Joint research by the Nursing & Midwifery Council (NMC) and the General Dental Council (GDC) show that professionals who engage during a fitness to practise process have more positive outcomes.

Key findings from the research are:
  • There are some clear differences in FtP procedures across the nine UK health regulators and the research identified five models. The differences centred on whether regulators find impairment or not at the adjudication or panel hearing stage of their process, and at which points they are able to issue recorded censures. 
  • Despite the differences, the concept of seriousness is used in two main ways in FtP processes across health regulators; to help define misconduct itself and to place a particular misconduct on a spectrum of seriousness to determine an appropriate sanction. 
  • Some types of misconduct carry a presumption of seriousness that is broadly consistent across all regulators. These are sexual misconduct, dishonesty, and criminal convictions. However, when it to comes to situating an act or omission on a spectrum of seriousness, there is variance within and between regulators due to a number of factors affecting a case. 
  • In addition to considering the nature of a misconduct, regulators consider aggravating and mitigating factors to help decide the level of seriousness of an FtP case. These include considering the extent or risk of harm, registrant engagement level, registrant’s attitudinal issues, environmental factors, and whether the misconduct took place at work or social setting. 
  • A registrant’s level of engagement in FtP proceedings can be a key factor in determining the seriousness of a case and the eventual outcome of it. Registrant’s engagement, such as responding to their regulator, co-operating with investigations, and attending panel hearings, was found to be especially important in decisions about impairment and sanctions. Recent developments in case law on this issue found that it is a professional obligation for regulated professionals to engage with their regulator. However, the research shows that this position had not been adopted by all panels across regulation. 
  • Legal advice and representation were seen as important in supporting registrants in navigating the complex FtP process and making them aware of the importance of full engagement with proceedings. However, the research found that legal representation varied between professional groups with doctors, dentists and pharmacists typically said to have legal representation while nurses, dental care professionals and pharmacy technicians were reported as having higher levels of self-representation.
  • FtP matters pertain to regulators’ statutory objectives and decisions about seriousness were often explicitly linked to these regulatory objectives, namely ensuring public safety and maintaining public confidence.

Tom Scott, Interim Executive Director of Professional Regulation, said:

“We’re grateful to the GDC for collaborating with us on this research and to the research team at the University of Plymouth for their diligence and excellent work on this complicated area. These findings will form an important part of our work around the concept of seriousness in FtP cases. We hope it will encourage even more professionals to engage with us early on in the FtP process.

“We regularly review and update our guidance based on the best available evidence. While our research shows differences in how regulators make decisions concerning seriousness, the government’s work on regulatory reform could help to address this. We hope this will help to maintain confidence in our FtP processes and our role in supporting health and care professionals to provide safe, effective and kind care.”

GDC Executive Director, Fitness to Practise, John Cullinane, said:

“The findings in this report will inform all our work where the concept of seriousness is relevant and this research provides useful evidence to inform our ongoing work to improve our fitness to practise processes. Our outdated legislation, however, severely limits how much progress we can make, preventing proportionate and responsive approaches in many areas of our work.

“We continue to press the Government to deliver the reforms they consulted on last year which we believe will give us the freedom to make significant improvements for the benefit of both patients and dental professionals.”

Read the full report on the concept of seriousness in fitness to practise cases.

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