What do I do?

A referral to the General Medical Council (GMC) is an extremely worrying thing for any doctor. Understanding how it works is essential to identifying what will happen, when and what you should be doing.

The first thing to know is that a referral to the GMC does not necessarily mean you will face action. They will generally only take action if the complaint is serious enough and they take the view that, if true, your fitness to practise may be impaired.

The second thing to know is that a referral to the GMC starts a process which can and ordinarily is very long and drawn out.

The third thing you need to know is that it is always in your best interest to co-operate. Burying your head in the sand may work for a short time but very quickly it will do nothing but work against you – and may even be used as evidence against you later.

The fourth and final thing you need to know – get professional advice. Find a representative who actual specialises in this whether that be your union or private representation. Do your homework and make sure you have representatives you are experts in GMC defence. Doing this early will save you time, money and very possibly your career.

So how does it work?

Initial assessments.

All complaints made are considered on an initial basis to see if it warrants an investigation. This may involve some provisional enquiries. Any cases which are deemed not to be appropriate for their consideration will likely be referred to your responsible officer for local administration.

If it is decided that the complaint is suitable the GMC will open an investigation.


It may well be that the first you hear about the complaint at all is when the GMC contact you to just prior to an investigation opening. You will be informed about the complaint and will have the opportunity to comment. This will come in the form of a ‘Rule 4 Letter’. There seems to be a growing trend in people being advised to say nothing. We consider, in many cases, that this is a major error in judgement. Remember that this is not the only chance you will get to comment or respond but it is without doubt the most valuable.

You will also be asked, assuming the GMC do not already know, for the details of your employer. They will also be contacted and asked if they have any concerns about your fitness to practise.

The investigation will then proceed as you might expect. Remember that without a response from you, people who are helpful to you may not be spoken to or facts you advance considered. The GMC investigation could cover everything from documentary evidence, internal papers, witness statements from anyone relevant and indeed experts, assessments on you including your competence, performance and health.

You are entitled to be informed throughout how matters are progressing and should make sure your representative is keeping up to date with the GMC on developments on your behalf. It is best to have a conduit to make sure any response or information from you goes through your lawyer. Please remember anything said or done by you at this stage will be included. To give an example – we have recently represented doctors who instructed lawyers to send cease and desist letters to the party behind the complaint. The letters asked them to stop posting information online and to withdraw the allegation. This, rather than the actual referral, ended up being the main problem in their case.

Interim orders may become an issue at this stage so please see our blog for further details on that.

Upon conclusion of the investigation the evidence collated by the GMC will be sent to the case examiners. First however, they will write to you to give you the opportunity to comment. This comes in the form of the Rule 7 Letter. If you have decided not to comment already – this is the point at which we advise you absolutely must. The case examiners will decide what happens from there.

Please see our next blog for information on case examiners and the dreaded Rule 7 letter.

Do not hesitate to contact us if you have any questions.

Stephen McCaffrey and Catherine Stock