Fitness to practise in New Zealand: complaints, competence and discipline

In New Zealand, "fitness to practise" covers three things: your competence, your health and your conduct. All of it sits under the Health Practitioners Competence Assurance Act 2003 (the HPCA Act), which exists to keep the public safe by ensuring every registered practitioner is competent and fit to practise. The Act set up 18 responsible authorities, one for each profession or group, from the Medical Council and Nursing Council to the Paramedic Council and the Chinese Medicine Council.

Four bodies do most of the work when something goes wrong:

One tribunal, the HPDT, hears charges for every registered profession. It has operated since 18 September 2004. That shared structure is why the pathway below applies whether you are a GP, a registered nurse, a dental hygienist or a physiotherapist, even though each authority runs its own triage and uses its own code.

Most matters stop early. Only a small share reach formal investigation, and fewer still reach the Tribunal. Here is the full route, from first contact to appeal.

1. A concern is raised. A patient or anyone else complains; a colleague or employer reports a competence worry (an employer is obliged to tell the RA if someone leaves or is let go over competence); a court conviction is notified; or someone raises a health concern.
2. HDC comes first for consumer complaints. Complaints about how you treated or behaved towards a health consumer are sent to HDC first; the RA must wait for HDC's decision before acting on that complaint, other than to protect the public in the interim.
3. HDC assesses the complaint. The Complaints Assessment Team can close the complaint, send it back for you and the complainant to work through with support from the Nationwide Health and Disability Advocacy Service, hand it to the RA, the Privacy Commissioner or another agency, make recommendations such as an apology or education, or open a formal investigation.
4. Formal investigation (only a minority of complaints). Your written response is normally due within 15 days. HDC may take advice from a clinician in your field, sends you a provisional opinion to comment on, and then reaches a final view on whether the Code was breached. The final report usually goes to your RA, and an anonymised version is published. HDC says most investigations take two to three years.
5. Your RA triages. The Medical Council uses a Notifications Triage Team; the Nursing Council Registrar decides whether the issue is about health, conduct or competence and assesses risk. Options run from no further action or an educational letter to a review or referral.
6. Competence or health pathway. The RA may review your competence (HPCA Act ss 36–44) or look at whether a health condition affects your practice (ss 45–51).
7. Conduct pathway: a Professional Conduct Committee. For conduct concerns, and convictions, the RA appoints a PCC to investigate. It then makes recommendations to the RA and/or a determination, which can include laying a charge.
8. The Tribunal hears any charge. Only a PCC or HDC's Director of Proceedings can bring a charge. The HPDT decides whether professional misconduct is proven and, if so, what penalty to impose.
9. Appeal. RA decisions on registration, practising certificates and conditions are appealed to the District Court. HPDT decisions are appealed to the High Court.

The Code of Health and Disability Services Consumers' Rights is the legal floor for every provider. A provider escapes a breach finding by showing that it took reasonable steps, given the circumstances, to honour the rights; the onus of showing that lies on the provider. Many complaints are about communication (Right 5), information (Right 6) or consent (Right 7), rather than clinical skill alone.

If a complaint comes to you, the HDC encourages providers to respond sensitively and aim for low-level resolution. HDC says around 30% of complaints are resolved by direct discussion. Sending HDC the account, notes or documents it requests does not put you in breach of privacy or confidentiality.

After a formal investigation, the Commissioner can recommend an apology, education or service changes. The gravest breaches may be passed to the Director of Proceedings, who may charge you before the HPDT or take a case to the Human Rights Review Tribunal. You can ask HDC to review its own decision, or complain to the Ombudsman.

A competence review is about whether your practice meets the required standard, not about punishing you. You get notice, a chance to be heard and the right to bring a support person (s 37). If the review finds a problem, the RA may order (s 38):

• a competence programme (s 40), often with supervision and reporting;
• conditions on your scope of practice;
• an examination or assessment;
• counselling or assistance.

Section 39 allows the RA to suspend or condition your practising certificate mid-review if it believes serious harm is possible. Failing to complete a programme can lead to a changed scope or suspension, but it is not on its own a ground for discipline (s 43). Under s 44(4), what you say in a competence review or programme is off-limits as evidence in other proceedings.

Each RA runs this its own way. The Medical Council, for example, may use a Preliminary Competence Inquiry or a Performance Assessment Committee, and educational programmes after a PAC typically last about 12 months. The Midwifery Council describes its competence reviews as educative and supportive, with a panel of experienced midwives.

The health pathway (ss 45–51) deals with physical or mental conditions that may affect practice. It can involve a medical examination, restrictions or interim suspension, and it is separate from discipline.

Most PCCs have three members: two from the practitioner's profession plus a lay person. In nursing cases the Council adds a Māori member where either the nurse or the complainant is Māori. The PCC investigates and gives you the chance to be heard. At the Nursing Council, investigation material is disclosed at least three weeks before the PCC meeting.

What a PCC can recommend to your RA

• a review of your competence, or of your fitness to practise on health grounds;
• conditions on your scope of practice, or suspension;
• counselling (at the Nursing Council, an education letter);
• referral to the Police.

What a PCC can determine

• that no further steps be taken;
• that the complaint be referred to conciliation;
• that a charge be laid before the Tribunal.

There is no appeal from a PCC, but its decision can be challenged by judicial review in the High Court. Separately, if alleged conduct casts doubt on whether your practice is appropriate, s 69 lets the RA suspend or condition your practising certificate until the investigation or prosecution ends. Where serious harm is feared it may do so first and hear from you afterwards, with the Nursing Council's guide saying the practitioner is then heard within 20 working days.

For a hearing, the Tribunal sits as five members: the chair or a deputy chair, three practitioners from your own profession, and one layperson. Charges are brought on grounds set out in s 100 of the HPCA Act. The most common is professional misconduct, which covers negligence and malpractice under s 100(1)(a), and under s 100(1)(b) conduct that has damaged, or could damage, the profession's reputation. Charges can also rest on some convictions, working without an APC or beyond your scope, or ignoring conditions or orders.

Misconduct is decided in two steps. Step one is an objective look at whether what you did, or failed to do, was malpractice, negligent, or behaviour that tends to discredit the profession. Second, it asks whether the departure from standards is significant enough to warrant a disciplinary sanction.

Penalties under section 101

As an example, in a 2023 medical case (1319/Med22/547P) the Tribunal imposed censure, two years of conditions including an education programme on prescribing ethics, and costs. Decisions go on the HPDT website, and anyone wanting their name kept out must apply for suppression.

When the High Court set out the principles for penalties in Roberts v Professional Conduct Committee [2012] NZHC 3354, it listed protecting the public, maintaining professional standards, rehabilitation, consistency, choosing the least restrictive appropriate penalty, and proportionality. Rehabilitation and the least restrictive outcome are where your own actions matter most. Committees and the Tribunal look at what you understand about what happened and what you have changed since.

• Get advice early. Contact your indemnity insurer, your union (for example NZNO for nurses), your professional association or a lawyer before you respond.
• Respond honestly and on time. Give a factual, respectful account. Do not alter records.
• Show understanding, not only regret. Explain what went wrong, why, and the effect on the consumer and their whānau.
• Remediate with evidence. Targeted learning, supervision, audit of your own practice and written reflection show change over time.
• Look after yourself. Investigations can take a long time. Your employer's assistance programme or your GP can help.

Each responsible authority handles triage, reviews and investigations in its own way. Read the guide for your regulator:

• Medical Council complaint process for doctors
• Nursing Council complaint investigation
• Midwifery Council competence review
• Dental Council complaint process
• Pharmacy Council complaints about pharmacists
• Professional Conduct Committees for allied practitioners

A Bill to amend the HPCA Act (the Health Practitioners Competence Assurance Amendment Bill) had its introduction on 18 May 2026. The Ministry of Health describes it as strengthening ministerial direction of regulators, adding accountability duties and create a streamlined process for reviewing registration decisions. It is still before Parliament. It is not law, and its final content may change, so everything on this page describes the HPCA Act as it currently applies. We will update this guide if the Bill passes.