During May and June 2014, the Professional Standards Authority (PSA) audited the initial stages of the General Dental Council’s (GDC) fitness to practise (FTP) process for the period 1 November 2013 to 30 April 2014. As Claire Wilks discusses, the results of the audit demonstrate the ongoing difficulties experienced by this regulator in fulfilling its FTP processes.

The audit

The PSA reviewed a sample of 100 cases which had been closed without proceeding to a final hearing before a GDC FTP panel. 50 of those cases were from categories considered more likely to be ‘higher risk’, i.e. in their view there was a higher risk to public protection if proper procedures were not followed.

The structure of the GDC’s FTP process means that there are two stages at which cases may be closed without referral to a hearing in front of a FTP panel, by either:

  1. GDC FTP staff - if the case does not amount to an allegation that a registrant’s fitness to practise is impaired; or
  2. an investigating committee panel - if there is no ‘real prospect’ of the facts, as alleged, being found proved or if there is no ‘real prospect’ of a finding of current impairment being made.

In March 2010 the PSA led a meeting with representatives from the health and care professional regulators to agree a ‘casework framework’ describing the key elements common to the initial stages of an effective FTP process that is focused on protecting the public.

It was against this framework that the audit was carried out. Findings were made under the relevant sections of the framework:

  1. receipt of initial information;
  2. risk assessment;
  3. gathering information/evidence;
  4. evaluation and giving reasons for decisions;
  5. customer care;
  6. guidance;
  7. record keeping; and
  8. timelines and monitoring of progress.

Conclusions

The PSA has confirmed that it did not see any decisions to close cases in this audit which it considered risked patient safety. However, it is of the opinion that 25 instances across 22 of the cases raised questions about the maintenance of public confidence in the profession or the regulatory system. This included an error by the investigating committee to refer a case to the Professional Conduct Committee despite finding no real prospect of current impairment, premature decisions to close cases, avoidable delays, failures to progress cases, poor handling of complaints about the Investigating Committee (IC) process, failure to complete investigations in some voluntary removal cases and data protection breaches.

The PSA also had concerns about delays in publishing warnings on the online register and some failure to share information about FTP complaints with other regulators.

The PSA’s overall conclusion from the 2014 audit was that the inadequacies with the system of quality assurance and management oversight at the GDC identified in its 2013 audit largely remain and its findings reveal a decline in some aspects of the GDC’s performance. While it did not identify any decisions to close cases which it considered risked patient safety, it did consider that some decisions risked undermining confidence in the professions. They remain concerned that aspects of case handling and decision making by the GDC continue to risk undermining confidence in the regulator.

The PSA also recognises that it saw evidence of some improvements that had been implemented since the publication of its 2013 audit report. The primary improvement it identified was in relation to cleansing of data on the case management system and enhanced storage of documentation on case files in respect of IC decisions and Rule 10 cases. However some improvements are still required in these areas.

In response to this audit, the GDC has confirmed that it has implemented a number of measures that have improved the quality and timeliness of its case handling. The PSA will review the evidence of improvements made by the GDC in its 2014/15 annual performance review.