Following a fitness to practise case

Discovering your work as a dentist has been called into question can be a shock. Here, MDDUS dental adviser Claire Renton lifts the lid on the process involved

AN OFFICIAL-LOOKING letter lands on your doorstep and its first line reads: "I am writing to tell you that we have received some information about you which we are currently reviewing."

That’s the opening sentence in the correspondence that the GDC send when they are starting a "fitness to practise" investigation. It’s heart-sink stuff; it will take your breath away and is the start of a journey which can make you wish you had never thought of becoming a dentist in the first place. It may follow on from an unresolved patient complaint or it might follow from a health board or LAT investigation. It might also be completely out of the blue.

Horribly, it might even follow a dispute with a colleague, often over non-clinical matters, who realises there’s nothing like alleging you are not fit to practise to cause maximum damage. We have dealt with cases where dentists have sent screen shots of errors on their competitors’ websites to the GDC. We’ve also assisted dentists who have sold their practice and the incoming dentist has trawled through dental records to find a missing BPE or ungraded X-ray suggesting that the retiring chap is not fit to practise. Often, these disputes are fuelled by financial rather than patient safety motives but if a complaint is received at the GDC, they must investigate.

Get in touch

So, if you are unlucky enough to receive this letter from the GDC what should you do? Well two things: the first is get in touch with us as soon as you can. We are very familiar with GDC processes and we will support and assist you.

The second thing is to relax and stop panicking, then thank your lucky stars that you chose indemnity and not insurance for your cover for clinical practice. Why? Well, if you are with MDDUS you can be sure that a dental adviser will be allocated to you, and appropriate lawyers, experts and barristers will be engaged should you need them in order to protect your position. All the expense associated with this is covered by your indemnity provision and there is no cap on our expenditure. In other words, you will get everything necessary to support you.

I know that early in our careers we can feel invincible and that this will never happen to us, but lots of good dentists find themselves under the GDC’s scrutiny these days and it’s not until you are in that position that you appreciate the importance of indemnity cover. Compare that to simple insurance with a fixed cap for GDC cases and you’ll soon relax.

GDC pathways

There are a number of routes a GDC investigation can take. If the allegations are serious and, if proven, would show you are potentially unsafe or dishonest then an interim orders committee can be convened to assess whether restrictions need to be placed on your registration during the investigation. This usually happens within a week or so of your receiving the correspondence so it’s important to get in touch with MDDUS quickly.

Relax and stop panicking, then thank your lucky stars that you chose indemnity for your clinical
practice cover

An interim orders committee might be convened in private if there are health issues to be considered, such as alcohol or drug dependency or a mental health issue which could affect patient care.

Most cases however trundle along at a much slower pace. Once the GDC have been given the clinical records they are sent off to a GDC expert who makes a judgement on the quality of the care provided and, yes, you’re way ahead of me, the quality of the records too! Once assessed, the GDC decide if there is a case to answer and, if so, an investigating committee is convened. Allegations are sent to the dentist along with a copy of the GDC’s expert witness report. We are usually given around four weeks to write a response to these allegations.

The investigating committee meets in private and our response to the allegations is made in writing. The committee has a number of options for disposal of cases. It may decide that there is no case to answer; it may issue the registrant with a letter of advice or a letter of warning which may be published on the GDC register; or worst of all it may refer the case to a full fitness to practise hearing.

These take place in London and are run along the same lines as a court hearing where the GDC will engage lawyers and a barrister to make the case against the registrant. Scary stuff indeed, but don’t fret as we will have our full expert team of in-house lawyers and a barrister to defend you and offer advice and support at every stage.

Peace of mind

Unlike a criminal court where sanctions (jail/fines/community service etc) are applied depending on the nature of the crime, at a GDC hearing the panel is obliged to assess if you are currently impaired or if you are currently fit to practise. This is regardless of whether you have a past finding of misconduct for your care of the patient. Sanctions are only applied if you are currently impaired. Not surprisingly then a lot of time is spent by the MDDUS advisory teams ensuring that by the time your hearing date arrives you are absolutely fit to practise and your record keeping is up to scratch. We will also ensure you can demonstrate that any deficiencies have been remediated, and that you have properly reflected on any failings.

A GDC investigation is potentially a harrowing experience, with concerns about job security and the possibility of adverse publicity. However, cases rarely turn out as badly as the dentist fears. The team here at MDDUS are experienced in GDC work, we achieve good outcomes for our members and are here to support and provide guidance through unfamiliar territory at every step of the way.

Of course the best thing is to do all you can to avoid things escalating to the GDC. Do all you can to resolve complaints quickly and effectively, fully assess and treat your patients as if they were a beloved relative, refer to a specialist if you are in doubt, and keep meticulous records. Easy, eh? Oh and one last thing: if you fall out with a colleague, don’t refer them to the GDC unless patient care is really in danger. After all, how else will we be able to keep the GDC’s annual retention fee down if we provide them with inappropriate cases to investigate?

Claire Renton is a dental adviser at MDDUS