Fear of the GDC: A personal perspective on perception, reality and responsibility

Supporting professionalism and learning

We want to regulate in a way which promotes learning over fear, supporting dental professionals to continuously demonstrate professionalism, rather than driving behaviours through the threat of fitness to practise. Our role is to give clear, easy to use guidance that supports dental professionals to show good judgement and professional behaviour in providing good oral healthcare for patients and the public.   

How fear shapes practice

Dentistry is a demanding profession. High levels of responsibility, combined with knife-edge margins for error and a culture of perfectionism, culminate in a form of emotional burden that is often significant and frequently underestimated. When the fear of regulation is then coated onto this environment, it may profoundly influence professional behaviour. I have seen how the fear of complaint or investigation can drive defensive dentistry and the impact this can also have at a personal level. Clinical notes typically become bloated but not necessarily better.¹ Decisions may feel safer but are not always more appropriate and may not always be in the patient’s best interest. Time and effort that should be devoted to communicating with patients and delivering care is instead redirected towards protecting oneself against hypothetical future scrutiny. This benefits neither dental professionals nor the patients we serve.

For some colleagues, the cumulative pressure becomes unsustainable. Reducing clinical work, stepping away from NHS practice, leaving the country, or exiting the profession altogether are becoming increasingly familiar responses. Regulation is rarely the sole factor behind these decisions, but fear of regulatory consequences is frequently cited as a significant contributor.

What changed my perspective

Having previously acted as an independent adviser and expert witness, in 2017, I was offered the opportunity to serve as an in‑house clinical adviser at the GDC and subsequently lead the clinical advisory team. From a personal perspective, this was a tough choice and required major compromises to be made. However, the chance to make a change was one that I felt I had to embrace. Building on the shift in the tone set by Shifting the Balance in 2016, as a wider team and directorate, I feel we have been able to actively promote and embed a fair, balanced, reasonable, and proportionate approach. This is demonstrated by a blog I wrote on the direction advocated with the review of clinical records during a FtP investigation. The outcomes of this approach are seen by the available evidence, and the data simply does not support much of the mythology that many of us grew up with.

The 2025 FtP statistics are instructive. From a registrant base of just over 131,000, approximately 1770 FtP referrals were received in 2025 (about 1% of registrants). Therefore, the chances of being involved with an FtP investigation are relatively small. However, in line with other healthcare regulators, the number of potential concerns GDC FtP received increased by 26%, from 1401 in 2024 to 1766 in 2025. There may be a myriad of reasons for this, however, as a clinical adviser, I have observed the increased use of AI by patients with the drafting of correspondence. In 2025, orthodontics was the most common area of dentistry where concerns were raised, and the most common overall clinical issue was the standard of examination that took place. I have previously written about concerns being reported to the GDC and DCS about aligner therapy.

Nevertheless, as with recent years, most concerns raised with the GDC are resolved at an early stage, with the overwhelming majority (85% in 2025) never reaching a hearing. Serious sanctions remain rare and are often reserved for cases typically involving, dishonesty, repeated failings, serious professional misconduct, or a clear risk to patients or public confidence.

In 2025, there were just 18 removals from the register- approximately 0.01% of registrants. Single‑patient clinical concerns - the scenario that silently haunts many conscientious dentists and DCPs almost never result in removal from the register. This data should also be placed in context, with tens of millions of treatments delivered across the UK each year and the plethora of risks associated with treatment execution. Even hearings themselves account for only a small proportion of cases overall (110 initial Professional Conduct Committee hearings in 2025). The number of hearings since our case examiners were introduced in 2016 have also substantially reduced from 333 in that year, with their scope to resolve less serious cases without the need to convene a panel.

Many single‑patient concerns that meet specific criteria are now investigated through the Initial Inquiries process. Since its launch in September 2023, over 650 cases have now been opened under this ‘fast‑track’ initiative, with approximately 71% assessed and the assessments completed in a mean timeframe of 17 weeks (16 week median), compared with around 30 weeks previously.

None of this is to suggest that the FtP process is easy. Any investigation is inherently stressful, and I do not underestimate the psychological impact on those involved. However, the GDC is duty bound to consider matters referred to us. But there is an important distinction between something being stressful and it being career‑ending. Too often, within the profession, we have conflated the two and not considered how things may look in the absence of any regulation and public protection in healthcare, especially with patient safety – as I have personally experienced overseas.

A regulator that has had to listen

The GDC has not been deaf to these concerns. In recent years, it has explicitly acknowledged the climate of fear within dentistry and the harm that disproportionate regulation can cause. From my perspective, there has been a genuine and measurable shift. Earlier clinical adviser input with aspects such as Initial Inquiries and triage, a stronger emphasis on proportionality, and more humane communication have all contributed to change. Low‑level concerns are increasingly identified and closed without unnecessary escalation. There is greater recognition of context, and consistent with our recently proposed Strategy, the ability to demonstrate early insight and meaningful reflection is hopefully set to play an increasingly important role.

These changes do not erase past experiences, nor do they make regulation comfortable. However, they do represent a regulator trying to evolve constrained by legislation, precedent, and public expectations, but nevertheless moving in a more balanced and proportionate direction.

Responsibility lies on both sides

It would be simplistic to place responsibility entirely at the regulator’s door. As a profession, we have at times contributed to the very climate of fear we now criticise. We sometimes warn students rather than educate them and we occasionally share extreme cases without proper context. We allow the GDC to be “weaponised” as a threat, rather than understood as a safeguard. Professional maturity really requires a more balanced and collective approach, one in which all key stakeholders must recognise and fulfil their responsibilities.

After nearly three decades in dentistry, my view is clear: dental professionals who act honestly, reflectively, and in good faith should not practise in fear of the GDC. Mistakes and complaints will happen. Regulation exists to manage risk and protect the public and not to punish imperfection. When we understand how the system functions rather than how it is rumoured to function, fear becomes more contained, more rational, and more manageable.

We owe it to the next generation of dental professionals to replace inherited anxiety with clarity and to foster a professional culture in which accountability and compassion coexist.

This blog is part of a series by Shamir Mehta, please read his other blogs:  

• How patient consent can help build trust and confidence
• Dental record keeping: what is professional, reasonable and in the interest of patients? 
• Clear aligner treatment: What can we learn from complaints and concerns? 
• Drills, spills, and protocol: when dentistry doesn’t quite go to plan
• ‘Bonding boom’ - composite bonding insights for dental professionals

References

1. Mehta SB, Rattan R, D Cruz L. Note bloat. Br Dent J. 2025 Sep;239(5):343-349. doi: 10.1038/s41415-025-8604-8. Epub 2025 Sep 12. PMID: 40940487; PMCID: PMC12431838.