Assessing insight when a registrant denies allegations in fitness to practise proceedings

The Medical Practitioners Tribunal Service (MPTS) has published revised tribunal guidance that will come into effect on 24 November 2025.

This update, the MPTS said, introduces “clearer decision-making frameworks for panels assessing allegations in fitness to practise proceedings.” Key areas of focus include professional boundaries, online and social media conduct, and a more structured approach to aggravating and mitigating factors. The guidance also refines how tribunals handle dishonesty and sexual misconduct cases and has been reorganised for improved clarity and consistency.

Key substantive changes

Professional boundaries

The updated guidance places greater emphasis on context and power imbalance when evaluating breaches of professional boundaries. Tribunals are directed to assess patterns of behaviour, the vulnerability of those affected, and the doctor’s position of trust or authority. Factors such as consent, recurrence, supervision arrangements, and the doctor’s role in enabling or preventing the conduct are now explicitly listed.

Social media and online conduct

For the first time, social media and online behaviour are explicitly addressed. Tribunals are instructed to consider the intent behind posts, their reach, any breach of confidentiality, and the impact on individuals and public confidence. Remediation efforts—such as removing content or issuing apologies—must be supported by evidence of insight and behavioural change.

Aggravating and mitigating factors

The guidance expands and clarifies the lists of aggravating and mitigating factors. Panels are expected to explain how each factor influences their assessment of seriousness and sanction. Aggravating factors include repeated misconduct, targeting behaviour, and harm to vulnerable individuals. Mitigating factors such as early admission, effective remediation, and positive references must be supported by objective evidence.

Dishonesty and sexual misconduct

Tribunals are now required to apply refined thresholds and reasoning in dishonesty and sexual misconduct cases. The guidance stresses the seriousness of these allegations and the importance of demonstrating insight and rehabilitation before considering restoration or reduced sanctions. Panels must show how their decisions align with GMC standards and relevant case law.

Structure and examples

The revised guidance has been reorganised for easier navigation and includes practical examples and indicators of seriousness to support consistent decision-making.

Comparison with previous hearing resources for doctors

Earlier MPTS hearing resources for doctors focused primarily on procedural aspects of hearings, such as timelines and general expectations. They offered limited guidance on behavioural assessment and emerging conduct contexts.

The new guidance, effective 24 November 2025, builds on these resources by introducing substantive criteria for evaluating conduct, remediation, and insight. Doctors and representatives should now rely on the updated guidance to ensure their submissions and evidence align with current tribunal expectations.

Insight in the absence of an apology

An apology is frequently viewed as tangible proof of reflection. However, an absence of apology — particularly when coupled with a denial of wrongdoing — does not automatically mean there is no insight.

When assessing insight without an apology, panels may, amongst other things, look for:

1. Engagement with the process:

Does the registrant acknowledge the concerns raised, even if disputing the factual allegations?

2. Reflection on wider professional duties:

Has the registrant shown understanding of the ethical or communication issues underlying the case? Insight may be shown through acknowledgment of systemic weaknesses or personal stressors that contributed to the concerns.

3. Evidence of remediation:

Even if the registrant denies the allegations, have they undertaken relevant training, supervision, or audits to mitigate any perceived risk? Proactive remediation can strongly indicate genuine insight.

4. Awareness of public confidence:

 The registrant may recognise how the situation could appear to others and how trust in the profession could be affected, regardless of whether they accept fault. This awareness of perception and professionalism can itself evidence insight.

The overarching aim of any fitness to practise process is to protect the public, maintain confidence in the profession, and uphold standards. A nuanced approach to insight ensures fairness to registrants who, for legitimate reasons, maintain their innocence.

 Conclusion

In healthcare regulation, insight remains one of the most powerful indicators of fitness to practise. However, genuine insight is not confined to those who confess or apologise. A registrant who maintains their innocence can still show deep understanding of professional expectations, awareness of public confidence, and proactive remediation.

The Case for Early Legal Advice

Given the potential regulatory consequences, healthcare professionals facing dilemmas about raising concerns—or those subject to investigation for failing to do so—should seek early, specialist legal advice. Kings View Chambers offers expert legal representation in GMC fitness to practise matters. Their barristers specialise in regulatory law and understand the nuances of professional obligations, workplace culture, and evidentiary standards. Early engagement can help healthcare professionals navigate investigations, prepare robust responses, and protect their careers.