GMC undertakings are an agreement between you and the GMC about your practice, made at the end of an investigation or at a hearing. Conditions are imposed by a tribunal and can last up to three years. Both can restrict your practice or require retraining, and both are published on the medical register. At CrownEthics, we wrote this guide for doctors who have been offered, or may face, either.

What is the difference between undertakings and conditions?

Both restrict your practice or require you to do something, such as retraining. The difference is how they come about. Undertakings are agreed with you. Conditions are imposed on you by a tribunal.

What do they usually cover?

The GMC says they restrict a doctor’s practice or require them to do something, such as undertake retraining. Supervision is a common example. You are responsible for arranging suitable working arrangements, and your responsible officer must approve them before you start or restart work. The GMC says it will contact you regularly to check progress and may ask others, such as your employer, to confirm that you are complying.

When does a tribunal impose conditions?

The sanctions guidance says conditions might be most appropriate where a case involves health, performance, a specific shortcoming in practice, or language. It describes them as workable where you have insight, retraining or supervision is the most suitable response, the tribunal is satisfied you will comply, and you can respond positively to remediation.

It also says conditions should be appropriate, proportionate, workable and measurable, with clear objectives so you know what is expected and a later review can assess whether the issues are resolved. Suspension is different: it prevents you from practising, and is used where a lower sanction would not be enough to protect the public.

What happens at a review?

Where conditions are imposed, a review hearing is likely. The guidance says the tribunal needs objective evidence that you appreciate the gravity of the matter, have not repeated it, have maintained your skills and knowledge, and that patients will not be put at risk. Conditions can be renewed for a further period at review. A doctor should not return to unrestricted practice unless the tribunal considers it safe.

What if you breach them?

The GMC says it will consider further action if you do not comply, if your health or performance worsens, or if new concerns arise. That can lead to a tribunal referral with more serious outcomes. Speak to your defence organisation as soon as you think you may be struggling to meet a requirement, before it becomes a breach.

How can remediation help?

Conditions and undertakings both depend on insight and evidence of change. Learning that matches the concern, a specific reflection and a record of changed practice all support a review. Our guide to insight and remediation explains what regulators look for, and our remediation portfolio checklist shows how to organise the evidence. If you are earlier in the process, see how the case examiner stage works.

Our GMC remediation courses include Insight, Remediation and Reflection, which support the evidence side, and the GMC Professionalism course covers competence, workplace culture and raising concerns. No course can promise an outcome or replace the advice of your defence organisation.

Sources: the GMC’s information for doctors who have undertakings or conditions and the MPTS sanctions guidance. Check the regulator’s website for current guidance.