GDC fitness to practise procedures

• The GDC received 1,264 new concerns in 2022 - a decrease of 6% on the previous year.
• The great majority of complaints to the GDC are closed without action on the dental professional's registration, but a GDC investigation is still a source of great anxiety to any dental professional under scrutiny.
• Understanding the process and knowing what to expect can help ease these fears, so here we give an overview of the GDC's fitness to practise (FTP) procedures.

Four stages

There are four stages to the GDC concerns procedures, which we explain below. At each stage in the process, the GDC tells the parties involved in writing what decisions have been made about the concerns raised.

Stage 1 - Initial Assessment Team

The Initial Assessment Team will assess the concerns to see if the GDC are the right organisation to deal with them. The GDC statistical report has examples of the types of cases it can examine, including:

• serious or repeated mistakes in clinical care
• failure to examine a patient properly or seek their consent before treatment
• serious breaches of confidentiality
• potential criminal offences, including fraud and sexual misconduct
• not having adequate professional indemnity or insurance.

The GDC will either:

• assess the information and allocate a case to the casework team for consideration, or
• decide not to open a case and tell the complainant why they are not doing so. You won't receive any correspondence about this stage having taken place.

Stage 2 - casework

The casework team will look into the concern to see whether it should proceed to the next stage.

This stage involves notifying you about the concern. This early stage letter will contain limited information, like the name of the complainant. It also asks you to provide the GDC with further information, such as:

• your employer's details
• the patient records in clinical cases
• proof of your indemnity.

It's vital you tell us you have received this letter as soon as possible.

The DDU will allocate your case to an expert dento-legal adviser (DLA). Our DLAs are all dentists themselves and can guide you through the process and help manage any anxieties you might have. They can also advise you at this early stage on the appropriate remediation that can be carried out, to demonstrate (if necessary) that your fitness to practise is not currently impaired (see below).

You will only have seven days to comply with the request for further information, although the GDC doesn't always strictly enforce this if there are mitigating circumstances, such as you being on leave.

The casework team will:

• write to your employer to notify them of the complaint and ask if they have any other concerns about your practice
• review the records
• instruct a clinical dental adviser to write a report
• determine whether the case should be referred to the next stage, called the Rule 4 stage, for more detailed consideration by the case examiners
• consider whether this is a health case, which means seeking your consent to obtain a medical report.

The casework team will then either write to you to either:

• confirm that the case is being closed with no further action, or
• confirm that the case potentially amounts to an allegation that your fitness to practise is impaired.

If the case proceeds, you'll receive a bundle of documents, including the patient complaint, the patient records, the clinical advice report obtained, and a set of allegations which you must respond to within 28 days.

The DDU dento-legal adviser will instruct a solicitor to help you draft a response to the allegations. We will also usually invite you to a meeting (either in person or online) so we can discuss the case with you. The solicitor can draft a response for your approval.

The GDC explains that no decision is made at this stage about whether an allegation is true.

Delays in investigations

The GDC website explains that it aims to make a decision within four months from the date the concern is received. Alternatively, if a case proceeds to the case examiners, a decision will be made within six months from when a concern was received.

However, the DDU's experience is that currently cases are taking much longer to reach the next stage - up to a year in some instances. We are doing all we can to raise these delays with the GDC and encourage the regulator to speed things up, in the interest of the health and wellbeing of our members.

GDC pilot

Starting on 4 September 2023, the GDC began piloting a six month scheme aimed at speeding up these early stages of investigation. In cases relating to a single patient clinical practice, where the dental professional involved has no previous fitness to practise concerns, the GDC will limit the amount of information it gathers. This will usually be confined to obtaining the patient records and a swift report from a clinical adviser.

The GDC says it hopes this will improve the "timeliness and proportionality" of investigations and "reduce the impact of fitness to practise investigations on the health and wellbeing of participants." During the pilot the GDC may expand the criteria for the type of case that could be included.

The DDU awaits developments on this pilot with interest.

Stage 3 - case examiners (also called Rule 4)

Once you have provided your detailed response, through your solicitor, the case is transferred to the case examiners. Again, the delay can be significant and it's not unusual to have to wait for six months for the case to be considered by the case examiners.

The case examiners (one lay and one dental) will consider the allegations, the records, the clinical advice report, your response, and any further comments from the person who raised the concerns. According to the GDC in 2022, 34% of cases reached this stage.

The case examiners don't consider whether or not the allegations are true, but if there is a real prospect of the allegations being found proved if the matter proceeds to a hearing. They then consider whether those allegations would amount to misconduct and whether the dental professional's fitness to practise would be found to be currently impaired.

It's important to realise that any practice committee must find current impairment in order to issue a sanction on your registration. For this reason, the DDU can support you in showing evidence of remediation (see below).

The case examiners will decide whether to refer the allegation to the Dental Professionals Hearings Service for a full public inquiry.

Alternatively, they may take the following action:

• agree a set of undertakings with you
• send you a letter of advice
• issue a warning
• take no further action.

Interim orders committee

The GDC can apply for an interim order to restrict a dental professional's practice at any time during the process. If that happens, the matter goes before an interim orders committee (IOC).

The IOC considers whether it is necessary to make an order restricting the dental professional's registration for the protection of the public, in the public interest, or in the interest of the individual concerned. This is pending the outcome of an inquiry by one of the practice committees. The IOC does not investigate the allegations or conduct a fact-finding exercise. Again, the DDU will be able to help you with representation at such a hearing.

The IOC may:

• impose a suspension (up to 18 months with six monthly reviews), meaning you won't be able to work as a dental professional
• impose conditions (up to 18 months with six monthly reviews), such as requiring you to have supervision for certain treatments
• decide that no order is necessary.

Stage 4 - practice committees

This final stage is a full public inquiry before an independent committee of the Dental Professionals Hearings Service. This happened in 16% of cases in 2022.

The Dental Professionals Hearings Service is the adjudication function of the General Dental Council that is separate and independent from the GDC's investigation and prosecution functions. The hearings are conducted in public and managed by independent committees made up of dental professionals and lay people.

The committee hears evidence from all parties, and submissions from barristers on your behalf and on behalf of the GDC, and makes a decision. If any allegations are proved, the committee then decides if your ability to practise as a dental professional is affected and what action they should take.

The committee can take a number of steps. The most serious is to remove your name from the Register, which means you are 'struck off' and cannot practise. You have the right of appeal.

They can also:

• take no action
• issue a reprimand
• place conditions on registration
• suspend registration.

DDU statistics for 2022 show that 50% of dental member cases at the GDC practice committee were concluded with no finding of impairment. The equivalent GDC figure for outcomes overall is 18% (for 2022).

Insight and remediation

Demonstrations of insight into the causes of the incident that led to the complaint and providing evidence of remediation to put things right can be powerful ways for a dental professional to demonstrate they are fit to practise.

In the DDU's experience, dental professionals who show insight and evidence of remediation are much less likely to be erased or given a serious sanction. Our experienced dento-legal advisers are always available to provide advice about specific remediation that can be carried out, depending upon the nature of the allegations against you.

Last word

We would encourage any DDU member receiving notification of a complaint to the GDC to make contact with us as soon as possible, and before responding.

We recognise that GDC investigations are stressful for dental professionals and so we'll offer a prompt online meeting or phone call so you can meet the adviser who'll be supporting you, ask any initial questions and receive early guidance and reassurance.

We are experts in assisting dental professionals at the GDC, and it's never too soon to ask for help.

This page was correct at publication on 26/09/2023. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.