Excessive fitness to practise referrals leave UK health professionals under growing strain

Across the UK’s health and care sector, concern is growing about the excessive and unnecessary use of fitness to practise (FtP) referrals by employers, with evidence from multiple regulators showing that a substantial proportion of referrals are premature, disproportionate, or should have been resolved locally.

While fitness to practise processes are designed to protect the public, regulators themselves have repeatedly acknowledged that inappropriate referrals can cause serious and avoidable harm to registrants, contributing to stress, anxiety, and long-term damage to professional wellbeing — even where no regulatory action is ultimately taken.

The hidden cost of inappropriate fitness to practise referrals

Regulatory data and thematic reviews consistently show that many employer referrals are closed at an early stage, often because they fail to meet the statutory threshold for fitness to practise or relate instead to capability, performance management, workplace conflict, or health issues.

For the individual health or care professional, however, the consequences can be profound.
Being referred to a regulator — regardless of outcome — commonly leads to:

• Significant stress and anxiety

• Deterioration in mental health and sleep

• Fear about reputation, employment, and career progression

• Prolonged uncertainty lasting many months or even years

From our experience, professionals often tell us that the referral itself is more damaging than the alleged concern, particularly where the issue could have been addressed through supportive local management.

Regulators acknowledge the problem — and seek to reduce unnecessary referrals

UK regulators including the GMC, NMC, HCPC and others have all introduced employer-facing guidance, decision-making frameworks, and employer advice services aimed specifically at reducing unnecessary or premature fitness to practise referrals.

A consistent message runs through this guidance:

Fitness to practise should be a last resort, not a risk-management default.

While much of this guidance is directed at employers, it also highlights important steps that health and care professionals themselves can take to protect against inappropriate escalation.

What health and care professionals can do to protect themselves

Drawing collectively from regulator guidance, employer advice services, and fitness to practise data, the following actions are repeatedly identified as effective safeguards:

1. Seek expert regulatory or legal advice at the earliest opportunity, before concerns are framed or escalated as fitness to practise matters.
2. Understand the fitness to practise threshold and challenge concerns that relate to capability, performance, or health rather than impairment.
3. Request local resolution first, including supervision, retraining, mediation, or a performance improvement plan.
4. Keep independent, contemporaneous records of incidents, meetings, feedback, and remedial steps.
5. Demonstrate insight and reflection early, supported by written evidence linked to professional standards.
6. Request occupational health involvement where health or wellbeing is a factor, to prevent inappropriate disciplinary framing.
7. Insist on clear, specific, and evidenced allegations, rather than vague or emotive assertions.
8. Ensure capability and conduct processes are not wrongly conflated, a recognised driver of unnecessary referrals.
9. Contextualise any previous incidents carefully, clearly showing remediation and sustained improvement.
10. Challenge disproportionate or premature referral decisions through HR, professional bodies, or speaking-up routes.

Taken together, these steps reflect what regulators themselves say should happen before a referral is made and can substantially reduce the risk of avoidable regulatory investigation.

Why early specialist defence advice matters

From our work as specialist fitness to practise defence lawyers, we know that early engagement makes a critical difference — not only to outcomes, but to a professional’s wellbeing during the process.

Early advice can:

• Prevent concerns being misclassified as FtP matters

• Ensure proportionate and accurate framing of issues

• Protect against procedural unfairness

• Reduce stress by providing clarity and strategic direction from the outset

At Kings View Chambers, we focus exclusively on fitness to practise defence.
With over 30 years of combined specialist experience, we are recognised as one of the leading teams in this field, particularly in GMC and MPTS defence.

We understand that fitness to practise investigations are not just regulatory processes — they are deeply personal, often distressing experiences that can affect careers, wellbeing, and reputation.

Our approach is built on:

• Expertise – decades of specialist FtP defence experience

• Empathy – recognising the anxiety and uncertainty professionals face

• Excellence – consistently rated “excellent” by clients

• Support – guiding you through every stage with professionalism and care

We offer a free, no-obligation telephone consultation, allowing you to speak directly with one of the most experienced fitness to practise defence teams in the UK.