GMC Case Examiner Stage Explained

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GMC · Case Examiner Guide

What Happens at the GMC Case Examiner Stage? Warning, Undertakings or Tribunal

By CrownEthics Reviewed by qualified professionals 9 min read Updated 7 October 2026

GMC case examiners are a medical and a lay decision-maker who review the evidence at the end of an investigation and decide how the case ends: no further action, a warning, agreed undertakings, or referral to a tribunal hearing. They apply a “realistic prospect” test, and they weigh how well a doctor understands what happened and what has changed since. At CrownEthics, we wrote this guide for doctors whose case is at, or heading for, that stage.

Do this first

Before case examiners decide

1

Speak to your medical defence organisation. They know your case and will advise on what to include in your response.

2

Read the evidence in full. Note what is disputed, what is accepted and what is missing context.

3

Keep to the deadline. If you need more time, any extension request normally goes through your adviser.

4

Show insight and what you have changed. Specific, dated evidence carries more weight than general assurances.

5

Do not contact the person who raised the concern. It can be misread as trying to influence the process.

Who are the GMC case examiners?

There are two of them: one medical and one lay. They review the evidence collected during the investigation, including your response to the allegations, and decide the outcome together. If they disagree, the case goes to the GMC’s Investigation Committee.

Their decision usually follows your Rule 7 letter and your written response. For many doctors that response is the main opportunity to put their account, and their evidence of change, in front of the decision-makers.

2Case examiners, one medical and one lay
4Main outcomes available
2 yrsWarning published on the register

What test do case examiners apply?

They apply the “realistic prospect” test. In the GMC’s words, they ask whether there is a realistic prospect of establishing that a doctor’s fitness to practise is impaired to a degree justifying action. If there is not, the case can close. If there is, they decide whether a warning, undertakings or a tribunal referral is the right response.

What outcomes can they reach?

1No further actionCase closes+
The case ends with no restrictions. Case examiners can also issue advice, which is a formal response that does not restrict your practice.
2A warningPublished for a set period+
A warning does not restrict your practice, but it is published on the register for a period, which the GMC’s guidance gives as two years, and it remains on your GMC record.
3Agreed undertakingsAgreed with you+
Undertakings are an agreement between you and the GMC about your future practice. They can include restrictions or commitments such as retraining, and you can discuss the wording with your adviser before agreeing.
4Referral to a tribunalMPTS hearing+
Where there is a realistic prospect of impairment that justifies action, the case can be referred to the Medical Practitioners Tribunal Service. The MPTS is independent of the GMC and decides impairment and sanction at a hearing.

What do case examiners weigh?

The GMC’s decision guidance sets out the factors. In summary, they look at:

  • Seriousness: the nature and gravity of the departure from professional standards.
  • Insight and remediation: evidence that you understand what went wrong and have put it right.
  • Risk of repetition: whether the same thing is likely to happen again.
  • Public interest: whether public confidence in the profession would be undermined.
  • Context: your working environment, role, experience and personal circumstances at the time.

Insight and remediation are the two factors you can still influence. The seriousness of the original event is fixed, but a clear understanding of it and specific evidence of change are not.

Illustrative scenario (fictional)

Two doctors respond to a similar allegation about a delayed escalation. The first writes that the delay was due to workload, that it will not happen again, and attaches a general CPD certificate. The second explains what happened at each point, accepts where her judgement fell short, describes the escalation process she now follows, and attaches a certificate for a course that addresses escalation, with a dated reflection on what she changed. Neither outcome is guaranteed, but the second gives case examiners specific evidence of insight and remediation to weigh.

What evidence helps most?

The strongest evidence is specific, relevant and dated. A course can be part of it when it matches the concern and is followed by honest reflection and a change in how you work.

Our GMC remediation courses include Insight, which teaches the four-part framework behind the insight decision-makers look for; Remediation, which shows how to evidence change over time; and Reflection, which helps you write an account that says something specific. If your concern turns on consent, candour or probity, the GMC Ethics course covers them in depth.

If a defence organisation has already recommended a course, our guide on what happens next explains how to choose and use it.

What a course can and cannot do

A course can build understanding and leave you with dated evidence that you took the concern seriously. It cannot change the facts, guarantee that a case will close, or replace the advice of your medical defence organisation. Use it as one part of your response, guided by the people advising you.

Sources: the GMC’s guide for doctors reported to the GMC and its case examiner decision guidance. Check the GMC’s website for current guidance.

Build your evidence

Courses that support insight and remediation

The courses mentioned in this guide, with CPD hours.

1.5CPD hrs
Insight: Understanding Your Mistakes

The four-part framework behind the insight case examiners assess

£49
1.5CPD hrs
Remediation: Demonstrating Change

How to show, with dated evidence, that the gap has been closed

£49
1.5CPD hrs
Reflection: Learning from Your Practice

Reflective accounts that say something specific

£49
2.5CPD hrs
Ethics & Ethical Standards for Doctors (GMC)

Consent, confidentiality, candour and probity in depth

£75
All 4 courses aboveAutomatic discount, no code needed
£222 £188.70 Save £33.30
View GMC remediation courses
Questions answered

Frequently asked questions

What do GMC case examiners do?+
Case examiners review the evidence at the end of the GMC’s investigation, including your response, and decide how the case should end. They can close it with no further action, issue a warning, agree undertakings with you, or refer it to the Medical Practitioners Tribunal Service for a hearing.
Who are the GMC case examiners?+
There are two, one medical and one lay. Together they decide the outcome. If they disagree, the case goes to the GMC’s Investigation Committee to decide.
What is the realistic prospect test?+
It is the test case examiners apply. They ask whether there is a realistic prospect of establishing that a doctor’s fitness to practise is impaired to a degree justifying action. If there is not, the case can close. If there is, they consider a warning, undertakings or referral to a tribunal.
Can I respond to the evidence before case examiners decide?+
Yes. Doctors are given the evidence gathered and can comment on it, usually through the written response invited in the Rule 7 letter. Your medical defence organisation will advise on what to include, so speak to them before you reply.
Will a warning appear on the medical register?+
A warning is published on the register for a set period, which the GMC’s guidance gives as two years, and it stays on your GMC record after that. Check the GMC’s current publication and disclosure policy, because the detail can change.
How long does the case examiner stage take?+
The GMC’s guide for doctors says the decision itself typically takes around three weeks once the investigation is complete. The investigation before it usually takes much longer, so check current timescales with the GMC or your adviser.
Does completing a course change what case examiners decide?+
No course can promise an outcome. Case examiners weigh seriousness, insight, remediation, the risk of repetition, the public interest and the context. A relevant course, followed by honest reflection and evidence of changed practice, can help you show insight and remediation, alongside your adviser’s advice.

This is educational content, not legal advice. If you are facing a live GMC concern, contact your medical defence organisation first. No course or outcome is guaranteed.