What is the MPTS and how is it different from the GMC?
The Medical Practitioners Tribunal Service (MPTS) runs hearings about doctors' fitness to practise in the UK. It is part of the GMC structurally, but it works separately from the GMC teams that investigate concerns and present cases. In a tribunal, the GMC is one party and the doctor is the other. The tribunal sits in the middle and makes the decision.
This separation matters. The people who looked into your case are not the people who decide it. The tribunal hears the evidence fresh, listens to both sides and gives written reasons.
Most GMC investigations never reach a tribunal. Many are closed, or end with advice, a warning or agreed undertakings decided by GMC case examiners. A case is referred to the MPTS when the GMC considers that a tribunal needs to decide whether the doctor's fitness to practise is impaired.
Who sits on a medical practitioners tribunal?
Each tribunal has three members. At least one is a doctor and at least one is a lay member (someone who is not medically qualified). In most hearings the chair is legally qualified and also advises the tribunal on the law. In some cases a separate legal assessor gives legal advice but takes no part in the decision.
Tribunal members are trained and follow published MPTS guidance so that decisions are consistent from one case to the next. They are not employed by your trust and have no connection to your case.
Other types of MPTS hearing
- Interim orders tribunal (IOT): decides whether your practice needs to be restricted or suspended while an investigation continues. It does not decide whether the allegations are true.
- Review hearing: looks again at a doctor who already has conditions or a suspension, to decide whether they are safe to return to unrestricted practice.
- Restoration hearing: considers an application from a doctor who was erased. A doctor cannot apply until five years after erasure.
- Non-compliance hearing: can follow if a doctor refuses a GMC request for an assessment or information during an investigation.
What are the three stages of an MPTS hearing?
A new tribunal hearing follows three stages in a fixed order. The tribunal only moves to the next stage if the previous one requires it.
- Stage 1: Facts: The tribunal decides whether the GMC has proved the allegations. It uses the civil standard of proof, the balance of probabilities. This means it asks whether something is more likely than not to have happened. Facts you admit are usually recorded as proved at the start.
- Stage 2: Impairment: If facts are proved, the tribunal decides whether your fitness to practise is impaired today. The question is about current and ongoing risk to public protection, not only what happened in the past. Your insight and remediation are central here.
- Stage 3: Sanction: If you are found impaired, the tribunal decides what action is proportionate to protect the public. If you are not impaired but there was a significant departure from professional standards, the tribunal can give a warning instead.
The tribunal usually announces its decision at the end of each stage before moving on. That gives you and your representative the chance to make submissions at the impairment and sanction stages, based on what has been found.
What outcomes and sanctions can an MPTS tribunal give?
The possible outcomes are set out in law and in MPTS guidance. They range from no action to erasure from the medical register.
| Outcome | What it means | Key points |
|---|---|---|
| No action | The case ends without any restriction. | Rare after a finding of impairment, because the tribunal must explain why no action protects the public. |
| Warning | A formal warning. It is not a sanction and does not restrict your practice. | Given when you are not impaired but there was a significant departure from standards. |
| Undertakings | Commitments you offer about your future practice. | Only possible if the GMC agrees. They work much like conditions. |
| Conditions | Restrictions or requirements on your registration, such as supervision or limits on certain work. | Can be imposed for up to three years, and reviewed before they end. |
| Suspension | You cannot practise as a doctor in the UK for a set period. | Up to 12 months, usually followed by a review hearing. |
| Erasure | Your name is removed from the medical register. | Not available where the case relates solely to health or knowledge of English. You cannot apply for restoration for five years. |
When a tribunal imposes conditions, suspension or erasure, it also considers whether to make an immediate order. Normally a sanction only takes effect once the appeal period has passed. An immediate order makes the restriction start straight away, where that is needed to protect the public, is in the public interest, or is in your own interests.
How do tribunals decide on a sanction under the new MPTS guidance?
New MPTS guidance for tribunals took effect on 24 November 2025 for hearings that started on or after that date. It replaced the older sanctions guidance. If your hearing began earlier, your representative will advise on which guidance applies.
Under the newer approach, the tribunal first assesses the level of risk to public protection as lower, medium or higher. It then uses a banding for the type of case to find a starting range of sanctions. Case types include clinical concerns, dishonesty, sexual misconduct, violent or abusive behaviour, discrimination, health, English language, and convictions or other regulatory findings.
Several things affect where a case sits:
- The seriousness of the facts found proved.
- Features that make it more serious, such as persistence, abuse of a professional position, or reckless disregard for patient safety.
- Context about you and your working environment at the time.
- Your response to the concerns, including insight and remediation.
A tribunal can move away from the banding, but it must explain why. At the most serious end, context and personal factors usually carry less weight. Character references can help but may not outweigh the need to protect the public. Always check the current guidance on the MPTS website, as it can change.
What does the tribunal look for in insight and remediation?
Insight means you understand what went wrong, why it mattered, and what you would do differently. Tribunals look for this in your reflection, in how you speak about the events, and in how you have engaged with the process.
Remediation means the steps you have taken to address the concern. The tribunal considers whether the problem can be remedied, whether it has been, and how likely it is to happen again. Some concerns, such as a gap in one clinical skill, are easier to remedy than concerns about attitude or honesty.
MPTS guidance makes clear that objective evidence usually carries more weight than your own statement that you have changed. Useful evidence can include:
- Certificates from courses that directly address the concern.
- Reports from a clinical or educational supervisor who knows about the allegations.
- A statement from your responsible officer.
- Audits, feedback or workplace-based assessments showing changed practice.
- A written reflection that links what you learned to specific changes you have made.
I have reflected deeply on this incident and I have learned a great deal. I am a caring doctor and this will never happen again. I have completed several online courses.
I did not check the patient's latest blood results before prescribing, and I relied on a handover note. That put the patient at risk of serious harm. I now review results myself before every new prescription. I completed a prescribing safety course in March and my supervisor has reviewed 40 of my prescriptions since then, with written feedback attached. I have also shared what I learned at our departmental teaching session.
The weaker answer makes promises. The stronger one names the specific failing, accepts its impact, shows a concrete change and offers evidence that someone else has checked.
Are MPTS hearings held in public?
Yes, hearings are generally held in public. Members of the public and the press can attend, and decisions are published. Parts of a hearing are held in private when the tribunal considers confidential information or information about a doctor's health.
Knowing the hearing is public can add to the stress. It may help to talk to your representative early about what will be heard in private, and to plan support for the days of the hearing. Many doctors find it useful to speak to a confidential support service, such as the BMA's wellbeing support or a practitioner health service.
Tomas, a specialty doctor, was suspended for nine months after concerns about his assessment of acutely unwell patients. Before his review hearing he completed a relevant course, kept a reflective log, and arranged an observer post where a consultant assessed his practice. He shared the consultant's report and his log with his defence organisation, who put them before the tribunal. The tribunal's task was to decide whether he was now safe to practise, and whether conditions were needed for a period. The evidence he gathered gave the tribunal something concrete to weigh. (This is a fictional example. Every case is decided on its own facts.)
Can you appeal an MPTS tribunal decision?
A doctor found impaired can appeal to the courts. The appeal must be lodged within 28 days of being notified of the decision. Which court hears it depends on your registered address: the High Court in England and Wales, the High Court in Northern Ireland, or the Court of Session in Scotland.
The GMC can also appeal if it considers the outcome is not enough to protect the public. The Professional Standards Authority can refer a decision to court for the same reason. Other decisions, such as a warning, may be challenged in a different way. Appeals are technical, so take legal advice before deciding what to do.
Preparing well, with the right support
Your representative will deal with the legal side. What you can control is the quality of your reflection and the evidence of change you bring. Start early, keep it specific, and focus on the actual concern rather than general learning.
If you want a structured way to understand the process, our Fitness to Practise Explained: GMC, NMC and HCPC Processes course walks through each stage in plain language. Insight and Remediation: Building Your Evidence helps you plan and record the kind of evidence tribunals give weight to. If your case involves honesty concerns, Probity and Dishonesty: Ethics Course for Healthcare Professionals focuses on that area. None of these can predict or change an outcome, but they can help you present genuine learning clearly.
Frequently asked questions
How long does an MPTS hearing last?
It depends on the case. A straightforward hearing where facts are admitted may take a few days. A contested case with many witnesses can run for several weeks, sometimes with breaks between sessions. The MPTS will give you a listed length in advance. Your representative can explain what is likely in your case and how the timetable may change.
What is the difference between the GMC and the MPTS?
The GMC investigates concerns and, if a case goes to a hearing, presents it as one party. The MPTS runs the hearing and appoints the tribunal that makes the decision. The MPTS is operationally separate from the GMC's investigation function, so the people deciding your case are not the people who investigated it.
What is the standard of proof at an MPTS tribunal?
The tribunal uses the civil standard, the balance of probabilities. It decides whether an allegation is more likely than not to be true. This is a lower standard than in a criminal court, where guilt must be proved beyond reasonable doubt. The GMC has to prove the facts. You do not have to prove you did nothing wrong.
What is the maximum suspension an MPTS tribunal can give?
A tribunal can suspend a doctor's registration for up to 12 months at a time. A review hearing is usually held before the suspension ends. At review, the tribunal can extend the suspension, replace it with conditions, allow a return to unrestricted practice, or in some cases erase the doctor. Indefinite suspension is possible only in limited health or language cases.
Can I attend an MPTS hearing remotely?
The MPTS confirms the format of each hearing in advance, and arrangements can differ between cases. If you have a preference, or a reason you cannot attend in person, raise it early through your representative or the MPTS case team. Attending in whatever format is agreed usually helps, because the tribunal can hear directly from you about your insight and learning.
Will an MPTS warning stop me working?
No. A warning is not a sanction and does not restrict your practice. It is given when a tribunal finds you are not impaired but there was a significant departure from professional standards. A warning is recorded and can be visible to others, so check the GMC website for how long it is shown. It is still important to show you have learned from it.
Can I be erased from the register for a health problem?
Not where the case relates solely to your health or knowledge of English. In those cases the tribunal can use conditions or suspension instead. Erasure may become possible if other findings, such as misconduct or a conviction, are also part of the case. Your defence organisation can explain how this applies to your circumstances.
Related courses
Fitness to Practise Explained: GMC, NMC and HCPC Processes
This course explains, step by step, how fitness to practise concerns are handled by the UK health regulators, from the first referral to a final…
Probity and Dishonesty: Ethics Course for Healthcare Professionals
This course explains what probity means for UK healthcare professionals, how dishonesty arises in records, CVs, timesheets, sickness absence,…
Insight and Remediation: Building Your Evidence
This course explains what UK healthcare regulators mean by insight and remediation, how they are assessed at each stage of a fitness to practise…
Sources and further reading
- Medical practitioners tribunals: how they work. Medical Practitioners Tribunal Service.
- Guidance for MPTS tribunals: Medical practitioners tribunal hearings (doctors). Medical Practitioners Tribunal Service.
- Sanctions guidance for members of medical practitioners tribunals (February 2024). Medical Practitioners Tribunal Service.
- Appeals. Medical Practitioners Tribunal Service.
- Good medical practice 2024. General Medical Council.
- Medical Act 1983. UK Parliament (legislation.gov.uk).
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
What Does 'Insight' Mean in a Fitness to Practise Case?
What insight means in a fitness to practise case, how the NMC and GMC assess it, how to show it in a reflective statement, and what weakens it. Plain UK guide.
What Happens at an NMC Fitness to Practise Hearing?
What happens at an NMC fitness to practise hearing: who attends, the three stages, possible sanctions, hearings versus meetings, and how to prepare calmly.
HCPC Fitness to Practise: A Guide for Physiotherapists, Paramedics and AHPs
HCPC fitness to practise process explained for physiotherapists, paramedics and AHPs: triage, investigation, the ICP, hearings and sanctions.