Originally introduced for Physician Associates and Anaesthesia Associates, this model aims to streamline decision-making, reduce unnecessary escalation to tribunals, and promote more proportionate outcomes. It is now being positioned as the blueprint for reform across other healthcare regulators.
The current regulatory landscape for other healthcare professionals
The current approach to fitness to practise investigations’ for doctors, nurses, physiotherapists, optometrists and dispensing opticians and dental professionals is a structured and often lengthy pathway. Each statutory regulator, including the General Medical Council, Nursing and Midwifery Council, Health and Care Professions Council, General Optical Council and General Dental Council, operates its own fitness to practise procedures, whilst sharing common principles aimed at protecting the public and maintaining professional standards.
The core stages of the fitness to practise process, as implemented by the various regulators, broadly involve:
- Initial concern and triage
Concerns may be raised by patients, employers, colleagues, members of the public, a self-referral or from the regulator itself. These are triaged to determine whether they fall within the regulator’s remit and whether they suggest there is a risk of impaired fitness to practise.
- Investigation
If the concern is deemed serious enough to raise a fitness to practise concern, a formal investigation is launched. This may involve gathering medical records (where relevant), interviewing witnesses, instructing experts and requesting evidence from the registrant.
- Case Examiner / Investigating Committee review
Case Examiners assess, on the basis of the documentary evidence alone, whether there is a realistic prospect of a finding of current impairment, which may result in the case being closed, the issuing of advice or a warning, or an invitation to agree undertakings or a referral to a fitness to practise hearing.
- Tribunal or panel hearing
If referred, a hearing is held before a fitness to practise panel / tribunal, which considers both documentary and oral evidence and decides whether the registrant’s fitness to practise is currently impaired. The most common and well-known sanctions include a warning / reprimand, conditions, suspension, or erasure from the register.
- Appeals and Reviews
Registrants may appeal decisions, and some sanctions are subject to periodic review.
The process can be lengthy, with cases typically lasting at least a year from initial notification of a complaint, which then progresses all the way to a substantive hearing.
What are accepted outcomes?
The accepted outcomes procedure is a new mechanism that allows regulators to resolve fitness to practise cases without convening a formal panel hearing. Instead, the professional under investigation can agree to a proposed outcome at an early stage —such as a warning, conditions, or undertakings—based solely on the regulator’s paper-based assessment of the case. It is said that this approach is more proportionate, efficient, and less adversarial, while still protecting the public and maintaining confidence in the profession.
The Professional Standards Authority has issued guidance to support regulators in implementing these powers, noting that accepted outcomes should be used where:
- The facts are not disputed;
- The professional accepts the proposed outcome;
- The outcome is sufficient to protect the public and uphold professional standards.
Looking ahead
The accepted outcomes mechanism can offer certain advantages for registrants when used in appropriate cases. The most obvious being the avoidance of lengthy fitness to practise proceedings, which in turn reduces registrants' stress and the overall duration of the process.
However, this may not fit every case. There is a recognition that accepted outcomes are optional, so it is open to a registrant to refuse an accepted outcome offered by their regulator but there may be implications of such a refusal which need to be carefully considered. For instance, it remains to be seen whether regulators will consider a registrant’s refusal of an accepted outcome as evidence of a lack of insight on their part should any subsequent fitness to practise panel find against them.
The assessment of whether a registrant has demonstrated insight into the concerns raised is routinely an integral consideration in terms of both the impairment and sanction stages of fitness to practise proceedings. As such it would be very concerning if a registrant's refusal of an accepted outcome were to be held against them. It seems contrary to the principles of fairness and due process if registrants were penalised for opting for a hearing, to enable the evidence to be properly tested, particularly where cross-examination of the regulator's witnesses is crucial to the case.
If regulators are minded to regard a registrant’s refusal of an accepted outcome as an aggravating factor in subsequent proceedings, this is likely to further exacerbate the pressure registrants may already feel to accept the offer, even where they dispute the facts of the regulator's case or the seriousness of their alleged conduct. The concern that rejecting an accepted outcome might potentially strengthen the regulator's case, and heighten the perceived risks of going to a hearing, may be too unpalatable for some registrants. This is particularly relevant to registrants who are not legally represented or may already feel pressured due to financial or personal circumstances. As a result, some registrants could feel compelled to accept a pre-determined outcome even if it may not be in their best interests
A final thought
In conclusion, while there are potential benefits to these reforms there are also a number of prospective drawbacks, which registrants need to be mindful of as accepted outcomes become more prevalent in healthcare regulation. Not every case is suitable for this approach, and there is a worrying risk that some registrants may feel pressured to accept this pathway which is a real cause for concern. There is a delicate balance to strike between fairness and expedience. Whether an accepted outcome is appropriate in a specific case will depend on the particular circumstances of the matter. It is therefore advisable that registrants seek legal representation and support from their defence organisation promptly if concerns regarding their fitness to practise arise, so such matters can be given timely consideration.
If you are impacted by any of these issues and / or wish to discuss the accepted outcome reforms, please get in touch with our expert Healthcare Team.
Thank you to Rukmanie Hodges and Hannah Cheesebrough for contributing to the production of this article.
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