Transparency, trust and improving the fitness to practise process

27 March, 2024 by Stefan Czerniawski

We know that Fitness to Practise (FtP) is a stressful and difficult process. We can’t make the stress go away altogether, but we want to do what we can to minimise stress and anxiety and ensure that the small number of dental professionals who are involved in an investigation each year are supported by us and others and that their wellbeing and mental health is a priority.  

There are two important issues that we’d like to explain at this point: the level of detail published from Interim Orders Committee (IOC) hearings, and how we plan to report deaths during an FtP investigation. 

Overriding both of these are issues of transparency and trust, which I’ll return to later in this update. 

Reviewing the level of detail published from IOC hearings  

We know that the impact of an FtP investigation can be far-reaching and stress can be caused by both the experience and the information which is published or made available around it. Last year, following an inquest, a coroner raised concerns with the GDC about the level of detail which is published regarding allegations being considered at an IOC hearing. 

First and foremost, it was with great sadness that we learned about the death of a dentist whose case was under investigation and our deepest sympathy and thoughts are with their family.  

We recognise the concerns raised by the coroner and at the time, work was already underway to review the policy in relation to the publication of IOC outcomes, taking account of the constraints of the current rules and legislation. The recommendations will be reviewed by the Registrar in the coming months, before a decision is made on any changes. 

In carrying out this work, we have: 

  • considered the challenge of balancing the level of published information which might be necessary to fulfil our role in protecting patient safety and public confidence in the dental professions with the interests and impact on the registrant 
  • engaged with Chairs of the independent FtP committees to understand their views 
  • engaged with the Nursing and Midwifery Council (NMC) and the Health and Care Professions Council (HCPC) as the other UK regulators with a starting point of public IOC hearings, to understand their approach to more limited publication.

Reporting causes of death during FtP investigations

We have shared the work we have done so far to understand and report the causes of death of dental professionals where there is an active FtP case, the sensitivities with gathering the information required, and our commitment to reporting this data in line with the GMC’s approach. We have further work to do to bring together a report that covers the period 2019 to 2022, which we will publish in 2024. Future reports will cover a three-year period. 

The work we have done will enable us to put in place the necessary processes to allow us to record the cause of death of dental professionals who die while subject to an FtP investigation. 

We will use the same categories of the cause of death as the GMC, namely:

  • deaths due to natural causes 
  • deaths from external sources (including suicide) 
  • and deaths from other or unspecified causes. 

We will report this information no sooner than two years after the reporting period, to allow time for the cause of death to be formally recorded and for the certificates and conclusions to be gathered and analysed. Again, similarly to the GMC, we will not publish data where small numbers in a particular category means that there is a risk of identifying individuals, in consideration to their families and colleagues.  

Reducing stress in the FtP process  

Driven by our own research into people’s experiences of FtP, we have made changes to the FtP process where we can and where legislation doesn’t restrict us. Some examples are:  

  • working with external stakeholders, we have updated letters that dental professionals receive during an investigation to ensure an empathetic tone and include signposting to health and wellbeing support.  
  • new guidance on indemnity and insurance emphasises that dental professionals should consider what health and wellbeing support might be available to them if they are subject to an investigation, when choosing cover.  
  • the Dental Professionals Hearing Service (DPHS) has updated guidance for participants in hearings and new case management procedures to ensure that more hearings proceed on time, reducing the overall length of an investigation.  
  • we began an initial inquiries pilot in September 2023 for clinical issues to ensure fewer professionals are subject to a lengthy investigation.  
  • we are providing training to panellists and legal advisers who hear fitness to practise cases, to support vulnerable individuals in the hearing process, and a Participant Support Officer who supports unrepresented registrants by explaining the hearing process.  

Further work is underway to explore the practical support that would be useful for all participants in our regulatory processes, including the effectiveness of our Hearing Support Coordinators and the timing and type of communications we provide to witnesses. This includes a learning programme for staff at all levels involved in FtP, so that we better understand the impact of regulatory processes on mental health and stress in those we regulate and are equipped to recognise the signs of stress on an individual. We are also developing a process to undertake a serious incident review when we find out that a dental professional has died while subject to an FtP investigation.  

Transparency is important to building trust  

The fitness to practise process has to balance different interests. It must be fair to the dental professionals against whom concerns have been raised, but its fundamental purpose is to protect patients and the wider public when failures to observe professional standards risk harm to patients or risk undermining public confidence in dentistry. We know that many dental professionals are not confident that that balance is set in a way which is fair to them, so it’s important that we do what we can to explain why the system works as it does and to be clear about the steps we are taking to improve it. 

If the process – and the regulator – are not trusted, that in itself can create a risk to patient care through defensive practice and as a result of adding to the stress of already stressful work. Being involved in a fitness to practise case will never be a wholly pleasant experience, but it can be one in which there is better understanding of the risks of being brought into the process and of ending up with an adverse outcome, and it can be one in which there is greater transparency about how the fitness to practise process works, how it can be improved – and how the legislative framework constrains our ability to make all the improvements which might be desirable. 

There isn’t a single or simple right answer to the questions of how we ensure that the fitness to practise process gets the balance right, but by being more transparent about how we approach these issues we hope we can discuss them constructively, with a shared commitment to ensure that the system works as well as possible – in everybody’s interest.  

The Samaritans give clear guidance that assumptions must not be drawn between circumstances and cause of death due to suicide and that reporting must be sensitive to the subject. We would ask all dental professionals and interested parties to act in accordance with this guidance.   

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