When healthcare professionals appear before fitness to practise panels, their level of insight often plays a central role in determining both current impairment and sanction. Panels expect registrants to reflect on the concerns raised, understand their implications, and demonstrate steps to prevent future risk.

Yet one of the most challenging situations arises when a registrant does not apologise and maintains their innocence despite findings of fact or ongoing allegations. How can a panel assess “genuine insight” in such circumstances?

This article explores that question, drawing on recent and established principles from fitness to practise case law and regulatory guidance, including reference to the recent case of Foy-Yamah v General Medical Council [2025] EWHC 2846 (Admin).

What does “insight” mean in fitness to practise?

Across healthcare regulators, “insight” describes a registrant’s ability to understand and reflect upon:

• what went wrong or gave rise to concern,
• the impact of their actions (or alleged actions) on patients, colleagues, and public confidence, and
• the steps they have taken, or will take, to ensure such concerns are not repeated.

It goes beyond mere apology or remorse; it is about awareness, reflection, and change.  Evidence of reflection and remediation is key to determining whether a practitioner’s fitness to practise is currently impaired.

Remorse and apology may evidence insight, but they are not necessarily synonymous with it. A practitioner may feel deeply reflective and committed to improving standards without offering an explicit apology — especially if they maintain that the allegations are unfounded.

The role of insight in decision-making

Fitness to practise panels must consider insight at two stages:

1. Impairment: Does the registrant currently pose a risk to patients or public confidence? A lack of insight often points to an ongoing risk of repetition.
2. Sanction: Where impairment is found, the depth of insight helps determine whether a lesser or more severe sanction is needed to protect the public and uphold professional standards.

Panels are therefore required to make explicit findings on the registrant’s level of insight and whether it demonstrates genuine remediation and learning.

Insight in the absence of an apology

An apology is frequently viewed as tangible proof of reflection. However, an absence of apology — particularly when coupled with a denial of wrongdoing — does not automatically mean there is no insight.

When assessing insight without an apology, panels may, amongst other things, look for:

1. Engagement with the process:

Does the registrant acknowledge the concerns raised, even if disputing the factual allegations?

2. Reflection on wider professional duties:

Has the registrant shown understanding of the ethical or communication issues underlying the case? Insight may be shown through acknowledgment of systemic weaknesses or personal stressors that contributed to the concerns.

3. Evidence of remediation:

Even if the registrant denies the allegations, have they undertaken relevant training, supervision, or audits to mitigate any perceived risk? Proactive remediation can strongly indicate genuine insight.

4. Awareness of public confidence:

 The registrant may recognise how the situation could appear to others and how trust in the profession could be affected, regardless of whether they accept fault. This awareness of perception and professionalism can itself evidence insight.

The overarching aim of any fitness to practise process is to protect the public, maintain confidence in the profession, and uphold standards. A nuanced approach to insight ensures fairness to registrants who, for legitimate reasons, maintain their innocence.

 Conclusion

In healthcare regulation, insight remains one of the most powerful indicators of fitness to practise. However, genuine insight is not confined to those who confess or apologise. A registrant who maintains their innocence can still show deep understanding of professional expectations, awareness of public confidence, and proactive remediation.

The Case for Early Legal Advice

Given the potential regulatory consequences, healthcare professionals facing dilemmas about raising concerns—or those subject to investigation for failing to do so—should seek early, specialist legal advice. Kings View Chambers offers expert legal representation in GMC fitness to practise matters. Their barristers specialise in regulatory law and understand the nuances of professional obligations, workplace culture, and evidentiary standards. Early engagement can help healthcare professionals navigate investigations, prepare robust responses, and protect their careers.