Fitness to practise learning
What can you learn from the fitness to practise process?
You can make positive changes to your practice and dental services by reflecting on the insights and trends identified from the fitness to practise process.
Here you will find our new learning tools designed to help you understand the types of fitness to practise concerns raised and the different issues represented. We provide details of what happened following the initial assessment and the reasons for our actions. These insights will help you to reflect on your own practice and to learn from the experience of others.
We have produced three publications:
This work forms part of our efforts to shift the balance of our activities upstream, that is, before things go wrong, to realise our statutory objectives of:
- Protecting the health, safety and wellbeing of the public.
- Promoting and maintaining public confidence in the dental professions.
- Promoting and maintaining proper professional standards and conduct for members of those professions.
Further details on the initial assessment stage of the fitness to practise process can be found below. The figure shows the inital assessment process and the referral routes used in the processing of concerns when they are received. The frequently asked questions provide the details and legislative framework for the initial assessment process.
This is our first release of this type of analysis of fitness to practise concerns, so we are interested to hear what you think. We would be grateful if you could take the time to provide us with some feedback on the content and presentation of these publications, using our online form.
Please take the time to read, consider and share these insights with your colleagues and dental teams. Most importantly, please think about any adjustments you might make that could improve the quality of care and services that provided by you and your dental team.
Figure 1: Summary of the initial assessment process
How do we initially assess concerns?
The initial assessment decision group (IADG) meets each working day to review the concerns received since the previous meeting. The IADG is made up of GDC staff members responsible for various stages of the fitness to practise process and includes clinical dental advisers. The ability to draw on a range of relevant expertise ensures the nature of the concern is well understood and that balanced decisions are reached at the earliest possible point in a case.
The IADG assesses every concern on the information provided by the person or organisation who has raised the concern. In some cases, more information is needed before a decision can be made. In these circumstances, the concern will be placed on hold until the details needed are received. A sample of decisions made by the IADG is audited internally to ensure decision making is consistent.
Each concern raised is considered by the IADG using the 'Initial Assessment Test' (IAT) (outlined below).
1. Does the information give rise to a concern that:
- harm has been caused, or may have been caused, to a member of the public, and/or
- public confidence in the profession has been, or may have been, undermined?
2. Could further investigation result in a different answer to i) and ii)?
In this context, 'harm' is not just physical, for example, damage to a patient's dentition from a clinical incident. It can be a range of different types of harm, such as emotional, psychological and financial. The IADG must consider the term broadly, when assessing concerns.
The IAT also refers to 'public confidence'. This is the expectation the public has for dental professionals to act, or behave, in a safe and professional manner. Investigations will be opened when serious shortcomings in conduct and competence have the potential to undermine public confidence in the dental professions or services.
Public confidence matters because people are less likely to access services when they lack confidence. Further, public confidence can be influenced by good regulation. High levels of public confidence can remove some barriers to access dental services and low levels of confidence can create them.
Public confidence involves all those connected with the provision of dental care and services, not just the regulator. It includes taking steps to ensure, as far as possible, that standards of competence and conduct, across the dental profession, are conducive to public confidence in the dental professions and services.
How does the initial assessment decision group reach a decision?
The initial assessment decision group (IADG) comes to a joint decision about whether the initial assessment test (IAT) (see above) has been met for each concern raised. It is important to note, that at this stage, there does not need to be full evidence to show that the IAT has been met. Instead, the IADG assesses whether the concern, on principle, would be a fitness to practise issue should it be proven true. The Dentists Act 1984 (as amended) S27(2) and 36N(2) provides the grounds for which fitness to practise can be impaired.
The IADG will also consider the scale of the risk of harm to patients, or damage to public confidence, that the concern carries. This assessment of risk helps to determine how urgent the investigation needs to be, including whether it needs to go through a more urgent process called the Interim Orders Committee (IOC). It is then for the next stages of the fitness to practise process to gather the evidence necessary to complete the investigation.
When do we refer cases to the NHS?
The initial assessment decision group (IADG) may decide to refer a concern to NHS England or NHS Wales if the treatment has been provided by a dentist on the NHS dental performer's list. NHS Northern Ireland (NI) and NHS Scotland do not have the powers to investigate concerns, and therefore, refer concerns directly to dental practices. We cannot make a referral to the NHS NI, or NHS Scotland, once it has been submitted.
Any concern, which is assessed as carrying a potentially significant risk, will need to be investigated by us, regardless of whether the treatment is NHS or private.
Concerns that we refer to the NHS must be low-level in nature (i.e. are assessed as not carrying significant risk) and do not give rise to a fitness to practise concern. They are most often, but not exclusively, isolated incidents. The concerns referred to the NHS must also fit within one or more of the following categories:
- complaints handling
- behaviour/attitudinal concerns
- record keeping
- contract issues.
The number of referrals to the NHS are normally quite low, and there are various factors that may contribute to this outcome. Firstly, as explained above, there are very specific circumstances in which the IADG can refer a concern to the NHS, and often, the nature of the concern raised includes a potential fitness to practise issue that needs investigation. Secondly, over recent years, across dentistry, the benefits of local complaint resolution have been promoted. This has coincided with a reduction in the overall numbers of complaints coming to us. This suggests that more patients are seeking a resolution to their concern directly from their practice.
Our online triage tool may also be contributing to the relatively low number of concerns the IADG is referring to the NHS. The triage tool is designed to direct those with concerns to the most appropriate route from the outset.
When will we investigate a concern?
We will investigate a concern when it relates to a dental professional's 'fitness to practise' which is defined in the Dentists Act 1984 (as amended) S27(2):
A dental professional's fitness to practise is of concern when it relates to:
- deficient professional performance
- a charge, caution or conviction for a criminal offence
- adverse physical or mental health.
It doesn't matter if the concern raised occurred outside the UK, or if it occurred at a time when the individual was not registered with the GDC.
Some concerns will be closed after initial assessment because they fall outside of our scope. These concerns include assisting with refunds or compensation, immigration issues, civil matters unrelated to dentistry, employment or commercial disputes and concerns involving tax.