The General Medical Education and Registration Council of the United Kingdom (shortened to General Medical Council in 1951) was created by the Medical Act of 1858  and charged with establishing a register "to distinguish the qualified from the unqualified" . The General Medical Council established a medical student register, which was put "on hold" during the second world war and never reactivated .
The document "Tomorrow's Doctors", first published by the General Medical Council in 1993, and revised in 2003 , provided recommendations for medical schools which identified the knowledge, skills, attitudes and behaviour expected of new graduates. There was emphasis on the need to protect patient safety (paragraph 83), and a clear statement that by awarding a medical degree, a university is confirming that the graduate is fit to practise (paragraph 84).
In 1997, the General Medical Council published its first guidance for medical students entitled "Student Health and Conduct" . This document, which has been superseded and no longer reflects current policy, included advice on specific student issues such as anxiety and stress, psychiatric illness, drug and alcohol abuse, behavioural problems and physical illness, as well as addressing general topics such as the length of the course (a maximum of seven years was recommended), the duty to protect patients, the need for confidentiality, and the options for students "not suited to medicine". In addition, since, 2005, graduating students have, when applying for General Medical Council registration, been required to confirm that they are fit to practise.
In July 2001, Eversheds produced a report to Universities UK and the Council of Heads of Medical Schools on medical student fitness to practise, and recommended principles for the adoption by universities of fitness to practise procedures "that are fair to individuals, reflecting legislative requirements, and that do not necessarily follow a uniform and rigid pattern across all institutions. Subject to consistency with the principles, the detailed procedures will be for determination by individual institutions taking account of their own statutory and regulatory systems" . Those universities that had not established fitness to practise arrangements were urged to do so as a matter of priority. In September 2007, the Medical Schools Council and the General Medical Council published their detailed guidance on matters relating to fitness to practise in medical students . This set out the professional behaviour expected of medical students, following the headings used in the General Medical Council's guidance for doctors "Good Medical Practice" . It also delineated matters relating to medical student fitness to practise, such as areas of misconduct, sanctions, threshold of acceptable behaviour, making decisions, and key elements in student fitness to practise arrangements. The application of this guidance in medical schools, along with the recent implementation of General Medical Council training in fitness to practise procedures for medical school staff, promotes a consistent approach to student fitness to practise in a diverse group of institutions.
Student fitness to practise is also being addressed by other healthcare professions, and, for example, in August 2007, the Nursing and Midwifery Council published their guidance "Good health and good character. Guidance for educational institutions" which was intended to ensure consistency about how the Nursing and Midwifery Council's requirements were interpreted and put into practice . This guidance also set out a requirement that educational programme providers should take appropriate action if any issues relating to good health or good character arise, and it stated that from September 2007 all programme providers were required to have a fitness to practise panel to consider health and character issues and ensure that public protection was maintained. This guidance was revised in June 2008 .
A national workshop for medical school administrators on the subject of medical student fitness to practise, run jointly by the University of Manchester (Tim David and Sally Bray) and Field Fisher Waterhouse (Sarah Ellson and Judith Chrystie), a firm of lawyers specialising in professional regulation, was held at the University of Manchester on 8 November 2007, a few months after the publication of the Medical Schools Council-General Medical Council guidance. At this workshop it became apparent that there was variation in the way that student fitness to practise panel hearings were managed, reflecting the different university statutes and regulations. In December 2008, Tim David contacted Jocelyn Aldridge at the Medical Schools Council, to enquire about the arrangement for student fitness to practise cases, and to assist with this enquiry a survey was conducted to examine this variation, and this report documents the findings.