Reforming the GMC: What it means for doctors

The UK government is undertaking the most significant overhaul of medical regulation in more than 40 years. While many of the proposed reforms are welcome, some raise important questions about fairness, due process and trust in the regulatory system. 

The Medical Act, which underpins the GMC’s powers, was created in a very different era. It received Royal Assent in July 1983. Margaret Thatcher had just been re‑elected and Return of the Jedi was drawing queues around the block. Since then, doctors have been regulated under legislation that predates the internet, electronic health records and many of the realities of modern medical practice. 

Many would agree that the current framework needs urgent updating to be fit for purpose, and Medical Protection has been pushing for reform. 

A government consultation has just concluded on draft legislation that would replace the Medical Act entirely, and we have been scrutinising it closely to understand how this might affect our members and the profession. 

Our assessment is that the draft GMC Order is a mixed bag. It contains a number of positive changes, but there are also areas where we believe significant improvements are needed before the legislation is finalised. 

Appeals 

One of the most disappointing aspects of the draft Order is the decision to retain the GMC's right to appeal fitness to practise decisions. 

I say disappointing because independent reviews reached the opposite conclusion. Separate reviews in 2018 led by Sir Norman Williams and Dr Leslie Hamilton both recommended removing the GMC's right of appeal, arguing that allowing the regulator to challenge decisions made by a tribunal it had itself established risked undermining confidence in the independence of the adjudicatory process. The government and GMC accepted those recommendations at the time. 

The current policy position represents a clear departure from that consensus. It argues that the GMC's right of appeal should be retained because the regulator has a strong record of success when challenging tribunal decisions. This somewhat misses the point. The argument has never been about whether they overuse this power – it has been whether there is sufficient independence between the GMC and its panels for it to be the appropriate body to hold such an appeal. There is also the question of whether doctors should face the burden of two bodies having duplicated rights of appeal over the same decision. 

Medical Protection’s view remains that the right to appeal tribunal decisions in the public interest should sit solely with the Professional Standards Authority (PSA). The PSA is independent of the GMC and already exists to provide external oversight of healthcare regulators. It is also deeply unfair that doctors remain the only profession regulated by a body that has a statutory right to appeal decisions made by its own tribunal, in addition to the PSA’s existing powers. 

Evidence obtained by Medical Protection shows that removing this duplication would not compromise patient protection. While much is made of the GMC’s success rate in appealing panel decisions, since 2016 the PSA has had an 88% success rate, compared with 70% for the GMC. This demonstrates that an effective, independent mechanism already exists to challenge decisions where necessary. 

To compound matters, the draft Order goes a step further by proposing new appeal rights for both the GMC and PSA against interim order decisions. 

Medical Protection does not support this proposal. Interim orders are precautionary, time‑limited measures imposed before the facts of a case have been established. They are designed to manage immediate risk, not determine the final outcome of proceedings. Allowing appeals at this early stage risks prolonging an already stressful process for doctors, without clear evidence that current safeguards are inadequate. 

For these reasons, we believe that appeals against fitness to practise decisions should remain the responsibility of a single independent body — the PSA — and that the proposed extension of appeal rights to interim orders should not proceed. 

Changes to fitness to practise processes 

The draft Order aims to make fitness to practise investigations quicker, fairer and less adversarial for both doctors and those who raise concerns. 

One of the most significant changes would be to allow doctors to accept a proposed sanction or erasure or suspension without the need to go to a hearing. This could reduce the number of cases requiring a full tribunal hearing and spare doctors and patients the stress of lengthy proceedings. 

In principle, we support measures that avoid unnecessary hearings when outcomes are agreed. Similar arrangements already exist for lower-level outcomes and there is a reasonable case for extending them.

However, appropriate safeguards will be essential. 

As currently drafted, a doctor who does not respond within 28 days to a proposed sanction could face suspension or erasure without a hearing. It has to be remembered that these are busy doctors, who are facing very seriousness allegations, being expected to take in a large volume of evidence, and to consider an outcome that will have a profound impact on their career and life more broadly. 

That is why we have recommended extending the response period to at least 56 days and ensuring that reasonable requests for additional time are ordinarily granted. Where sufficient time cannot be agreed, the case should proceed to a hearing in the usual way. 

The GMC will also need to exercise considerable care when implementing this new approach to ensure case examiners are able to be effective in this expanded role.

Perhaps our greatest concern is the impact on doctors who do not have legal representation, including international medical graduates who are more likely to face fitness to practise proceedings without legal support. We believe these changes make it all the more important that doctors understand how important it is to be with an organisation like Medical Protection and to have strong medicolegal protection in place. 

Protecting unwell doctors 

As our Chief Executive, Karen Miller, has set out in Casebook+, one area where the government has listened to the profession is the very welcome decision to retain health as a distinct category of impairment. 

A significant proportion of doctors that are subject to a GMC investigation have existing concerns about their mental and/or physical health, and these are often exacerbated by the investigation.

Retaining health as a separate category supports a more compassionate and proportionate approach to cases involving doctors with significant physical or mental health concerns. It avoids conflating health conditions with misconduct or poor performance, encourages doctors to seek support earlier and enables processes that better reflect individual circumstances. It also enables the GMC to implement measures that are compassionate to the doctors’ needs. 

Medical Protection coordinated a joint letter signed by 32 medical organisations urging the government to retain these protections within the GMC's fitness to practise framework. This outcome reflects the strength of feeling across the profession as well as a willingness in the government to listen to our concerns. 

Next steps 

These are just a few of some of the important points in the new legislation. 

The consultation on the draft Order closes on 23 June 2026 and we will be responding in full, as well as engaging with the DHSC, the GMC and other stakeholders with the aim of ensuring the final framework delivers fair, proportionate and effective regulation for doctors. 

I would encourage members to read our full consultation response, which is available on the Medical Protection website – www.medicalprotection.org