What does seriousness in fitness to practise (FtP) mean for dental professionals?

12 May, 2022 by Elizabeth Gonzalez Malaga

Elizabeth Gonzalez Malaga, a dentist and the Clinical Fellow at the GDC, explores some of the key findings from the recent publication of our cross-regulatory research into the concept of seriousness in fitness to practise cases

Despite being aware that only a very small number of registrants face fitness to practise (FtP) hearings, as a dentist I know well the worry that an FtP investigation can cause to dental professionals. The General Dental Council (GDC) recognises that it can be stressful and seen as confusing when a concern is raised, hence its commitment to making improvements to its processes to ensure it is efficient in protecting the public. The GDC also needs a better FtP process and is pressing the government to introduce the legislative reforms which would allow changes to be made.  

As part of its commitment to a proportionate and targeted FtP system, the GDC, together with the Nursing and Midwifery Council (NMC), commissioned research to investigate how seriousness in FtP is understood and applied by UK health professional regulators. 

The research provides valuable findings for all in the sector to consider, including individual dental professionals such as myself.

How should you engage with the FtP process? 

The research shows that a registrant’s level of engagement with their regulator is an important factor in how the seriousness of an FtP case is determined and the eventual outcome of it. The sooner and more clearly the regulator can understand the dental professional’s position, the more it becomes possible to make a full assessment of the concern. This is why it’s beneficial to engage with the FtP process, but what does engagement mean?  

In practical terms, it means that, as dental professionals we should respond to correspondence from the GDC at all stages of the FtP process, provide information when requested, make themselves available to co-operate with the investigation and attend hearings. It’s our opportunity to give our side of the story to the concern raised. Being engaged doesn’t mean that you’re admitting wrong-doing – it just means providing information to explain your position. 

Whether or not we agree with the concern raised, it’s worth considering what learning it has identified. Tailoring our continuous professional development (CPD) priorities around this might help to show how we’ve considered the concern and started remediation if the concern is referred to case examiners. CPD will help us to improve our practice regardless of the outcome of the concern.  

Legal advice and representation

The best way for a patient to resolve their concern is to contact the dental professional or practice directly. If the patient does then complain to the GDC, around three-quarters of concerns are investigated by case examiners, with the majority then closed with no further action. Only a very small proportion go on to a hearing.  

However far a concern proceeds, as dental professionals we should also talk to our indemnifiers. The research showed that legal advice and representation is a benefit to professionals when navigating the FtP process. 

It's good practice to know what type of indemnity you have, particularly if you’re indemnified by an employer’s cover. Understanding whether it entitles you to legal representation in FtP hearings is important. 

As part of your annual registration with the GDC, you’ll make a declaration of your indemnity cover and this is a good time to check the type of cover. You might have to confirm your indemnity cover when you join a new dental team too.  

If you don’t have legal representation, the GDC can signpost to other organisations that might help with representation or other forms of support

Environmental and contextual factors

The COVID-19 pandemic added significant challenges to already overstretched healthcare systems. Work environments, organisational issues and team interactions are all parts of the environmental context that are considered in FtP decision-making. 

However, the research highlights that these factors are more likely to be accepted as mitigation if there is evidence that the registrant had raised concerns within the workplace, for example in emails, and if it can be corroborated by other witnesses. This finding is a reminder to us registrants of our professional duty to raise concerns when something poses a risk to patients, members of the public or colleagues, and for employers to act upon feedback and concerns raised by their staff.  

Differences across regulators

One of the first things that struck me when joining the GDC as a Clinical Fellow was the realisation that all functions and activities undertaken by the GDC are governed by its legislative framework. Each healthcare regulator operates under its own legislation, bringing differences to FtP procedures and outcomes across regulators. The risks to patients posed by each profession and public views and expectations of different professions also varies.  

The research showed that there are some fundamental differences between regulators in how and when seriousness is considered during an FtP process, partly due to the differing legislative frameworks each operate in. However, there is some similarity and consistency in how seriousness is generally understood and used, especially for cases involving dishonesty, sexual misconduct, violence and some criminal convictions. 

Although the GDC is continuing to make improvements to the FtP process, current legislation is outdated and restrictive, limiting the ability to make significant changes. However, the findings from this research will inform work to develop a more consistent and proportional FtP system when regulatory reform makes this possible. This will ensure that patients continue to have recourse when something goes wrong, and regulation continues to build public confidence in the dental profession. 

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