How Clinical Competence Concerns Are Assessed by the GMC

Many GMC investigations involve allegations of misconduct, dishonesty or criminal conduct. However, the GMC also investigates concerns about a doctor’s clinical competence and professional performance.

These cases can be particularly challenging because they often involve detailed scrutiny of day-to-day practice, clinical judgement and decision-making.

For many doctors, a performance investigation can feel like a direct challenge to their professional identity and years of training. Understanding how the GMC approaches these cases is therefore essential.

What Are Clinical Competence Concerns?

The GMC may investigate where there is evidence suggesting that a doctor’s professional performance has fallen below the standard expected of a reasonably competent practitioner.

Performance concerns can arise in many ways. They may involve repeated clinical errors, poor prescribing, inadequate record keeping, deficiencies in clinical knowledge, failures in assessment or diagnosis, poor decision-making, or a wider pattern of substandard patient care.

The GMC is generally more concerned with persistent or systemic deficiencies than isolated mistakes. Even highly competent doctors can make occasional errors. The regulatory concern usually arises where the evidence suggests that patient safety, professional standards or public confidence may be affected because of ongoing shortcomings in performance.

Deficient professional performance is not about punishing every individual mistake. The central question is whether the doctor’s overall standard of practice raises a current fitness to practise concern.

How Do Performance Concerns Reach the GMC?

Performance concerns may be referred by NHS Trusts, private employers, Responsible Officers, colleagues, patients, families, coroners or other healthcare organisations.

In many cases, an employer or Responsible Officer will attempt to address concerns locally before making a referral to the GMC. However, serious incidents, repeated concerns or evidence of risk to patients may result in earlier regulatory involvement.

The source of the referral matters, but it is not decisive. The GMC will consider the nature of the concern, the available evidence, the level of risk and whether the matter requires regulatory action.

What Is a GMC Performance Assessment?

Where concerns about competence arise, the GMC may direct a formal Performance Assessment as part of its fitness to practise investigation.

The assessment is carried out by GMC-appointed assessors and is tailored to the doctor’s employment or previous employment. Its purpose is to obtain an objective view of the doctor’s professional performance, knowledge and skills.

A Performance Assessment is not simply a decision about whether one allegation is proved. It looks more broadly at the doctor’s overall standard of practice and whether that practice meets the standard expected for the role being undertaken.

The assessors prepare a written report. That report is disclosed to the doctor and may also be disclosed to an employer for whom the doctor provides medical services.

What Does a GMC Performance Assessment Involve?

The precise format will depend on the doctor’s area of practice and the concerns being investigated.

A Performance Assessment will generally involve review of a sample of clinical records and practice documents, interviews with the doctor and relevant third parties, and tests of competence designed to assess knowledge and skills. It may also consider clinical judgement, decision-making, systems of work and the wider context in which the doctor has been practising.

The process can be extensive. Doctors often underestimate the level of preparation required, particularly where the assessment covers a broad period of practice or complex clinical issues.

Because the report may become central evidence in the GMC investigation, preparation should be careful, structured and realistic.

What Happens If You Refuse a Performance Assessment?

Doctors are expected to cooperate with GMC investigations and assessments.

Failure to engage with a Performance Assessment can itself become a significant regulatory issue. It may lead to further action and can make it more difficult for the GMC to assess whether the doctor is safe to practise.

If there are genuine concerns about the assessment process, the scope of the assessment or the doctor’s ability to participate, specialist advice should be obtained before declining to engage.

What Happens If the Assessment Identifies Deficiencies?

A poor Performance Assessment does not automatically end a doctor’s career.

The GMC and any subsequent Tribunal will consider the seriousness of the deficiencies, whether patients were harmed, the doctor’s insight, remediation, evidence of improvement and the risk of repetition.

Many doctors are able to address performance concerns through retraining, supervision, reflection and structured remediation. The critical issue is often not simply whether shortcomings existed, but whether the doctor understands them and has taken meaningful steps to address them.

A doctor who recognises legitimate concerns and can evidence improvement will usually be in a stronger position than a doctor who responds defensively to every criticism.

Why Are Insight and Remediation So Important?

In performance cases, insight and remediation frequently become decisive.

Insight means more than saying that mistakes were made. It requires the doctor to understand what went wrong, why it happened, how patients or colleagues may have been affected, and what needs to change.

Remediation should be targeted to the concerns identified. It may include focused education, supervised practice, mentoring, reflective work, clinical training, audit, professional development or changes to systems of work.

The GMC will want to see evidence that any deficiencies have been identified, understood and addressed. General assurances are rarely enough.

What Are the Possible Outcomes?

Not every performance concern results in formal regulatory action.

Depending on the evidence, the case may be closed with no further action, resolved with advice, result in a warning, lead to undertakings, or be referred to a Medical Practitioners Tribunal.

Undertakings may be appropriate where concerns can be safely managed through restrictions, supervision, training or other safeguards without formal Tribunal proceedings.

If the case proceeds to a Medical Practitioners Tribunal, the Tribunal may impose conditions on registration, suspend the doctor, or, in the most serious cases, direct erasure from the medical register. The outcome will depend on the seriousness of the concerns, the level of risk and the doctor’s response.

Can a Doctor Continue Practising During a Performance Investigation?

Often, yes.

Many doctors continue practising while a GMC investigation is ongoing. However, where there are concerns about patient safety, the GMC may refer the case to an Interim Orders Tribunal to consider interim conditions or interim suspension.

Whether restrictions are necessary will depend on the nature of the allegations, the evidence available and the level of risk identified. The fact that a performance investigation has opened does not mean that restrictions will automatically follow.

Why Early Advice Matters

Clinical competence cases are often among the most complex GMC investigations because they involve detailed clinical evidence, expert opinion, performance assessment evidence and questions about current practice.

The way a doctor responds in the early stages can significantly affect the outcome. In many cases, careful preparation for a Performance Assessment, early engagement with remediation and a strategic approach to the evidence can make a substantial difference.

Specialist legal advice can help ensure that performance concerns are properly contextualised, evidence is presented effectively and opportunities for remediation are identified at the earliest possible stage.

About Jared McNally

I am a Partner and Head of Professional Discipline at Clifford Johnston & Co. I have more than 22 years’ experience representing doctors and other professionals facing serious regulatory allegations, disciplinary proceedings and career-threatening investigations.

My work is focused on protecting professionals when their registration, reputation and future are at risk. I regularly act for individuals and trade union members across the UK in complex regulatory matters, including cases before the GMC and MPTS.

I understand how personal and professionally difficult clinical competence concerns can feel. A GMC performance investigation is not just about one incident or one criticism. It can involve detailed scrutiny of a doctor’s judgement, clinical records, decision-making, knowledge, skills and current fitness to practise. The response must address the evidence carefully, place the concerns in proper context, and show insight, remediation and reduced risk where appropriate.

I am a member of the Association of Regulatory and Disciplinary Lawyers, reflecting my specialist focus on professional regulation and disciplinary proceedings. My approach is direct, strategic and evidence led. As an experienced GMC Solicitor, I help doctors respond to clinical competence concerns, present remediation and supporting evidence, challenge unsupported criticism, manage any proposed undertakings or conditions, and protect their registration, reputation and professional future.