Fitness to practise in focus: trust, fairness and the future

GMC Chief Executive Charlie Massey's remarks at Pulse Live, Cardiff on Thursday 2 July. 

Good morning. It's a pleasure to be here in Cardiff and thank you for having me.

I’m going to talk today about some of the myths and realities of our fitness to practise processes, and steps we have taken to build trust in them.

But I want to start by acknowledging the reality of general practice today.

We collect evidence every year about doctors' workplace experiences. And these data have for the past number of years shown that general practitioners have been under more pressure than any other group of doctors. It is therefore not a new phenomenon, and in fact, it predates the pandemic.

Of course, the pressures facing GPs are not experienced in the same way everywhere. The challenges facing somebody working in a rural community are likely to look different from those facing a GP in a large urban practice, and different GP roles experience slightly different issues.

But across the specialty, GPs are facing the same underlying challenge – how to provide the best possible care in the face of significant and increasing pressures on time and capacity.

To add some colour to that, last year more than six out of ten GPs told us they struggled to provide sufficient patient care at least once a week, compared with four out of ten doctors across the profession. And GPs were clear that workload pressure was the most significant barrier, with 32% of GPs citing it as such, compared with 16% of doctors overall.

Our qualitative data show that for many doctors, one of the most difficult aspects of working under pressure is the feeling that they are unable to provide the level of care they believe their patients deserve. That gap between professional standards and day-to-day reality can be deeply demoralising.

At a time when so many GPs are working in such challenging circumstances, it is understandable that the possibility of a complaint or regulatory investigation can weigh heavily. And when complaints from members of the public are rising, it is understandable that those worries can be amplified.

We've seen evidence of the impact that can have in the recent Pulse White Paper, with reports of more GPs practising defensively because of fears about regulatory consequences.

Those findings are concerning, but perhaps not entirely surprising. We regularly survey doctors about their perceptions of our work, including our fitness to practise processes. In our 2025 survey, just 27% of GPs felt that the GMC would deal with concerns about them fairly and appropriately, taking the context in which they work into account.

That matters in its own right because it can create anxiety and uncertainty for doctors already working under intense pressure. But it also has wider consequences if it is encouraging more defensive approaches to care and affecting the culture of openness and learning that underpins patient safety. So, it is a real priority for us to build doctors’ confidence in how we handle complaints made to us.

One important element to this is to improve understanding of our role and our processes, and to be clear about what is and is not likely to get doctors into trouble with us.

This starts with being clear about what fitness to practise does – and does not – involve.

In 2024, out of a total of 70,000 licensed GPs on our register, we assessed around 2,900 concerns relating to GPs. So, while every concern needs to be taken seriously, it’s important to be clear that the overwhelming majority of GPs will never find themselves at the centre of a fitness to practise investigation.

We’re also aware that many doctors assume that if a concern is raised, it will result in a full investigation. In reality, more than nine in ten concerns about GPs do not.

In 2024, around 250 of the concerns we received reached our threshold for investigation. And only 49 cases proceeded to a hearing. Put another way, that was around one hearing for every 1,400 licensed GPs. The number of GPs who ultimately received a sanction was smaller still – around one in every 2,000 licensed GPs.

Putting the statistics to one side, one of the most corrosive fears for any doctor to face is that an isolated mistake made under pressure could result in them losing their licence. But the reality is that the sorts of issues that result in the most serious sanctions against doctors very rarely relate to clinical issues.

In 2024, there were 185 new MPTS hearings involving doctors. Around nine in ten involved allegations of misconduct, criminal convictions or both. There were no hearings brought solely on the grounds of a doctor's clinical performance. So the reality is that sanctions are most often sought only for the most serious concerns that put patient safety or the public's trust in doctors at risk.

Better understanding is helpful, and I hope some of these facts help to bust myths about the level of risk faced by GPs – or any other doctor – trying to do their best in incredibly challenging circumstances. But it would not be enough simply to explain our processes if we were not also prepared to improve them.

Over the last decade, we’ve made a number of changes in response to what we have heard from doctors and others involved in our processes.

One of the most significant changes has been the introduction of provisional enquiries. Analysis of our data showed that we were sometimes opening full investigations simply because it was the only way to obtain the information needed to understand the concern properly.

Previously, where further information was needed to understand a concern properly, it was often necessary to open a full investigation to obtain it. We can now refer certain concerns to the provisional enquiries team, who gather targeted information at an early stage before a decision is made about whether a full investigation is required.

The reason this is a positive development for doctors is because the provisional enquiry process allows us to close cases much more quickly than would be the case if they proceeded to investigation. On average, we are able to complete Provisional Enquiry cases in nine weeks compared to an average of around nine months for cases that proceed to investigation.

And this is also important because the Provisional Enquiry process results in the vast majority of cases being able to be closed without proceeding to investigation. In 2024, almost nine in ten provisional enquiries involving GPs were closed without the need for a full investigation with just over one in ten progressing further.

That illustrates the value of obtaining targeted information at an earlier stage, rather than moving straight to a full investigation. It also means fewer doctors, patients and families needing to experience the uncertainty and distress that can accompany lengthy regulatory processes.

Reducing unnecessary investigations is important. But there will always be cases where a full investigation is necessary. We therefore need to think not only about the decisions we make, but also about how people experience the process itself.

Clear communication is a key part of that. We’ve listened to doctors’ feedback and changed the way we communicate, placing much greater emphasis on personal contact and helping people understand what is happening, when and why.

We’ve also strengthened the support available, recognising that being subject to an investigation can be a difficult experience regardless of the eventual outcome.

We’ve also changed the way we handle cases involving health issues, ensuring doctors are treated with compassion and supported appropriately. Where necessary, a process can now be paused so that treatment and recovery can take priority.

But we must also be willing to examine our own systems and challenge ourselves where evidence suggests improvements are needed.

A number of years ago, we undertook a regulatory fairness review and accepted all of its recommendations. I spoke publicly at the time about the fact that bias exists in organisations and systems, including regulatory systems. Recognising that reality is an important part of addressing it.

Since then, we’ve reported publicly each year on the progress we have made.

We’ve also set ourselves goals in areas that sit outside our direct control, but within our sphere of influence.

In 2021, we set a target to eliminate disproportionate employer referrals of black and minority ethnic doctors and internationally qualified doctors. At the time, black and minority ethnic doctors were twice as likely to be referred to us by their employer, while internationally qualified doctors were three times more likely.

Concerned by those differences, we commissioned independent research to understand what was driving them. The resulting report, Fair to Refer?, found no evidence that the disparities were explained by differences in doctors' capability. Instead, it identified a complex range of workplace and system factors that contributed.

That’s why we have worked closely with employers to understand and address the causes.

But there’s more to do, particularly in primary care. Our most recent data showed that designated bodies in primary care were more likely to have disproportionate referral rates than others elsewhere in the system.

We’ve made significant headway and are now close to achieving our goal of eliminating disproportionate employer referrals. We’ve also recently published research drawing on interviews with employers and responsible officers and our existing evidence base. It identifies the key interventions to support more proportionate employer referrals, providing helpful additional insight as we continue this work.

It cannot be right that some groups of doctors have markedly different experiences in the workplace, and as a consequence are more likely to be referred to us by their employer. That’s why we remain committed to eliminating those disparities wherever we find them. The same principle underpins our ambition to eliminate differential outcomes in medical education and training. Fairness must extend across the whole of a doctor's professional journey.

While I’m confident that the changes we’ve made have made a real difference, I know that fairness and proportionality cannot simply be declared. They have to be visible in the way we work. That means being transparent about how our processes operate, the decisions we make and the outcomes we reach. It’s one of the reasons why, later this summer, we will publish a redesigned fitness to practise report.

We publish our data each year, but we want to provide more context around the figures, helping people understand not just the numbers, but what they mean. That helps support a more informed conversation, one that benefits doctors, patients and the public alike.

We also continue to invest in research, engagement and outreach because an appreciation of the experiences and expectations of those affected by our work is fundamental to continuous improvement. Recent public confidence research has also provided valuable insight into how the public views doctors' conduct outside work, and the extent to which those views can affect confidence in the profession. The findings suggest that the public expects regulators to take an interest in serious concerns about behaviour outside the workplace, even where they do not directly involve patient care.

Understanding those expectations is key because it helps us identify where change may be needed.

But there are limits to what can be achieved within a legislative framework that was established more than 40 years ago, in a healthcare system very different from the one in which doctors practise today.

That’s why I’m pleased that the UK government– in consultation with governments across Wales, Scotland and Northern Ireland – has committed to reforming the legislation underpinning our work. And, overall, we have welcomed the government’s proposals for reform as they will give us greater flexibility to modernise our processes, helping us respond more effectively to the realities of healthcare while continuing to protect patient safety and uphold standards.

To conclude, the way regulation is understood and experienced can have a real impact on how doctors work and the decisions they make. That means we must continue listening, learning and changing, while remaining transparent about what we do and why we do it. It means continuing to develop a system that supports doctors to practise confidently and professionally, while maintaining the standards that patients rightly expect.

When doctors have confidence that complaints will be handled proportionately and fairly, regulation can support openness and learning rather than fear and defensiveness.

We have learned a great deal from doctors' experiences and made changes in response, but we recognise there is more to do. We must continue to improve doctors’ experiences of regulation, so that they can focus on giving patients the care they came into medicine to provide.

Thank you.