If a complaint about a dentist is referred to the General Dental Council (GDC), the case will be investigated, and can lead to a hearing and subsequent imposition of sanctions.
In this post, the latest in our series of blog posts about legal services for professionals, we will help you to understand what constitutes an offence, the process of sanctioning, and provide clarity on the support available for you as a dentist.
WHO ARE THE GENERAL DENTAL COUNCIL?
The General Dental Council (GDC) is the professional body responsible for registering and upholding the standards of all dental professionals practising in the UK.
Once a complaint about a dental professional has been referred to the GDC, it will be investigated by Case Examiners, who must decide whether there is a case for the Committee. If they decide there is not a case, they can end proceedings with advice or a warning to the registrant.
If there is indeed a case, the matter will be elevated to a disciplinary hearing before one of four Practice Committees – this is the final stage of the complaints procedure. At this stage it is important to note that the allegations have not been tested or proved.
The four Practice Committees are as follows:
- The Professional Conduct Committee (PCC) is charged with determining whether or not a dental professional’s fitness to practise is impaired on the basis of the facts found proved. Where a registrant’s fitness to practise is found to be impaired the PCC decides whether to impose a sanction.
- The Professional Performance Committee (PPC) deals with cases where it appears that a dental professional’s performance is consistently falling below an acceptable standard.
- The Health Committee (HC) deals with cases where the dental professional’s fitness to practise is impaired by reason of ill health.
- The Interim Orders Committee (IOC) can, as an interim measure, suspend or place conditions upon a dental professional before a full inquiry by a PC. The suspension may be renewed or revoked later.
WHAT SORT OF OFFENCES ARE CONSIDERED FOR TRIBUNAL HEARINGS?
Offences that are considered for tribunal hearings generally fall into one of three broad categories:
- Personal Behaviour – this includes offences relating to sexual misconduct, abuse of the privileged position enjoyed by registered professionals, violence, dishonesty, misleading behaviour, criminal convictions, cautions or other outcomes from the criminal process, and the misuse of social media and the internet.
- Clinical cases – this includes offences relating to single clinical incidents, treatment planning, informed consent, record-keeping, prescribing medicines, implants, pre-purchased treatments, cosmetic treatments, tooth whitening, working outside the scope of practice, or working beyond training and/or competence.
- Concerns allied to clinical care – this includes breach of GDC or other relevant standards, failure to treat patients and staff with respect, failure to raise concerns, complaints mishandling, practising without appropriate indemnity insurance, and advertising concerns.
WHAT ARE THE SANCTIONS THAT CAN BE IMPOSED?
There are several levels of sanctions that can be imposed from the least to most serious, they are as follows:
1. Reprimand: This is a statement of the Committee’s disapproval, but the registrant is still fit to practise with no restrictions and so no other action needs to be taken.
A reprimand may be suitable where most of the following factors are present (this list should not be taken to be exhaustive):
- there is no evidence to suggest that the dental professional poses any danger to the public;
- the dental professional has shown insight into his/her failings;
- the behaviour was an isolated incident;
- the behaviour was not deliberate;
- the dental professional acted under duress;
- the dental professional has genuinely expressed remorse;
- there is evidence that the dental professional has taken rehabilitative/corrective steps;
- the dental professional has no previous history.
2. Conditions: This is where restrictions are placed on the registrant’s registration for a set amount of time. The conditions may include that the registrant must take further training and provide evidence to prove that they are taking steps to improve. The conditions usually have to be reviewed within a certain time.
Conditions may be appropriate when all or most of the following factors are present (again, this list is not exhaustive):
- there are discrete aspects of the registrant’s practice that are problematic;
- any deficiencies are not so significant that patients will be put at risk directly or indirectly as a result of continued – albeit restricted – registration;
- the registrant has shown evidence of insight and willingness to respond positively to conditions;
- it is possible to formulate conditions that will protect the public during the period they are in force;
- it is possible to formulate conditions that satisfy these requirements: necessary; clear; relevant; proportionate; workable; capable of being monitored/reviewed; addressed only to the registrant and not a third party.
3. Suspension: The Committee can suspend the dental professional’s registration. This means that the registrant cannot work as a dental professional for that set period of time. A Suspension Order is set for the minimum amount of time that the PCC considers it necessary to protect the public, and may not exceed 12 months.
Suspension is appropriate for more serious cases and may be appropriate when all or some of the following factors are present (this list is not exhaustive):
- there is evidence of repetition of the behaviour;
- the registrant has not shown insight and/or poses a significant risk of repeating the behaviour;
- patients’ interests would be insufficiently protected by a lesser sanction;
- public confidence in the profession would be insufficiently protected by a lesser sanction;
- there is no evidence of harmful deep-seated personality or professional attitudinal problems (which might make erasure the appropriate order).
4. Erasure: This is the most serious sanction as it removes a registrant’s name from the register. This means that they can no longer work in dentistry in the UK. Erasure is the most severe sanction that can be applied by the PCC and should be used only where there is no other means of protecting the public and/or maintaining confidence in the profession. Erasure from the register is not intended to last for a particular or specified term of time. However, a registrant may apply for restoration only after the expiry of five years from the date of erasure.
Erasure will be appropriate when the behaviour is fundamentally incompatible with being a dental professional: any of the following factors, or a combination of them, may point to such a conclusion:
- serious departure(s) from the relevant professional standards;
- where serious harm to patients or other persons has occurred, either deliberately or through incompetence;
- where a continuing risk of serious harm to patients or other personsisidentified;
- the abuse of a position of trust or violation of the rights of patients, particularly if involving vulnerable persons;
- convictions or findings of a sexual nature, including involvement in any form of child pornography;
- serious dishonesty, particularly where persistent or covered up;
- a persistent lack of insight into the seriousness of actions or their consequences.
IS IT POSSIBLE TO AVOID PUBLICITY OF A HEARING?
Hearings are normally held in public. However, rules of procedure allow all Practice Committees to proceed in private on a discretionary basis.
Circumstances in which all or part of a PCC hearing may be held in private include (this is not an exhaustive list):
- where it is necessary to protect the interests of any of the parties, for example juvenile or vulnerable witnesses; or
- where it is necessary to protect information about a registrant’s health; or
- where it is necessary to protect the private or family life of the registrant; or
- where the Committee is of the opinion that publicity would prejudice the interests of justice.
Before deciding to hear a case or part of a case in private, the PCC should invite representation from the registrant and other parties to the hearing, and take advice from the legal adviser.
The PCC are required to limit the private part of any hearing to the minimum necessary in order to achieve the identified objective.
Anyone may attend the public parts of a hearing.
WILL MY INSURANCE COVER LEGAL FEES?
If you find yourself in need of legal support, you should check the terms of your relevant policy. You may have a household policy which covers legal fees or you may have legal expenses insurance.
You should be aware that some insurers will state in their terms that you must use one of their prescribed solicitors, however, the true position is that you do not have to go with their choice. The Insurance Companies (Legal Expenses Insurance) Regulations 1990 allow you to choose which solicitor will be appointed in respect of any proceedings conducted on your behalf.
Some unions may offer preliminary help and legal advice and provide you with financial assistance towards your legal fees. It is worth noting that legal rights have time limits, so you should check with your union and insurers as soon as possible.
HOW WE HELP
If you are subject to a disciplinary hearing from the GDC, they will have explained their reason for doing so in a letter. We will review your case and advise you on your chances of success. We will explain the processes and advise you on the best way of proceeding, and set about gathering evidence to support your case.
At your hearing we will represent you and argue that you are fit to practise and show how this is supported by the evidence obtained.