Dental regulation through the General Dental Council was only established as recently as the middle of the last century (1956) following on the heels of the creation of the modern NHS in 1948. At that time there were only 16,000 dentists practising in the UK. Today, more than twice as many dentists are registered and regulated by the the statutory corporation whose powers and duties set out in the Dentists Act 1984.
The prime purpose of the GDC, as with all professional bodies, is to ensure the protection of the public. The principle means through which this is achieved are the fitness to practise committees and secretariat. The protection of the public and the maintenance of confidence in the profession is plainly not a dispensable luxury but a necessity, albeit one that can come at a cost, in every sense.
Regardless of the title of the regulator or the particular profession in which one is engaged, the common experience of those who become the object of professional regulation or fitness to practise proceedings is that it is generally found daunting and occasionally thoroughly unpleasant.
A professional person with an unblemished record and long history of achievement in their career may, upon the whim of another or because of a circumstance beyond their control, find themselves in receipt of a notification from their regulator that a complaint has been made. Such a notice will almost inevitably presage a lengthy and potentially unpalatable episode in the professional’s life. It might well be argued that this is the natural consequence of standing accused, even if that be so, limiting the damage is a natural and sensible response.
The larger and better resourced regulators have more experience (and perhaps capacity) enabling them to make the experience of standing accused of ‘unfitness’ more bearable for their registrants but, there is nevertheless an inherent difficulty in a system of self-regulation where it is the regulatory body that brings the case, investigates, employs the prosecutor, provides the rooms where the hearing takes place and appoints those that are to make the determinations. Thus the perception of the registered professional may be, in all these circumstances that the odds are stacked in favour of the regulator and the outcome predetermined. This perception, if it exists, is not though entirely justified; the statutory committees established to deal with these issues will in fact, at least in part be made up of fellow professionals who are well aware of the difficulties and strains placed upon a professional in practise and the processes of a regulator are subject to law and protections are in place which aim to guarantee a fair hearing.
Whatever the professional’s perception of the process, there can be little doubt that the better informed he or she is, the more likely it is that this will produce a favourable outcome and incidentally, ameliorate the feeling of being a pawn in someone else’s game. Some useful information can be garnered from this GDC website page www.gdc-uk.org/aboutus/thecouncil/pages/governancemanual.aspx which provides links for the principle legal provisions. The statute and rules provided there make for heavy reading but there is some more straightforward guidance available through www.gdcuk.org/Membersofpublic/Hearings/Pages/Hearings.aspx. It may be of help though to have here provided a broad outline of the process rather than attempting to tackle the primary statute and rules.
The process
The disciplinary process will commence after a complaint has been received by the GDC. Complaints usually come from patients, colleagues, employers or the police (in the case of a criminal investigation). The complaint may relate to conduct, competence or the health of the professional or a combination of these matters which touch upon the question of fitness to practise.
Once a complaint has been received by the GDC there are three potential stages to the process depending on how far it gets. The stages are:
1) Review by the registrar
2) The investigating committee stage
3) The practice committee stage
Initial consideration of the complaint is made by the registrar. This part of the process is designed to weed out complaints which have no place in the process for instance because the complaint does not relate to a registered dentist or is conspicuously frivolous.
If the registrar determines the complaint amounts to ‘an allegation’, the dentist will at that stage receive the notification of the allegation. The notification will contain a summary of the allegation, be accompanied by a copy of the documents in the registrar’s possession which relate to the allegation and invite the dentist to respond in writing.
Responding to the allegation at this stage is the first opportunity the dentist will have to state their position. It need hardly be emphasised that getting this stage right is paramount in importance; it may be determinative of the eventual outcome. The other important consideration is that it is never in your interests to sit on the correspondence; a failure to respond will only make a bad situation worse and may even give rise to a further and separate fitness to practice misconduct allegation.
Almost invariably advice should be sought at this stage from a lawyer well versed in this area of law. It may well be you have cover through your professional indemnity insurance. Whoever you do consult in make sure you feel confident in their advice and support.
The next stage, once the dentist’s response is received and the papers relating to the case have been compiled is that the investigating committee will consider all the material they have available to them and determine what should happen next. At this meeting of the committee the accused dentist is not entitled to be present.
The purpose and function of the committee is principally to decide if there is a case for the dentist to answer. If there is, the investigating committee will have available to them a number of options: it may adjourn the hearing and direct the registrar to carry out further enquiries; it may dismiss the allegation; it may direct that the allegation be sent to a practice committee or it may issue a letter of warning or advice. If the investigating committee proposes a warning as a disposal, it is well worth bearing in mind that what at first may appear to be an attractive alternative to the a full disciplinary hearing may result in a permanent stain on the record of the accused and have a significant impact in the job market – be warned.
Thought may also be given at any stage in the process to interim orders, such as suspension or conditions of practise pending the resolution of the disciplinary process. The GDC will be concerned with the need to protect the public and will only make such an order if they consider it necessary having regard to the facts as they are then known. The profound consequences for a professional person made the subject of an interim order which is likely to have the effect of restricting either the manner of practise or the ability to practise at all is self-evident. In consequence, dentists will always have the right to appear and be represented before any committee making such a decision.
If the investigating committee decides to refer a case to one of the practice committees the dentist will be so informed and a date will eventually be set down for a hearing. At that hearing the dentist will be entitled to be present and represented and call evidence and question the witnesses called by the registrar.
The proceedings are intended to be as informal as possible while maintaining the necessary dignity and seriousness the process requires. The dentist should be allowed to sit next to their lawyer and discreetly provide instructions as when necessary. The pomp and circumstance of the court process is (thankfully) dispensed with.
The practice committee should be separate and independent of the investigating committee and will make the determination of guilty or not and if guilty decide sanction ranging from reprimand through to erasure from the register.
The evidence relied on by the registrar at the hearing will be presented to the committee by a lawyer instructed by the registrar. Usually this will be a barrister with considerable experience in the field.
It is always best to make sure you are equally well represented – advocacy skills really do count in these situations. It is an unfortunate truth that the facts do not always speak for themselves, they need to be presented in the most favourable and persuasive way. That is the role of the advocate.