Further fitness to practise improvements: reducing the impact on registrants and reporting our performance

28 February, 2023 by John Cullinane
We’ve been making changes that aim to improve our fitness to practise processes and systems, where we can within our current regulatory framework, and I explained some of them in a blog post late last year. It’s especially important that we do this, as it’s now clear that we will not see full reform of our legislation for years to come, and we know that fitness to practise can be a long and difficult experience for those involved. 

The latest changes we’ve made will reduce the impacts that long-standing or multiple investigations can have on those who are the subject of an investigation, and contribute to the improved performance that we all want to see. While each change we can make may be small, cumulatively they will make the experience for those who got through it, better in future.  

We will be tracking the impact of these changes, and other improvements we have been making, through an updated set of key performance indicators and timeliness measures which more accurately reflect the composition of our fitness to practise caseload. 

Closing cases that mirror an ongoing investigation by another authority  

We are now closing any open cases that mirror an ongoing investigation by another authority, for example by the NHS and MHRA, and asking them to inform us immediately if they later find any patient safety or public confidence issues that may need our intervention. We’re doing this at the Registrar’s direction. Cases involving an ongoing police inquiry, interim order, or where there are other open fitness to practise investigations, will not be closed in this way.  

Previously, we would open an investigation when another organisation told us they were considering matters that might call into question a dental professional’s fitness to practise. These often take a considerable time to conclude, and often result in us not taking any further action. The change we’ve made ensures we’re minimising the number of cases we investigate alongside another authority, reducing the impact on those who are subject to investigations, and making more effective use of our limited resources.  

We have trialled this approach, which has resulted in 18 cases being closed. We have not been subsequently contacted by any of the relevant authority in these cases with information that calls into question the dental professional’s fitness to practise. 

The change does not apply to all cases. Due to their seriousness, we will not close a case where there is an ongoing police inquiry. We will also not close cases where the dental professional is subject to an interim order on their registration, or has other open fitness to practise investigations. 

Not automatically opening a case for an NHS referral 

We will no longer automatically open a case referred to us by the NHS, where it is either investigating the matter, or dealing with concerns about a dental professional at a local level. Again, this will reduce the number of multiple investigations opened against the same dental professional, and reduce the number of new cases we open.  

We will open an investigation following an NHS referral where there is a serious and immediate risk to public safety or confidence (where the dental professional also practices privately, for example) and, if appropriate, refer the matter to the Interim Orders Committee. 

Closing exhausted cases on the approval of the Registrar 

We are reviewing and closing cases where there is no prospect of establishing that a dental professional’s fitness to practise is impaired. These cases are being reviewed and closed on approval by the Registrar. We’re reviewing cases where our lines of inquiry have been exhausted, or there is insufficient evidence available to raise an allegation that fitness to practise is impaired. 

Again, closing what are in some cases long-standing investigations will reduce the impact on those who are the subject of an inquiry and help us to focus on our current caseload.  

Being accountable and transparent on the results 

Alongside these changes, we’ve come up with a revised system for reporting the numbers of cases we receive, and the time it takes to progress them. We have developed more detailed information about our caseload. This has allowed us to build a new set of key performance indicators. But perhaps more importantly, our new reporting framework now gives the fitness to practise team the information they need to improve case progression and identify any operational issues hindering our performance.    

Our previous approach to measuring timeliness in fitness to practise assumed that all cases were the same and required the same level of investigation. Reporting all cases together has made it difficult for us to uncover the issues holding up investigations, and a small number of cases distorted overall results. Our new approach recognises that not all cases are the same, or progress at the same pace.   

We have spent 12 months developing and testing new key performance indicators for each stage of the fitness to practise process, based on groups of cases that share attributes or typically take similar lengths of time to process. We have shared the details of our new approach with the Professional Standards Authority. We now have a clear picture of how cases are progressing through the process, and where we need to focus our resources to keep investigations on track.  

Overall, these changes aim to reduce uncertainty and stress where possible for those who are subject to an investigation, and increase accountability and transparency as we improve our performance in fitness to practise.  

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