The best possible outcome

Dental adviser Sarah Harford shares her golden rules for responding to a GDC investigation

G. D. C. Three letters that make many a dentist nervous. An unexpected envelope or email from our regulator can generate a feeling of impending doom.

We dutifully pay the ARF each year, with the understanding that it is the General Dental Council's role to regulate the profession and protect patients. On its website the GDC states: “If there are concerns that shortcomings in a dental professional’s conduct or competence that are so great as to put patients at serious risk, or seriously damage public confidence in dentistry, we will investigate.”

Fortunately, MDDUS is here to guide our members through the GDC's initial assessment and investigatory process, and we urge you to contact us without delay if you receive a letter or email from the regulator.

Most importantly, you should keep calm and not panic. The last thing you want to do is act in haste and potentially damage your chances of a favourable outcome.

RULES TO REMEMBER

We often see dentists make the same mistakes in those early days after they’ve been notified of an investigation. Below are some golden rules to remember.

Clear complaints process. Patients often send a complaint directly to the GDC, without telling their dentist, because they’re unaware of the practice complaints process. It is wise to ensure all your patients know how to raise any concerns directly with your team.

Don’t ignore it. The first step in an initial assessment is usually a written request from a GDC case worker. The letter, which you might receive by email and/or post, generally begins: “We are writing to ask you to provide us with some information. This will help us in the early stages of considering a concern we have received about you.” At this point, call your indemnifier for advice. The proverbial ‘head in the sand’ technique really won’t help anyone at this stage. The GDC is seeking some specific information from you, by a deadline. This usually includes your employment details, proof of indemnity and, depending on the nature of the concern raised, possibly patient records.

Resist an angry response. Receiving a notice like this can be a shock. It is hugely important that you resist the temptation to make any comment to the GDC on the concern raised at this initial assessment phase. Dashing off a furious “how dare you accuse me” email, or even a lengthy warts-and-all account of everything that “went wrong” can be very damaging to your case and would be difficult to row back from later. Indeed, it is preferable for all correspondence (even a simple acknowledgement) to be conducted via your MDDUS representative; that is, after all, why you pay your subscription.

Don’t badger the complainant. There is nothing to be gained from contacting the complainant. Once the GDC has sight of the concern, it will continue to investigate it if felt warranted, even if the complainant tries to retract their concerns. A last-minute change of heart to suddenly offer a refund to the patient, once it is evident that the GDC has become involved, could be perceived as an attempt to “buy them off”. Conversely, you should not be receiving continued correspondence about a case from a patient who has already involved the GDC. In such circumstances, MDDUS can help you prepare a letter to them explaining that it is not appropriate for you to correspond with them directly while the GDC initial assessment or investigation is ongoing, and that you will respond either during the course of that process or once it is complete.

Be cautious when sharing with NHS. If you work under an NHS contract, the GDC will likely communicate with your NHS area team or health board regarding the concern raised. If your area team or health board contact you for comment at this early stage, please do not respond without first seeking advice from your indemnifier. Keep in mind that any information you share with the NHS could also be sent to the GDC. If the wording of your comment is not carefully considered, this risks compromising your GDC case.

Do not amend the clinical records. It may be tempting to “tidy up” or somehow alter clinical records before sending the requested copy to the GDC. It is extremely important that you do not do this. When under the spotlight, we will always wish we had written a clinical note in a slightly different way, but you will put yourself in a far worse position if it is determined that you have amended the records retrospectively. A simple criticism of your record keeping can often be addressed by completion of targeted CPD. But a retrospective amendment of records can lead to an allegation that your behaviour was ‘misleading’ and/or ‘dishonest’. This can transform an investigation from one which might otherwise be closed at the case examiner stage to instead being referred to a full professional conduct committee hearing, with an adverse outcome such as suspension or erasure from the register being a significant possibility. If you feel that there is information missing from the notes that may assist the GDC’s investigation, MDDUS can submit a letter detailing this information on your behalf, together with an appropriate explanation as to why it was not included in the clinical record at the relevant time.

Wait before offering your side of the story. The GDC and MDDUS will tell you if and when your side of the story is sought. This is usually only if your case progresses to a formal investigation and is referred for consideration by case examiners. At this next stage, your "observations" will be requested by the GDC, and MDDUS can help you draft your carefully worded response.

Target your CPD. The time taken for the GDC to perform its initial assessment can vary depending on the nature of the case and its administrative processes. MDDUS advises its members to make use of this time (and their nervous energy) to target their professional development to any areas relevant to the case. Even if the case does not progress, there is nothing lost in ensuring that PDP and CPD records are up to date.

MDDUS SUPPORT

While the prospect of a GDC investigation is daunting, bear in mind that almost a third of cases (29 per cent) are closed by the regulator before the dentist is even notified because they do not meet the threshold for initial assessment. In 2019, more than half of cases (59 per cent) were closed with no further action, advice or a warning, or in a few cases by agreeing formal undertakings with the registrant.

Of all the cases considered by the GDC at the various stages, only 15 per cent end up being referred to a full hearing. This includes cases relating to all types of concerns that may be raised about a registrant’s fitness to practise, not just clinical concerns.

There is a possibility that at some point in our career, we will be contacted by the GDC about a concern raised. Don’t panic or ignore it, and instead let us guide you through the process and help you achieve the best possible outcome.

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