Urgent improvement needed in GDC fitness to practise

GDC fitness to practise processes often result in "significant negative impacts" on the mental health and wellbeing of participants and could have "unintended consequences" for professional behaviour and practice.

This is the main finding from new independent qualitative research commissioned by the General Dental Council and based on the experiences of 70 individuals involved in fitness to practise procedures.

The research was undertaken by Hull York Medical School to inform improvements in fitness to practise processes, evidence preventative strategies and develop a sustainable approach to monitoring and evaluation of fitness to practise processes and outcomes. It involved interviews, a literature search and observation of fitness to practise hearings.

Among some of the key findings:

• Most participants in fitness to practise investigations or hearings perceived the outcome to be fair but the process itself negatively impacted their health, wellbeing, behaviour and practice.
• Process complexity and a perceived lack of clarity on how decisions were reached often resulted in feelings of mistrust and unfairness.
• Significant levels of stress and anxiety were reported that sometimes hindered the progress of investigations, as participants disengaged or left the profession.
• Participants reported feeling their professionalism was being called into question and they were presumed "guilty" until proved otherwise.
• Processes were perceived as adversarial rather than focused on the finding of fact and the protection of patients.
• Bias or racism in fitness to practise were perceived in referrals (those received by the GDC) and the provision of sanctions (decided by a fitness to practise panel).
• General reservations were expressed over the efficacy of the current fitness to practise process.
• Clearer and empathetic communications are needed with more regular contact with caseworkers, along with mental health and wellbeing support made available throughout fitness to practise investigations and hearings.
• Participants reported issues of disproportionality, particularly around the time taken and resources allocated to what were perceived to be minor concerns, based on the level of sanction ultimately decided by a fitness to practise panel.

Commenting on the report, Stephen Henderson, Head of Dental at MDDUS said: “MDDUS is keenly aware from our own advice and support services how overwhelming fitness to practise investigations can be for dentists and dental care professionals. They often take far too long to resolve and can lead to individuals feeling distressed, disengaged or leaving the profession altogether.

"That’s why, in addition to the professional, legal and pastoral support from our expert dental and legal staff, we also provide a free, independent and confidential emotional wellbeing service called YourHalo to all our members.

"We acknowledge the GDC's commitment to continue to improve how fitness to practise investigations are managed. Our dentist members and their teams are dedicated, highly skilled professionals, and it is vital that they receive fair and timely treatment by the GDC as well as the support they need to deliver a high standard of care to their patients.

"This 'lived experience' research describes many of the concerns reported to us by our members going through fitness to practise investigations and demonstrates how the need for reform could not be more pressing. We call on the UK Government to act swiftly to ensure the regulatory framework is fit for purpose and fairer for clinicians and patients alike."

GDC Executive Director, Fitness to Practise, John Cullinane, said: "We know that fitness to practise investigations can be stressful and that many take too long to resolve, with some becoming complex and adversarial. Much in this report reinforces our view on where improvements are needed, and its findings have confirmed our thinking on the best way to go about effecting that change.

"This work will be challenging, but improvements have already been made. For instance, by always encouraging local complaint resolution, we’ve seen a reduction of almost 1,200 concerns being brought to us in the six years to 2021. We increased the capacity in our casework team at the beginning of the year and are now starting to see the benefits of that change, and earlier this year we launched the Dental Professionals Hearings Service to highlight the independence of panels and hearings from the GDC.

"Only reform of our legislation can bring the kind of wholesale change which is so clearly needed. But, in its absence, if we are to continue improving fitness to practise, we must go on making repeated incremental changes to improve the process and experiences of those involved, and this is very much our plan."