Improving fitness to practise processes in the absence of regulatory reform

30 November, 2022 by John Cullinane
We know that a fitness to practise (FtP) investigation can be a stressful experience. Many cases are resolved quickly and with no action taken, but it is also true that many cases take too long to resolve and others become complex and adversarial.  
Most people view FtP from their own experience of it, or have a perception based on what they’ve heard from others. Research which we’ve recently published helps us to learn more about people’s experience. It’s part of our ongoing commitment to understand and learn about the impact of our regulatory activities. 

The way people experience FtP is driven by the underpinning system and processes – and the overly prescriptive legislation makes our FtP system cumbersome, onerous, long and difficult – for everyone involved, from the complainants to the registrants, to the staff trying to run the system.
This is why we have placed such emphasis on securing legislative reform, but our assessment is that reform will not happen for the GDC for some years to come. In the absence of reform, we’re increasing our efforts to improve our processes and systems within the current legislation, focusing where the most potential lies for improvements. It’s not the way forward that we would like to take but it’s the best option open to us. 

We know that we haven’t always got it right. We’re constantly looking for and implementing improvements to the process, and while each change may be small, cumulatively and iteratively they will make people’s experience better.

I wanted to share some of the improvements we have made and some we will make. This isn’t a promise for the future, it is what we are doing and have been doing for some time.

Making improvements to the process

We’ve done work to make it easier for people to know where to send their concern, always encouraging patients to speak to the dental professional or practice first. We’ve seen a reduction in the number of serious concerns that we receive from 2,545 in 2015 to 1,349 in 2021. 

Since November last year, we’ve increased the capacity of our fitness to practise casework team– we’ve recruited more people into the team, trained them up, built their confidence and we’re now just starting to see the benefits of this. 
We modernised our preliminary meeting guidance in February this year to ensure these meetings are used as an effective case management tool, and introduced flexible listings for hearings. This means we can now use preliminary meetings to narrow, refine, or resolve issues ahead of a full hearing. From April, we also started to list some of our hearings more flexibly, making it less likely that people experience delays or rescheduling.  
The Dental Professionals Hearings Service was launched in June, to emphasise the independence of panels and hearings from the GDC. It’s made it clearer for people who experience a hearing, bringing all of the information into one place, and improving the tone of voice in our communications and guidance. 
In October, we changed the process for making admissions at the start of a preliminary hearing, to reduce the time for the hearing and, ultimately, the stressful and adversarial nature of this part of the process. Dental professionals are now asked whether they admit to any of the charges set out for the fitness to practise hearing at the end of the preliminary stage. Where an admission is made, the practice committee will proceed on the basis that the facts have been proved, rather than require evidence to be presented in relation to all charges. It’s early days and we’re monitoring closely.
We’re currently consulting on Interim Order Committee guidance and associated information and the proposals will ensure that risks are assessed consistently and that decisions are proportionate and appropriate to the risks posed. 

Improving our understanding 

In our annual FtP statistical report this year, for the first time, we included a reliable breakdown of cases by protected characteristics, including ethnicity. This is part of our Equality, Diversity and Inclusion commitments. It’s early days in understanding what the data tells us and we plan to do more in this area in 2023, including encouraging patients in FtP cases to provide their EDI data to us too, so that we can see a breakdown of cases by their protected characteristics. 

We’ve completed some very important work this year to establish how we can report on the number of professionals who die during an FtP investigation and the cause of death – including by suicide – to improve our understanding. We’re going to collect data for the period 2019 – 2021 and publish a report of this in the first half of 2023.  
What people see and read has an impact on their experience and research shows that the tone of voice of the GDC’s communications has a big impact on perceptions. We’re going to review the letters and communications we use in FtP next year. 

We’re also going to review the mental health and wellbeing signposting that is offered to all participants in FtP – and the training and support we provide to our own teams. We know that it’s a stressful process and want to do what we can to make sure everyone has access to the right support.  

Helping everyone to understand the changes 

The FtP system and regime involves more than just the GDC – it includes education providers who instil the standards and behaviours into students and trainees. It includes defence organisations who are representing their clients, and other regulators such as the CQC and the NHS – and also the employers of dental professionals. 
At the centre of this are people – the dental professionals in an investigation, the patient who is then a witness to the investigation. The general public – who we all want to feel confident in the dental treatment they receive. And also, the caseworkers, decision makers and panellists who are investigating cases and making decisions.

Without regulatory reform, if we want to improve FtP we have no choice but to continue making a series of small changes rather than wholesale change. This approach will have more impact on people’s experience of FtP if everyone involved in the system understands the changes and helps others to understand them – which is why I wanted to explain them here.

Most importantly, the outcome of our actions has to be of benefit to patients and the public – a priority shared with everyone in the FtP system. 

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