General Dental Council (GDC) research find “significant negative impacts on the mental health and wellbeing of participants” which “could have unintended consequences for professional behaviour and practice.”

The research was commissioned to ‘understand and learn from’ the experiences of 70 individuals involved with fitness to practise. The GDC reported that the research, which looked at historical cases dating from 2015 – 2021:

“…found that although outcomes were seen as largely fair and effective, there were often significant negative impacts reported on the mental health and wellbeing of participants and, as a result, this could have unintended consequences for professional behaviour and practice.”

Key findings from the report

  • While most of those who had participated in fitness to practise investigations or hearings perceived the outcome to be fair, they also told us that the process itself had negatively impacted their health, wellbeing, behaviour and practice.
  • Fitness to practise operating procedures were largely seen as effective, and when the process worked well, there were favourable outcomes relating to patient safety and improved practice. While issues relating to timeliness, proportionality, understanding of process and decision-making created mistrust.
  • The complexity of the processes and a perceived lack of clarity on how decisions were reached often resulted in feelings of mistrust and unfairness.
  • Most participants felt dissatisfied and frustrated with the current fitness to practise process. Significant levels of stress and anxiety were created by the process, at times hindering the progress of investigations, as participants disengaged or left the profession.
  • Dental professionals reported feeling professionally ostracised, like their professionalism was being called into question, or that they had been presumed “guilty” until they had proved otherwise. Those feelings often exacerbated feelings of stress and anxiety.
  • Participants held the perception that the fitness to practise process was adversarial, rather than one focused on the finding of fact and the protection of patients.
  • There were perceptions of bias or racism in fitness to practise referrals (those received by the GDC) and the provision of sanctions (decided by a fitness to practise panel).
  • Those involved in decision making, who tended to be more familiar with the public protection and confidence purpose of fitness to practise investigations, had reservations about the efficacy of the current fitness to practise process.
  • Participants identified a need for clearer and empathetic communications, more regular contact with their caseworker and for mental health and wellbeing support to be 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.

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.” 

Insight Works Training