Experiences of GDC fitness to practise participants 2015 – 2021: A realist study

This study was done in order to look at experiences of Fitness to Practise
(FtP) processes in dentistry. FtP processes are started when concerns are
raised that a dental professional may have been treating patients poorly or
behaving in an unprofessional manner. The case is then closely looked at
to make sure the public are safe. The regulator for dental professionals, the
General Dental Council (GDC), must also make sure that the process is fair
but effective. We wanted to know how the process is experienced so that
improvements can be made.
Our study used many methods. We undertook over 70 interviews with those
involved in all aspects of FtP processes including those dental professionals
being looked at closely as well as the GDC and legal staff involved. We also
looked at published research papers on FtP in healthcare professions and
public facing GDC documents. We observed a small number of case hearings
online. We also discussed the findings with the GDC staff. All of our findings
were used to consider in what ways the GDC could improve the experience.
Overall, we found that the experience had a negative impact on the dental
professional’s state of mind. Indeed, certain parts of the FtP process may be
making things worse: for example, when cases take a long time to resolve
and also, when participants were unclear about the progress of their case.
Reassuringly, all participants felt the FtP outcomes were fair. They were,
however, less favourable about the overall process experience. The GDC
staff involved with the process believe it is effective. However, they were
unsure if it was done in the right way. Members of the dental professions
undergoing FtP procedures report needing more support. To enhance the
experience, there is a need for better organisation of the process and a more
empathic, formative approach. Quicker resolutions to less serious complaints
will also help. To build on our research, the GDC needs to look at how they
support particular individuals who may be at greatest risk of mental health
problems caused by the FtP process. There is also a need to explore how
other aspects of the GDC’s work influences the experience. NHS dentistry
in the post-COVID-19 era is struggling. A non-supportive FtP approach
might make things worse not only affecting the confidence of the individual
dental professionals (DPs) involved so reducing the dental procedures (i.e.
defensive dentistry) they will undertake but also resulting in them leaving
the profession. A formative, quality improving, and supportive approach is
attractive whilst recognising the GDC’s role as the regulator.