Fitness to practise

The NMC and HCPC both describe being fit to practise as having the skills, knowledge, health and character to practise safely and effectively. The HCPC adds that it is about more than competence: it also means treating people with dignity and respect and acting with honesty and integrity. Conduct outside work can raise a fitness to practise question if it could affect public protection or confidence in the profession.

The term is used in two ways. When you apply, the regulator asks about your health and character to decide whether you are fit to join. Once you are registered, "fitness to practise" is the process used when someone raises a concern about you.

International applicants are asked to declare criminal convictions, cautions, disciplinary findings and health conditions that could affect safe practice. Regulators also ask for evidence of good standing from every regulator you have been registered with, such as a certificate of good standing or CCPS. Open investigations abroad must be declared too. Regulators expect full and honest disclosure, because honesty is itself part of the character they are assessing.

Both the NMC and the HCPC publish guidance on health and character that explains how they assess declarations from applicants and registrants, and what information they may ask for.

1. Concern received: from a patient, employer, colleague, police or another regulator.
2. Threshold check: the regulator decides whether the concern is serious enough to investigate. When the GMC assesses a concern it looks at how far the doctor has departed from the standards in Good medical practice, or whether a health condition is affecting their ability to practise safely.
3. Investigation: evidence is gathered, and you are told and asked to respond.
4. Case examiners: at the GMC, two senior decision makers, one medical and one non-medical, review the evidence and can close the case with no further action, issue a warning, agree undertakings or refer it to the MPTS for a hearing.
5. Hearing: for doctors, the independent Medical Practitioners Tribunal Service (MPTS) decides whether fitness to practise is impaired. The NMC and HCPC run their own panels.

• No further action, advice or a warning. NMC warnings are published on its register for 12 months.
• Undertakings: agreed steps to address a concern.
• Conditions of practice: NMC conditions orders can last one to three years.
• Caution order: at the NMC, from one to five years, with no restriction on practice.
• Suspension: you are removed from practice for a fixed period.
• Erasure or striking off: an MPTS tribunal can erase a doctor so they cannot work as a doctor in the UK for at least five years.

Interim orders can restrict or suspend practice while an investigation is under way. Outcomes appear on the public register, which employers check through your GMC number or NMC PIN.

• Not declaring an old complaint or investigation from a previous country.
• Practising outside your scope of practice in a new system.
• Letting indemnity cover or revalidation lapse, which can itself become a registration issue.