A letter from the General Medical Council is one of the most alarming pieces of correspondence a doctor can receive. Whether it is a brief notification that a concern has been referred or a formal Rule 7 letter setting out allegations in detail, the instinct to act immediately is understandable. In almost every case, it is the wrong instinct.
This guide explains what different types of GMC correspondence mean, why the first few days matter so much, and what you should and should not do before you do anything else.
Which letter have you received?
The GMC uses different types of correspondence at different stages of its process. Knowing which one you have received affects how urgently you need to act and what your response should be.
- Provisional enquiry letter. The GMC has received a concern and is at the very earliest stage of considering whether to investigate. You may be invited to provide information informally. This stage can feel low-key, but it is not.
- Rule 7 letter. A formal allegation has been drafted and the GMC is inviting your response. This is the most critical document in any GMC investigation. Your reply becomes part of the permanent record and will be examined at every subsequent stage.
- Notification of investigation. A case examiner or case manager has been assigned and the investigation is formally underway.
- Interim Orders Tribunal (IOT) notice. The GMC is applying to restrict or suspend your licence to practise before the investigation concludes. This is urgent and requires specialist advice within hours, not days.
- Warning or undertakings proposal. The case examiners are considering resolving the matter without a hearing. You have a right to make representations, and this right matters enormously.
Do not respond to the GMC without legal advice
This applies at every stage, but it is most critical if you have received a Rule 7 letter. The GMC gives you 28 days to respond. Use them.
Doctors are trained to communicate clearly, to reflect honestly on their practice, and to take responsibility when things go wrong. These are excellent qualities in clinical care. In GMC proceedings, they can cause significant harm if exercised without legal guidance. A response that is too candid in the wrong places, that fails to challenge a factual error, or that inadvertently accepts a characterisation of events that does not reflect what actually happened, will follow you through every subsequent stage of the process.
The GMC’s investigators are experienced. They know how to read responses. A response drafted by a specialist solicitor is not about being evasive: it is about being precise, accurate, and strategic.
Do not contact the complainant or any witnesses
If you know or can guess who has made the referral, do not contact them. Do not ask colleagues to speak to them on your behalf. Do not ask anyone connected to the case for a statement without first taking advice on how to do so properly. Any contact that could be characterised as attempting to influence a witness is a separate and serious matter in its own right.
Be careful what you say to your employer or medical director
Your employer has their own regulatory obligations. If they are aware of a GMC referral, they may be required to conduct their own investigation or take interim action. Anything you say informally to your medical director or a manager before you have taken legal advice may be recorded and could be relevant later.
Your defence organisation or medical indemnity provider will provide support, and you should notify them. But their advisers are not the same as specialist regulatory solicitors: their primary obligation is to the organisation, and their experience of GMC proceedings varies considerably. Consider taking independent legal advice alongside any support they provide.
Start gathering documents now
Whatever the concern relates to, identify what documentation exists: clinical records, correspondence, rotas, supervision records, reflection logs, appraisal documents. Systems are updated, records are archived, and colleagues move on. Evidence that is straightforward to obtain today may not be available in six months.
Obtain what you can through proper channels. Do not remove, alter or annotate any existing records.
Why GMC cases are different from other regulatory investigations
The GMC’s process is more adversarial than that of some other regulators. The Interim Orders Tribunal can restrict or suspend a doctor’s registration within days of a referral. The Medical Practitioners Tribunal Service conducts formal hearings with legal representation on both sides. The potential sanctions include conditions, suspension, and erasure from the medical register.
The stakes are high and the process is long: most GMC investigations take between one and three years. Getting the right advice at the start is not a luxury. It shapes every stage that follows.
What happens after the investigation: the case examiner stage
Once the GMC investigation is complete, the case is reviewed by case examiners. Case examiners are decision-makers who have not conducted the investigation and are reviewing the evidence fresh. They can close the case with no further action, issue a warning, propose undertakings, or refer the case to the Medical Practitioners Tribunal Service for a hearing. The case examiner stage is one of the most important opportunities in the entire process. Written representations at this stage, if well-constructed, can result in a case being concluded without a hearing even where the underlying facts are not in dispute. We advise on when and how to engage at the case examiner stage, and what representations are likely to be most effective given the specific concerns raised.
Apologies and the duty of candour
Many doctors receiving a GMC letter want to apologise, particularly where a patient was harmed. This instinct reflects well on them as clinicians. Whether and how to express an apology in the context of a GMC investigation requires careful thought. An apology can demonstrate the insight and remorse that case examiners are looking for, and it can be a significant factor in achieving an early resolution. It can also, if poorly worded or made at the wrong stage, be read as an admission of matters that are factually disputed or go beyond what the evidence actually supports. The professional duty of candour also remains in force throughout a GMC investigation. We advise on how to discharge that duty appropriately while protecting your position in the proceedings.
If you are a doctor in training
Doctors in training face additional complexity when they receive a GMC letter. Your educational supervisor and postgraduate deanery or LETB may be notified and may be required to take their own steps, including considering your progress at ARCP. Your training programme could be affected before any GMC finding is made. Trainees also often have less confidence in challenging their employer or training programme and may feel more pressure to cooperate informally before taking legal advice. If you are a trainee, instruct a solicitor before speaking to anyone in your deanery or programme about the referral. The steps taken early in training-related cases can have consequences that extend well beyond the GMC investigation itself.
What to do right now
- Read the letter carefully and note any deadline for a response.
- Do not contact the GMC, your employer, the complainant, or any potential witness until you have taken legal advice.
- Write down everything you remember about the events referred to, while your recollection is fresh. Keep this private.
- Notify your defence organisation or indemnity provider.
- Instruct a solicitor who specialises in GMC fitness-to-practise proceedings. Not a general medical law solicitor. Not your union. A specialist.
Regulated by a different body?
We act for regulated professionals across all major UK bodies. If your regulator is different, we have guides for NMC-registered nurses, midwives and nursing associates, SRA-regulated solicitors, GPhC-registered pharmacists and pharmacy technicians, and HCPC registrants. For full detail on how we defend GMC investigations and Medical Practitioners Tribunal hearings, visit our GMC fitness to practise service page.
Regulatory Defence acts exclusively in fitness-to-practise proceedings. If you have received correspondence from the GMC and want to understand your position before deciding how to respond, we offer a free initial telephone consultation with no obligation. Call us on 0800 088 4700 or use the contact form on our GMC defence page.