to practise and their regulatory standing.

Question: Part 6 of the draft order relates to registration and includes provisions regarding the process of entering the register. It also includes provisions which enable GMC to provide assurance that individuals on its register have the necessary education, training, knowledge, skills and experience required to practise safely in the UK.

Do you agree or disagree that the draft order enables GMC to carry out its functions relating to registration sufficiently?

• Disagree

Please explain your answer:

As mentioned in our response to the previous question, we have concerns about what is proposed in the draft Order regarding the single registration model. Replacing the dual registration and licensing system with a single register may create confusion.

We also believe that physician associates (PAs) and anaesthesia associates (AAs) should be held on separate registers, rather than within a single unified register, in order to preserve clarity for patients, employers and practitioners, and to reflect the fundamentally distinct nature of these roles when compared with medical practitioners.

Doctors, PAs and AAs differ materially in terms of the depth and breadth of their education, their clinical autonomy, and the legal framework within which they practise. A single register, even if divided into parts, may not sufficiently communicate these differences and may also imply equivalence. From a patient safety and public assurance perspective, separate registers would support wider efforts aimed at ensuring patients can quickly and intuitively understand who is treating them and what level of training and authority that individual holds.

Protection of title

Question: Protected title status means it is a criminal offence for someone to practise and use a protected title without being registered with the relevant regulator and on the relevant register, or part of the register, relating to that regulated profession.

The draft order proposes that the titles of ‘apothecary’ and ‘licentiate in medicine and surgery’ should no longer be protected in legislation as they are not reflective of current practice. It also proposes that the title of ‘bachelor of medicine’ should no longer be protected as this is linked to a qualification rather than a professional title.

Do you agree or disagree that the titles of ‘apothecary’, ‘licentiate in medicine and surgery’ and ‘bachelor of medicine’ should no longer be protected in legislation?

• Agree

Please explain your answer:

We support this proposal and agree with the reasoning set out in the consultation. The titles ‘apothecary’ and ‘licentiate in medicine and surgery’ are outdated and no longer reflective of modern medical practice, while ‘bachelor of medicine’ relates to an academic qualification rather than a professional title.

Legislative protections should remain focused on titles that are relevant to current practice and assist the public in identifying appropriately registered medical practitioners.

Question: Under the draft order, ‘registered medical practitioner’ is due to become a protected title.

Do you agree or disagree that ‘registered medical practitioner’ should become a protected title?

• Agree

Please explain your answer:

We agree that 'registered medical practitioner' should become a protected title. Protecting the title would improve clarity for patients and support public confidence by helping ensure that individuals using the title are appropriately registered with the GMC.

In addition, we recommend the protection of other medical titles, including medical consultant, surgical consultant and specialist.

At present, there remains scope for doctors to present themselves to patients as specialists, including in private practice settings without clear or consistent parameters. This can create ambiguity for patients and risks undermining confidence in the distinction between different levels and types of qualification and experience. We proposed that an approach to strengthening protections in this area must recognise that doctors may demonstrate specialist-level expertise through a range of routes, including equivalent knowledge, skills, and experience outside of formal training pathways. The objective should be to improve transparency and consistency in how specialist status is described, rather than to restrict the legitimate use of the term where it is justified.

Consideration should therefore also be given to whether stronger protections and definitions are needed in relation to the use of specialist titles or representations of specialist status, in the interests of patient clarity and public confidence. More generally, the regulatory framework should ensure that patients are able to understand clearly whether a doctor is registered, and where relevant, whether they hold recognised specialist or GP status.

Question: In line with the recommendation of the Leng Review, the draft order proposes that ‘physician assistant’ replaces the title of ‘physician associate’, and ‘physician assistant’ becomes a protected title.

Do you agree or disagree that the title of ‘physician associate’ should be changed to ‘physician assistant’ and protected in law?

• Agree

Please explain your answer:

We support this change which we believe could play an important part in reducing the chances of there being confusion between respective roles.

Question: In line with the recommendation of the Leng Review, the draft order proposes that ‘physician assistant in anaesthesia’ replaces the title of ‘anaesthesia associate’, and ‘physician assistant in anaesthesia’ becomes a protected title.

Do you agree or disagree that the title of ‘anaesthesia associate’ should be changed to ‘physician assistant in anaesthesia’ and protected in law?

• Agree

Please explain your answer:

We support this change which we believe could play an important part in reducing the chances of there being confusion between respective roles.

Question: To allow time for the healthcare service to implement the new titles effectively, we are proposing that the protection of the ‘physician assistant’ and ‘physician assistant in anaesthesia’ titles will commence following a transition period of 6 months after the order comes into force, if approved by Parliament.

Do you agree or disagree that there should be a transition period in relation to moving from the associate titles to the assistant titles?

• Neither agree nor disagree

Please explain your answer:

We do not have a comment to make in response to this question.

Question: Should there be any protection of the ‘physician associate’ and ‘anaesthesia associate’ titles alongside the proposed new titles?

• Neither agree nor disagree

Please explain your answer:

We do not have a comment to make in response to this question.

Fitness to practise - mandatory removal from the register

Question: The draft order requires GMC to mandatorily remove a registrant from its register, if the registrant has been convicted of a serious criminal offence, as set out in schedule 4 (known as a listed offence), without GMC having to investigate or MTS having to hold a fitness to practise panel hearing to determine whether the registrant’s fitness to practise is impaired.

Do you agree or disagree with the listed offences set out in schedule 4 of the draft order?

• Disagree

Please explain your answer:

We do not agree that a fixed list of criminal offences is an effective or proportionate mechanism for determining mandatory removal from the medical register.

This proposal represents a significant departure from the established approach, under which fitness to practise decisions are made on a case‑by‑case basis following investigation and, where appropriate, a hearing. While we accept that some criminal convictions are so serious that erasure would be the likely outcome of a fitness to practise process, we do not support a system of automatic removal based solely on conviction for offences specified in legislation.

Criminal and regulatory processes serve distinct purposes. Criminal courts determine whether an offence has been committed and impose punishment proportionate to that offence. By contrast, the GMC’s role is to assess what a doctor’s conduct means for their current and future fitness to practise, in the interests of patient safety and public confidence. Mandatory removal based solely on criminal conviction cuts across this important distinction and prevents a balanced regulatory assessment.

A prescribed list of offences is inherently rigid and risks producing arbitrary outcomes. It may exclude other offences that would reasonably be regarded as equally serious, while failing to allow for nuance or relevant context in individual cases. Such an approach also removes discretion from the regulator to consider important factors including insight, remediation, the passage of time, and the likelihood of repetition.

GMC data covering complaints opened between 2020 and 2025 indicates that, once cases are concluded, doctors convicted of offences such as murder, attempted murder, rape, sexual abuse involving a child, and sexual assault are overwhelmingly erased from the register. This demonstrates that the current fitness to practise system is already capable of responding decisively to the gravest misconduct, without the need for automatic, offence‑based erasure.

We also note that the wider legislative framework already allows a regulator to propose erasure following conviction for a serious offence, with the option for the doctor to accept that outcome without a hearing. This provides a proportionate and pragmatic mechanism for resolving the most serious cases while preserving the integrity of the regulatory process.

If the government is determined to introduce a mandatory statutory approach, basing it on a fixed list of offences would, in our view, be a flawed approach. Any such provision would be more appropriately linked to the seriousness of the offence, such as the length of a custodial sentence, rather than relying on an inevitably incomplete and potentially arbitrary statutory list.

Further, if the government is determined to link mandatory erasure to specific criminal convictions, we would suggest that any such list be limited to offences that historically and consistently resulted in erasure in all cases. Evidence obtained by MPS through Freedom of Information requests indicates that this threshold is generally in cases involving registrants convicted of murder, attempted murder, serious sexual assault and sex offences involving a child. 

Question: Under the draft order, former registrants of GMC who have been mandatorily removed from the register following conviction for a listed offence in schedule 4 of the draft order will not be able to apply for re-entry to the register.

Exceptions would apply where the conviction has been quashed or was for a lower-level listed offence (blackmail or extortion), and the custodial sentence has been quashed and replaced with a non-custodial sentence.

Do you agree or disagree that former registrants who have been mandatorily removed from the register following conviction for a listed offence should not be able to apply for re-entry to the register, save for in the limited exceptional circumstances prescribed in the draft order? 

• Disagree

Please explain your answer:

We do not support an absolute prohibition on re-entry to the register for former registrants removed following conviction for a listed offence.

Decisions on restoration should be made on a case-by-case basis, allowing the GMC to consider the individual circumstances, including the seriousness of the offending, the passage of time, evidence of remediation and insight, the risk of reoffending, and whether the individual is fit to return to safe practice.

While we recognise the seriousness of the offences concerned, the regulatory framework should retain the ability to assess a doctor’s current fitness to practise rather than imposing a permanent statutory exclusion irrespective of future circumstances. Restoration to the register is already subject to a high threshold and extensive scrutiny, and the GMC is well placed to determine whether continued exclusion remains necessary in the interests of patient safety and public confidence.

A rigid prohibition on re-entry also risks undermining broader principles of proportionality and rehabilitation that underpin the regulatory system. It may also produce disproportionate outcomes in cases where there has been significant evidence of remediation, insight, or exceptional change in circumstances over a substantial period of time.

Fitness to practise - grounds for action

Question: Grounds for action set out the basis on which regulators can investigate and take action where there is a concern about a regulated healthcare professional’s fitness to practise. A regulated professional’s fitness to practise can only be found to be impaired if one or more of the grounds for action are met.

The draft order proposes that the fitness to practise of a regulated professional may be impaired if the regulated professional:

• is unable to provide care to a sufficient standard
• has behaved in a way which amounts to misconduct
• is adversely affected by a physical or mental health condition

Do you agree or disagree with the grounds for action set out in the draft order?

• Agree

Please explain your answer:

We agree with the proposed grounds for action, which are clear, coherent, and consistent with established principles underpinning the current fitness to practise framework. The proposed grounds appropriately capture the circumstances in which regulatory intervention may be necessary to protect patients and maintain public confidence.

We particularly welcome the decision to retain health as a distinct ground for impairment. Recognising physical and mental health separately from misconduct or deficient performance supports a more compassionate and proportionate approach to regulation. It acknowledges that health concerns require a different regulatory response and should not be framed in pejorative or disciplinary terms.

Retaining health as a separate category encourages earlier disclosure by practitioners, reduces stigma, and enables regulatory processes that better reflect the individual circumstances of doctors experiencing health difficulties.

This approach is consistent with patient safety, fairness, and the responsible use of regulatory powers.

We previously coordinated a joint letter, signed by 32 medical organisations, calling on the government to maintain existing protections in GMC investigations involving health matters. This outcome reflects both the strength of feeling across the medical profession and the government’s willingness to engage constructively with legitimate concerns.

Fitness to practise - proceedings

Question: Fitness to practise proceedings are one of the primary ways by which GMC ensures public protection. The fitness to practise model outlined in the draft order aims to make fitness to practise proceedings swifter, fairer and less adversarial for GMC’s registrants and people who raise concerns.

Do you agree or disagree that the fitness to practise powers and duties set out in the draft order for GMC and MTS are sufficient and proportionate for the safe and effective regulation of the professions GMC regulates?

• Agree

Please explain your answer:

Agreed outcomes

We support in principle that doctors and patients should not be put through a fitness to practise hearing when the doctor accepts the proposed sanction. A similar process already exists for lower‑level outcomes, and there is a case for extending it to sanctions involving suspension or erasure.

Fitness to practise hearings can place a significant emotional, psychological and professional burden on doctors, particularly in cases that extend over a prolonged period. Where a doctor accepts impairment and the proposed outcome, avoiding the need for a contested hearing may reduce unnecessary stress for all parties involved, including patients, witnesses and practitioners, while allowing concerns to be resolved more efficiently.

However, any such system must be underpinned by robust safeguards to ensure fairness. This includes the ability to give oral evidence where appropriate, and the continued right to a full hearing. It is also vital that these changes do not blur the separation between investigation and adjudication, and that transparency and public confidence are maintained.

We therefore believe the draft Order requires amendments to strengthen these safeguards.

As currently drafted, the draft Order would permit the GMC to impose a suspension or erasure without a hearing where a registrant does not respond within 28 days to a case examiner’s proposed sanction.

This timeframe will likely in many cases be insufficient for registrants to review the evidence and make representations, particularly where there is a material difference in interpretation. Given the large volume of information they may need to consider, as well as the serious consequences of outcomes such as suspensions or erasure, it is important that doctors are given a proper opportunity to engage with the process. We therefore recommend that the 28-day period be extended to at least 56 days.

In addition, any request for an extension within that timeframe should ordinarily be granted for a suitable period of time proportionate to the volume of material or circumstances that apply.

Where a suitable extension cannot be agreed, the matter should instead proceed to a hearing in the usual manner.

Outside of what is stated in the legislation, we think significant steps will need to be taken by the GMC in a range of areas to ensure this new approach is successful.

Firstly, the GMC will need to exercise considerable care in ensuring case examiners have the experience and capability to take on this expanded role in determining impairment and sanction – functions that are effectively adjudicatory. Case examiners will also need to be provided access to independent legal advice equivalent to that available to tribunals. The GMC should also ensure transparency, and we believe this should include ensuring that the identity of decision‑makers and any experts relied upon is no longer anonymised.

Secondly, targeted action will be required to mitigate the risks posed to doctors who do not have legal representation under this new approach. Doctors will be expected to respond to complex allegations and extensive evidential material, and to make decisions that may determine the course of their entire career, through written engagement within a relatively compressed timeframe. A failure to respond effectively in these circumstances could have severe and potentially irreversible consequences. These risks would be particularly acute for international medical graduates, who are disproportionately more likely to be unrepresented within fitness to practise processes. For this approach to operate fairly and effectively, it is therefore essential that the GMC and the NHS clearly highlight the importance of doctors securing appropriate medicolegal protection, in addition to the existing requirement to hold indemnity for clinical negligence claims.

Five-year rule

We do not support the proposed removal of the five-year rule. Section 35 of the Medical Act already provides a balanced approach by permitting the GMC to consider older concerns in defined and exceptional circumstances where it is in the public interest to do so.

Removing this safeguard entirely risks exposing registrants to investigation of spurious allegations dating back many years, or even decades, which raises well-recognised concerns about fairness and proportionality. Across legal and regulatory systems, the passage of time is consistently treated as a material factor in assessing whether proceedings can be conducted justly. For example, in both civil litigation and employment law, limitation periods exist to ensure that claims are brought while evidence remains available and reliable, and to protect against the inherent risks of faded memory, unavailable witnesses, and incomplete records.

These principles are directly relevant here. Investigating historic allegations where contemporaneous evidence may no longer exist and witness recollection may be significantly degraded creates a real risk of unfair outcomes, undermining confidence in the process for registrants as well as the public. It is also relevant that current fitness to practise is being determined, and this measure risks diverting regulatory resource away from more recent and pressing concerns affecting patient safety.

The existing statutory framework already strikes an appropriate balance by allowing older matters to be considered where there is a clear justification, while maintaining a general expectation of timeliness. Rather than removing the five-year rule altogether, any reform should retain a clear threshold or safeguard to ensure that the investigation of historic matters remains exceptional, justified, and demonstrably fair.

Publications

We also have concerns about the publication requirements of case examiner and fitness to practise decisions set out in the draft Order. While we support transparency, we believe these requirements go further than is justifiable or necessary to protect the public.

The draft provisions would require publication of decisions in circumstances where no warning, sanction, or substantive finding has been made. In practice, this could result in publication of outcomes in cases where concerns have not met the threshold for formal regulatory action.

It is unclear how publishing this information in such circumstances would not enhance public protection or confidence in the regulator.

The potential harms from this approach could be significant. Requiring publication where no regulatory action has been taken could expose doctors to unwarranted and avoidable reputational damage, arising from low‑level, unsubstantiated, or unfounded concerns. Such an approach risks creating the misleading impression that a doctor has been subject to regulatory criticism when, in fact, no concerns were upheld.

We therefore strongly suggest that the proposed publication requirements need to be amended so they are more targeted and proportionate, particularly in cases where no warning, sanction or substantive finding has been made.

Interim registration measures

Question: Under the draft order, a fitness to practise panel’s powers will be extended so that the panel can impose interim registration measures during registration proceedings, as well as during fitness to practise proceedings.

This would allow the panel to impose an interim registration measure while investigating whether a register entry is fraudulent, for example.

Do you agree or disagree that a fitness to practise panel’s power should be extended so that it can impose an interim registration measure during registration proceedings as well as fitness to practise proceedings? 

• Neither agree nor disagree

Please explain your answer:

We are not closely involved in registration proceedings and therefore do not have sufficient practical experience of these processes to take a clear view on this proposal. We would however emphasise the importance of ensuring that any such powers are applied proportionately and with appropriate safeguards.

We do have concerns about the publication requirements in relation to interim registration measures. These measures are precautionary in nature and are based on risk assessment rather than established findings of fact. Publication of decisions relating to interim measures, including where no decision is made to modify the measure, risks placing undue weight on interim proceedings and may create a misleading impression before any substantive determination has been reached.

We therefore question whether the proposed publication requirements are appropriately targeted and proportionate.

Evidence gathering

Question: Under the draft order, GMC may, for the purpose of gathering evidence in connection with registration, fitness to practise and interim registration measure proceedings, require a person to supply such information or produce such a document as GMC may specify. GMC will also be able to require a witness to attend a fitness to practise panel hearing or an appeal panel hearing.

Do you agree or disagree that the draft order provides GMC with sufficient and proportionate evidence-gathering powers?

• Neither agree nor disagree

Please explain your answer:

While the proposed powers appear reasonable in principle, it is not clear that additional evidence-gathering powers are necessary given the breadth of the GMC’s existing investigatory powers. We would welcome greater clarity on the specific gaps these provisions are intended to address, and how they differ in practice from the GMC’s current ability to compel information. In particular, consideration should be given to the safeguards and oversight that will apply to the exercise of these powers, especially if they reduce the need for judicial involvement in compelling evidence or witness attendance.

Rule-making powers

Question: Under the draft order, GMC is able to make rules on specific procedures in relation to:

• governance and operating framework
• education and training
• registration
• fitness to practise
• interim registration measures
• revision of decisions and internal appeals

Do you agree or disagree that the rule-making powers in the draft order are sufficient and proportionate for the regulation of the professions GMC regulates?

• Neither agree nor disagree

Please explain your answer:

We recognise the intention behind the draft Order to provide a more flexible and less prescriptive framework, enabling the GMC to respond more effectively to changes in practice. However, reducing the level of detail set out in legislation also places greater reliance on the GMC’s exercise of its rule-making powers. It is therefore important that these powers are used proportionately and with appropriate safeguards to ensure transparency, accountability and confidence in the regulatory system. This should include a clear responsibility for the regulator to engage with relevant stakeholders, including medical defence organisations.

Revision of decisions

Question: Under the draft order, GMC will be able to revise specific:

• registration decisions (except emergency registration decisions)
• fitness to practise decisions (except fitness to practise panel decisions)
• case examiner interim registration measure review decisions

Do you agree or disagree that the draft order provides GMC with sufficient and proportionate powers and duties in relation to revision of decisions?

• Neither agree nor disagree

Please explain your answer:

We recognise that the introduction of powers to revise decisions could provide a practical mechanism for correcting errors without the need for formal appeal, which may be beneficial in certain circumstances. However, we would welcome greater clarity on how these powers will operate in practice. In particular, it is important that any revision process is underpinned by clear safeguards and transparency regarding both the grounds on which decisions may be revised and the individuals responsible for making those decisions. This will ensure confidence in decision-making and avoid any perception that decisions are being revisited without appropriate oversight.

Appeals

Question: Under the draft order, applicants for registration, registrants and former registrants of GMC will have rights of appeal against specific registration and fitness to practise decisions.

Do you agree or disagree that the powers in the draft order provide individuals with sufficient and proportionate appeal rights?

• Disagree

Please explain your answer:

We do not consider the proposed appeal framework to be proportionate overall. While we recognise the intention to create a more coherent system, the expansion of appeal rights risks introducing unnecessary complexity and duplication. It is not clear that the current arrangements are insufficient, and there is a risk that the proposed model may increase delays, costs and procedural burdens for registrants without delivering clear benefits.

Question: Under the draft order, as per a recommendation of the Mann Review, GMC will have a right of appeal against specific interim registration measure decisions and fitness to practise decisions made by a fitness to practise panel to the:

• High Court of Justice in England and Wales
• Court of Session in Scotland
• High Court in Northern Ireland

Do you agree or disagree that GMC should have a right of appeal to these courts against specific interim registration measure and fitness to practise decisions made by a fitness to practise panel?

• Disagree

Please explain your answer:

GMC appeals in relation to final decisions

We do not support the GMC having a right of appeal against fitness to practise or interim registration measure decisions.

We recognise that when decisions are made about suspending or erasing a health professional from the register, it is important that there is an independent mechanism for decisions to be challenged in the public interest. Across all nine professional regulators, this latter role is fulfilled by the Professional Standards Authority (PSA), which provides an established and effective safeguard on behalf of the public.

The GMC is an anomaly in that, since 2015, it has been the only professional regulator with its own right of appeal against decisions made by its tribunal service, the Medical Practitioners Tribunal Service (MPTS).

As the investigating and prosecuting body, the GMC is not independent from proceedings in the way an oversight body such as the PSA is. The GMC being able to appeal such decisions risks undermining the separation between investigation, prosecution and adjudication that is fundamental to maintaining confidence in the fairness and impartiality of the regulatory system.

Maintaining parallel appeal rights for both the GMC and the PSA also creates unnecessary duplication, increases the risk of inconsistent litigation, prolongs already stressful proceedings for doctors and generates additional legal costs which are ultimately borne by the profession.

The consultation document argued that the GMC’s appeal right should be retained because the GMC has a strong record of success in the appeals it pursues.

However, evidence obtained by MPS through Freedom of Information requests indicates that the PSA has been successful in 88% of appeals it has been involved in since 2016, compared with 70% for the GMC over the same period. This reinforces our view that an additional overlapping GMC right of appeal is unnecessary given the existence of an established and effective independent oversight mechanism through the PSA. Further, reviews led respectively in 2018 by Sir Norman Williams for the government and Dr Leslie Hamilton for the GMC both recommended that the GMC’s right of appeal should be removed. Both reviews concluded that allowing the GMC to challenge decisions made by a tribunal it had itself established risked undermining confidence in the independence of the adjudicatory process. The recommendations were accepted at the time by both the GMC and the then government. It is therefore disappointing that the draft legislation does not proceed with this reform.

The consultation also relies on the findings of the Lord Mann review. However, we do not believe the review demonstrates that the existing appeals framework is inadequate or that public protection would be enhanced by maintaining parallel rights of appeal for both the GMC and the PSA., As such, we remain unconvinced that there is an evidence-based justification for retaining the GMC’s right to appeal and overturning the recommendations delivered by the Williams and Hamilton reviews.

We do note Lord Mann’s observations that, in the absence of a GMC right of appeal, there should be a clear and transparent process by which the GMC could raise concerns regarding MPTS decisions with the PSA, together with greater transparency around the PSA’s subsequent use of its powers. We consider this to be a preferable approach as it would preserve the PSA’s role as an independent oversight body and maintain the important separation between the GMC’s investigative and prosecutorial functions and the independent appeals process.

GMC appeals in relation to interim registration measures

We are also particularly concerned by the proposal to extend appeal rights to interim registration measure decisions.

Interim order decisions are made at an early stage in proceedings, often on incomplete or disputed evidence, prior to any determination of the facts. They are precautionary and time-limited measures intended to address immediate risk while investigations continue. The threshold for intervention should therefore remain high, and the process proportionate and fair.

Allowing appeals against interim order decisions risks introducing a more adversarial and litigious dynamic at a stage where decisions are intentionally provisional and subject to ongoing review. It may also place undue weight on interim decisions that are not findings of impairment or misconduct.

The existing framework already allows interim orders to be reviewed promptly where circumstances change or new information emerges. In practice, this is likely to provide a more timely and effective mechanism for managing risk than formal appellate proceedings. Given the speed at which investigations can develop, there is also a significant possibility that by the time an appeal is heard the evidential position will already have materially changed. Introducing appeal rights in relation to interim decisions is also likely to increase delay, cost and complexity within the fitness to practise process, potentially prolonging uncertainty for doctors, employers and patients alike.

Evidence obtained via a Freedom of Information request to the GMC indicates that the average appeal since 2018 in relation to MPTS decisions has taken 252 days to conclude. Given the inherently urgent nature of interim decisions – which are based on what immediate action is needed to protect the public or maintain confidence in the profession - such timeframes suggest that formal appeal processes of this kind are completely ill‑suited as a mechanism for reviewing them. By contrast, existing procedures provide for periodic review of interim orders within defined timeframes, together with the possibility of an earlier review where circumstances change. The comparatively lengthy duration of appeal processes is therefore difficult to reconcile with the primary objective of interim orders or of the wider need to progress cases to a fair and timely substantive determination.

A further concern is the impact on doctors who are not legally represented. Interim order hearings are intentionally designed to be accessible, reflecting their precautionary and time-limited nature. Introducing a right of appeal would move decision-making at this early stage into a more formal and legally complex arena. Unrepresented practitioners may be significantly disadvantaged in navigating appellate procedures, responding to legal arguments, or identifying grounds of appeal, particularly where the regulator is supported by dedicated legal resource. In practice, this risks rendering appeal rights less meaningful for those without representation, while placing pressure on individuals to obtain legal support at an earlier stage, increasing both financial and personal burden. This would represent a material shift away from the intended accessibility and proportionality of interim proceedings.

Question: Under the draft order, a consequential amendment will be made to the National Health Service Reform and Health Care Professions Act 2002 to allow PSA to appeal specific fitness to practise and interim registration measure decisions made by a fitness to practise panel to the:

• High Court of Justice in England and Wales
• Court of Session in Scotland
• High Court in Northern Ireland

Do you agree or disagree that PSA should be able to appeal specific fitness to practise decisions and interim registration measure decisions made by a fitness to practise panel to these courts? 

• Disagree

Please explain your answer:

PSA appeals in relation to final decisions

We support the role of the Professional Standards Authority (PSA) as an independent oversight body and consider it appropriate that it retains the ability to appeal final fitness to practise decisions in the public interest. The PSA provides an established and independent safeguard across all professional regulators, helping to ensure consistency, proportionality and public confidence in regulatory decision-making. Unlike the GMC, the PSA does not investigate or prosecute cases and is therefore appropriately positioned to exercise an oversight and appellate function in relation to final adjudicatory outcomes.

As mentioned in our answer to the previous question, evidence obtained by MPS through Freedom of Information requests also indicates that the PSA has a strong record of success in the appeals it brings, including a higher success rate than the GMC in cases pursued under its existing appeal powers. This reinforces the view that the current PSA appeal mechanism already operates as an effective safeguard where regulatory outcomes are considered insufficient for the protection of the public.

PSA appeals in relation to interim registration measures

We do not however support extending this power to interim registration measure decisions.

The consultation relies on the findings of the Lord Mann review to support extending the PSA’s appeals power to interim registration measure decisions. While we recognise the concerns raised by Lord Mann, we do not consider they establish a compelling case for introducing such measures.

Interim order decisions are fundamentally different from final fitness to practise determinations. They are made at an early stage in proceedings, often on the basis of incomplete or disputed evidence, and are intended to be precautionary and time-limited measures for the management of immediate risk while investigations continue. They are not findings of impairment or misconduct.

Given the provisional nature of interim orders, introducing a further layer of appeal risks creating disproportionate and unnecessary litigation at an early stage of proceedings. The current framework already provides mechanisms for interim measures to be reviewed promptly where circumstances change or new information becomes available. In practice, this provides a more timely and effective means of managing risk than formal appellate proceedings.

There is also a significant practical concern that by the time an appeal is heard, the evidential position may already have materially changed or the underlying investigation may have progressed substantially. This risks creating a process that is resource-intensive while offering limited practical benefit for public protection.

Extending appeal rights in relation to interim decisions may also increase delay, cost and procedural complexity within the fitness to practise process, potentially prolonging uncertainty for doctors, employers and patients alike. There is a risk that this could detract from the primary objective of progressing cases efficiently toward a fair and timely substantive determination.

PSA oversight of case examiners

We also note that the draft Order would extend the PSA’s oversight role to case examiner decisions.

While we understand the rationale behind this, particularly where case examiners may conclude a matter without referral to a fitness to practise panel, we have concerns that the proposed powers risk creating an increasingly complex and layered system of review and challenge in relation to case examiner outcomes.

Under the draft Order, case examiner decisions are intended to provide a more proportionate and efficient route for resolving appropriate cases. Introducing additional revision mechanisms, particularly when combined with existing appeal and review routes elsewhere in the regulatory framework, risks creating duplication, delay and uncertainty within the fitness to practise process.

In addition, if case examiner decisions become subject to broader revision mechanisms, there is a risk that the distinction between panel determinations and earlier-stage case resolution becomes increasingly blurred. This may reduce procedural certainty for doctors and undermine some of the efficiency benefits intended by resolving appropriate cases at case examiner stage.

We are particularly concerned by the proposed ability to seek revision of decisions where a case examiner determines that a doctor’s fitness to practise is not impaired. In our view, extending review powers to findings of no impairment represents a significant broadening of oversight mechanisms within the fitness to practise process and risks creating an environment in which closure for a doctor becomes increasingly difficult to achieve, even where no impairment has been identified.

More broadly, there is a risk that introducing revision powers, appeal rights and oversight mechanisms across multiple stages of the process could undermine confidence in the finality, clarity and proportionality of regulatory decision-making. Careful consideration should therefore be given to the cumulative impact of these proposals on the efficiency of the fitness to practise process, and to ensuring that any oversight framework remains clear, proportionate and appropriately targeted.

Question: Under the draft order, GMC will be permitted to administer its own internal appeals function. Applicants for registration, registrants and former registrants will be able to appeal specific registration and fitness to practise decisions to an appeal panel of GMC.

Question: Do you agree or disagree that the draft order provides GMC with sufficient and proportionate powers and duties to administer its appeals function? 

• Disagree

Please explain your answer:

We do not support the principle of internal appeals where the body responsible for making the original decision is also responsible for administering the appeal process.

While internal appeal and review mechanisms are not new in principle, we believe there needs to be a clear separation between the body that is responsible for the original decision-making and those responsible for considering appeals, something the draft Order fails to do. Independent appeal arrangements are an important safeguard that help maintain confidence among registrants and the public.

The draft Order represents a significant shift towards a more unified, GMC‑led appeals framework. Rather than preserving a degree of separation, both the original decision and the appeal would initially sit within the GMC. Although the internal appeal would operate independently of the original decision-maker, this raises legitimate questions about perceived independence.

In our view, appeal arrangements should be demonstrably independent, transparent and clearly distinct from the original decision-making process. This is particularly important given the broader reforms proposed by the Order, which confer significant new powers on the GMC across registration and fitness to practise processes.

About MPS

MPS is the world’s leading protection organisation for doctors, dentists and healthcare professionals with more than 300,000 members around the world. 

Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.

MPS is not an insurance company. We are a mutual non-for-profit organisation and the benefits of membership of MPS are discretionary as set out in the Memorandum of Articles of Association.

Contact

Should you require further information about any aspects of our response to this consultation, please do not hesitate to contact us.

Michael East
Policy and Public Affairs Manager
michael.east@medicalprotection.org

Alice O'Flynn
Policy and Public Affairs Officer
alice.oflynn@medicalprotection.org