Doctors under the Microscope: the GMC, the DBS and Regulatory Risk.

An article produced by Libby Anderson and Jonathan Meadows of Regulation Resolution.

Introduction

Doctors face a unique regulatory challenge: concurrent investigations by two separate regulators operating under different legal frameworks and standards of proof, each with the power to end their career. Understanding how the General Medical Council (GMC) and the Disclosure and Barring Service (DBS) interact, and diverge, is critical for any doctor facing allegations.

This article examines the overlap between these two regulatory regimes, identifies the tactical challenges this creates for medical professionals, and sets out a strategic approach to representation that accounts for both jurisdictions simultaneously.

The critical issue is not simply that both regulators have this power, but that they exercise it independently, with different legal tests and evidentiary standards, creating scenarios where a doctor may be cleared by the GMC yet barred by the DBS, or vice versa.

Background to GMC and DBS

The GMC is one of ten statutory regulatory bodies governed by the Professional Standards Agency. The GMC supervises registration, training, continuing professional development, and fitness to practise. If the GMC have concerns over a doctor’s fitness to practise, they will investigate the doctor and potentially refer them to the Medical Practitioners Tribunal Service (MPTS) for a hearing.

Aligned with this, but not fully overlapping, is the role of the Disclosure and Barring Service, a non-departmental public body established under the Safeguarding Vulnerable Groups Act (SVGA) 2006. Its job is to vet all individuals who want to work or volunteer with vulnerable people. It does this by assessing the potential risk caused to vulnerable adults or children by those working in regulated activity, and taking steps to bar those who are deemed to present a risk of harm. It maintains two barred lists, the children’s list and the vulnerable adults list; anyone appearing on one or both of those lists cannot work with children and/or vulnerable adults. Health care provided by a health care professional, such as a doctor, is regulated activity as defined by Schedule 4 of the SVGA 2006. Adult patients are always classified as vulnerable adults. If a doctor is on the DBS barred list, they cannot work in regulated activity, which means they cannot practise.

When concerns arise, they are often the subject of separate investigation by both regulators, and doctors can find themselves subject to concurrent fitness to practise proceedings and a barring decision. This combination of regulatory oversight ensures that doctors are competent and fit and proper people to be trusted with treating members of the public in highly vulnerable, often life-threatening situations.

The Overlap between GMC and DBS

There is significant overlap between the GMC and the DBS in terms of the role they play in safeguarding the public and ensuring only suitable people are practising as doctors, the material they consider in coming to their respective decisions, and information sharing.

Referrals to the GMC can come from employers, patients, members of the public, or even the police. If the police have cause to investigate, arrest or charge a doctor with a criminal offence, it is common for the doctor to be automatically reported to the GMC and any relevant information arising from the investigation to be passed over. This may apply even where there has been a decision not to prosecute, where a caution has been accepted, or where the offence is totally unrelated to the professional role. The GMC also places a positive duty on doctors to self-report any caution, charge, conviction, or adverse finding by a regulatory body or formal inquiry.

The DBS is not itself an investigatory body. It relies upon other organisations such as the police, the GMC, or the employing NHS Trust, to investigate concerns and then provide that material in the form of a referral. This includes police material, accounts given by doctors at any stage, and findings of fact and impairment in fitness to practise proceedings. The DBS then considers the material provided using their own risk analysis tools, and decide whether or not the subject of the referral should be barred from working with children, vulnerable adults, or both. Frequently, a referral to the DBS will be made at the same time as a referral to the regulator or the police.

Having become aware of any concerns raised, whether criminal, personal or professional, there is a process by which the GMC can make a referral to the DBS where they consider a doctor poses a safeguarding risk, even outside of formal patient relationships or clinical settings. As yet, there is no bilateral agreement between the DBS and the GMC. However, the GMC has published Guidance on making referrals to the Disclosure and Barring Service, available online.

The GMC can make a referral where:

(i) it is thought that a doctor has committed an autobar offence (a serious offence, normally violent and/or sexual, specified in the SVGA 2006), has engaged in relevant conduct, or may cause harm to a child or vulnerable adult in the future, and

(ii) where the doctor has been, is currently or may in future be involved in regulated activity with a child or vulnerable adult, and

(iii) the GMC is satisfied that the DBS may bar the doctor because of the conduct in question (the ‘may bar’ test). The conduct may have taken place in the UK or overseas.

Detailed guidance on each of these conditions is set out in the document referred to above. Even if the conditions are met, the GMC has a general discretion not to refer to the DBS in appropriate cases and provided there are good reasons for not doing so, for example, if another regulator or public body has already reported the doctor to the DBS in relation to the same matter. The DBS also has the power under section 42 of the SVGA 2006 to request specific information about a doctor from the GMC. This power is only used occasionally, but the GMC’s general stance is to comply with any such request subject to the nature of the information requested.

The GMC is a ‘competent body’ for the purposes of the Safeguarding Vulnerable Groups Act 2006. The DBS will usually use competent body findings of fact as facts in barring decision-making processes, unless there is information that causes the DBS to take a different view, but they are no longer bound to do so. It is common for the DBS to adopt the findings of fact of a competent body such as the GMC, for example, the facts found proven in the course of fitness to practise proceedings. This does not mean, however, that the DBS and GMC are bound to come to the same conclusion as to the future risk presented. It is possible for a doctor to face fitness to practise proceedings and be allowed to return to practise by their regulator having been found unimpaired, but then find that the DBS, taking a different view of the level of risk presented, place them on the barred list, preventing them from working in regulated activity.

Challenges for medical professionals

Being subject to regulation by both the GMC and DBS means that doctors and their representatives need to be aware of potential DBS proceedings as they respond to GMC charges, whether in writing or in oral evidence, because anything stated could be referred to in a barring decision. This is the case even where a doctor’s actions may be found not to be in breach of Good Medical Practice or not to amount to misconduct.

In considering impairment, the GMC must decide whether a doctor poses “a current and ongoing risk […] requiring restrictive action in response” (see Guidance for MPTS Tribunals, Section three: MPT hearings, Part B: stage two – impairment, published 30 September 2025). The analysis of impairment factors in the seriousness of the facts found proved, any relevant context about the doctor or their work environment, and how the doctor has responded to the allegations. This includes assessing the risk of the conduct being repeated in future, and the doctor’s level of insight and remediation. If a doctor poses no current and ongoing risk to public protection, a finding of no impairment will be made. If a finding of impairment has been made, then this means the GMC has found that the doctor poses a current and ongoing risk.

For someone to be placed on the barred list, the DBS must find that the person has at any time engaged in relevant conduct and is, or has been, or might in future be engaged in regulated activity relating to children or vulnerable adults, and that it is appropriate to include that person in the barred list (see SVGA 2006, Schedule 3). The statute defines each part of the test:

•  Relevant conduct includes that which endangers or is likely to endanger a child or vulnerable adult, or which would do if repeated. Relevant conduct explicitly includes sexual material relating to children or vulnerable adults, and violent sexual material.
• A person’s conduct endangers a child or vulnerable adult if it harms a child or vulnerable adult, causes a child or vulnerable adult to be harmed, puts a child or vulnerable adult at risk of harm, attempts to harm a child or vulnerable adult, or incites another to harm a child or vulnerable adult. Harm can be physical or mental.

Notwithstanding these definitions, there remains a broad scope of possible interpretations, and ‘harm’ is a relatively low threshold – arguably, almost anything could cause harm. For example, it is obvious that if a consultant surgeon brands their initials onto a patient’s liver, harm will be caused to that patient (see Liver-branding surgeon Simon Bramhall struck off medical register’, published 11 January 2022). That consultant would inevitably face criminal prosecution, regulatory investigation, and would be placed on the DBS barred list. This is an example of a high degree of physical harm committed in a clinical environment. Not all situations are so clear cut. If a tired, stressed resident loses their temper and shouts at a patient, this could be said to cause harm or potentially cause harm if repeated in future.

The GMC Guidance sets out over 40 examples of situations where they will consider whether or not to refer a doctor to the DBS and sets out the GMC position and guiding principles for each scenario. Some examples are summarised as follows:

Example 1: A doctor prescribes wrong medication or in excess of recommended dose to a patient, or prescribing unlicensed medicine as a result of intention to cause harm or such a callous disregard for procedure as to make the doctor a safeguarding risk. This may include where a pattern of harmful behaviour is demonstrated. In this case, the ‘may bar’ test may be met if the doctor intended to cause harm or where the doctor has abused their position of trust, and a referral to the DBS may be appropriate. The GMC will consider insight, remediation, and risk of repetition.

Example 2: A doctor provides false information to the GMC or another regulatory body. This may constitute ‘relevant conduct’ depending on the nature and extent of the false information given, and how seriously it undermines the regulatory body’s ability to carry out its statutory functions and protect the public. It will also depend on whether the false information was provided due to carelessness or whether it was calculated and deliberate dishonesty; the latter would suggest a callous disregard for procedure and may indicate a specific and serious risk of future harm to vulnerable adults and children. In such cases, the ‘may bar’ test is met and a referral is appropriate.

Example 3: A doctor engages in an inappropriate emotional relationship with a patient that breaches professional boundaries, for example, sending Facebook messages. The relevant conduct criteria will be met if professional boundaries have been breached in these or similar circumstances, because the patient will be at risk of emotional and psychological harm. The ‘may bar’ test may be met depending on the facts and circumstances of each individual case, in particular the overall seriousness of the doctor’s actions e.g. if the conduct was sexually motivated or the doctor inappropriately accessed patient records to obtain the patient’s contact details.

Finally, as a general point, if a doctor is found to have treated children or vulnerable adults while their fitness to practise was impaired for reasons connected to their health, performance, or lack of knowledge of the English language, this will amount to relevant conduct. This is because by treating patients whilst impaired, they have engaged in an act which endangers a child or vulnerable adult or is likely to do so.

Practical Guidance for Medical Professionals

In many ways, there is greater potential for a doctor to remain in practice following a GMC investigation compared to a DBS barring decision. If a doctor is found to be impaired by the MPTS, they may be made subject to conditions, or suspended, or struck off. In the case of conditions and suspension, these sanctions are strictly time-limited, and it is standard for individual cases to be reviewed periodically to reassess impairment and either continue the order, impose a more suitable order, or allow the doctor to return to practice unrestricted. Even in the event of strike off, doctors can apply for restoration to the register after a period of five years. In DBS cases, a barred person can only request a review of their barring decision in very particular circumstances, such as that they no longer work in regulated activity, the minimum barring period (10 years for adults) has expired, or new information has become available. There is also the right to appeal against a barring decision to the Upper Tribunal, but this is a lengthy, expensive and difficult process.

It is therefore in a doctor’s interests to prepare to address all potentially relevant conduct in a GMC case, even where that conduct is not the direct subject of a charge. This requires careful preparation before any hearing, and detailed scrutiny of the evidence to identify potential problem areas. This approach ensures that, in live evidence, the accounts given by GMC witnesses can be rigorously tested, and the doctor’s case can be fully explored, including relevant contextual matters. In many cases it will be in the doctor’s best interests to make admissions to some or all of the allegations raised, which paves the way for robust submissions as to insight and remediation to be made. However, any decision to make admissions must be carefully balanced against the potential findings in relation to impairment and sanction, and taking the strength of the evidence into account.

This is not to say that if a doctor does not make admissions, they cannot demonstrate insight and remediation. This is not the case. This is a well-established principle, provided for in the MPTS Guidance for medical practitioners tribunal hearings at paragraphs 89 and 90, and also in regulatory case law such as Sayer v General Osteopathic Council [2021] EWHC 370 (Admin) at [25], and more recently Gleeson v SWE [2024] EWHC 3 (Admin) at [139] to [148].

Doctors have the right to advance a robust defence to an allegation, including requiring the GMC to prove their case and bring witnesses to hearings. This may mean, for example, that an apology may not be forthcoming until after a witness has engaged in a hearing, and it may not be realistic to expect a doctor to immediately accept every finding in a fully sincere manner in the event of an unsuccessful defence. Even in such cases, a doctor can still provide some evidence of insight without having fully admitted to the circumstances of the allegation. However, in the absence of admissions, it is incumbent upon the registrant to demonstrate by other means that they understand the seriousness of the allegations and that steps have been taken to ensure that similar conduct would not occur in the future. This could be done through the provision of a reflective statement, through oral evidence at a hearing, or through evidence of remediation or retraining.

The GMC will not necessarily make findings of fact on every single issue raised, especially where they are not particularised in a charge, but it is important to try hard to avoid any unfavourable findings of fact at all. Where unfavourable facts are found, the doctor should try to address these by explaining the context, demonstrating reflection and insight, and carrying out remediation, with a view to showing that there is no risk of repetition in the future. A finding of no impairment and minimal risk of repetition allows for strong submissions on proportionality to be made to the DBS.

Being placed on the barred list can seriously hinder a doctor’s ability to respond to regulatory proceedings. A doctor who has been placed on the barred list may be at a disadvantage at the impairment or sanctions stage of regulatory proceedings. This is because if they have been barred, they will be unable to work and will be limited in what remediation they can show. It will also be harder to demonstrate safe practice or show that they have kept their skills current whilst unable to work. All these matters make it harder to show that there is no, or minimal, risk of repetition of the conduct in future, making it more likely that impairment will be found and that a more serious sanction is deemed necessary.

Historically, it was possible to persuade the DBS to stay their barring decision pending the outcome of any regulatory proceedings. This had the advantage of ensuring that the DBS had the benefit of the regulators assessment of the facts and current and impairment, whilst ensuring that the registrant was not disadvantaged at the impairment or sanction stage. However, this is becoming less and less common, particularly with the recent decision of XYZ v DBS (2025) EWCA Civ 191, which held that the decisions of regulatory bodies are not binding on the DBS.

Conclusion

In conclusion, medical professionals should be aware that their conduct could be the subject of scrutiny both by the GMC and the DBS, and that there is significant scope for information about doctors to be shared with and by both regulatory bodies.

The action taken by each regulator will normally be very fact and context specific. Both regulators will assess the harm caused or potential future risk of harm caused by the conduct, the risk of repetition, and the level of insight and remediation shown by the doctor, in order to analyse the risk to the public and whether any steps need to be put in place to protect the public. These steps could include conditions or suspension of a doctor’s registration by the GMC, or being placed on one or both barred lists by the DBS. Once subject to any form of restriction, it becomes harder to demonstrate insight and remediation, making it more difficult for a doctor to resume safe and unrestricted practice.

With this in mind, where criminal or regulatory concerns arise, it is critical to seek expert representation at the earliest opportunity, preferably by lawyers with experience in all relevant jurisdictions. This will ensure consistency in approach and ensure that appropriate tactical decisions are made so that the doctor’s position is best protected at each stage, whether that means making appropriate admissions, challenging the evidence at a hearing, or submitting detailed evidence of reflection, insight and remediation.