Problems in the process
If you’re just getting to this blog series late about the GDC lecture I did in Manchester then the first two links are here and here. Probably best to read them first if you can be bothered. Read the case here
In this post I just want to summarise and cover how I talked about problems that I could see in the process of regulation in the UK at the present time and it’s worth summarising these before I go into the rest of the issues. Clearly in trying to keep a blog post at a reasonable level I don’t want to get into phenomenal detail but I think the processes can be summarised as follows:
- The ease at which an individual patient (or clinician for that matter) can refer a clinician to the GDC and effectively catapult a complaint high up into the FTP process is causing enormous distress to dentists and enormous strain on resources of the GDC. 4,000 ‘complaints’ in a year, all of which are being investigated with the utmost rigour is an unsustainable situation which must be addressed as quickly as possible lest the system collapses, the GDC entirely run out of money and are unable to charge anymore to dentists and the dentists psychological health dramatically reduces. Whilst it did appear that people further up the political chain have no interest in this (at least until last Saturday), the system will have to sort itself and it will do so either by the GDC becoming bankrupt and being sucked into a ‘super regulator’ (this may not be better and may even be worse) or by people speaking to each other to resolve the system within the current framework before the framework is fixed.
- The fitness to practice process itself is fundamentally not working. It seems in the past 16 – 18 months there have been 10 cases that have gone through full FTP hearings (estimated to cost around £10,000 per day), which have led to verdicts of ‘no case to answer’. This is to take a registrant through a process similar to a criminal case with accusations, counter-accusations, huge and enormous psychological stress, potential damage to his/her business and commercial activities not to mention the huge collateral damage to his/her family life before going through sometimes 10 and 11 days of hearing to be found not guilty and be told that there was no case to be brought in the first place. How many of these cases do we have to have before the numbers are released and full investigations into the process are undertaken to ensure that they are infact fit for purpose.
- Interim Orders Committee. The IOC is the committee which is able to assess a potentially dangerous case where patient safety is significantly at risk and sanction a dentist prior to investigation being carried out and before an Investigation Committee or full FTP hearing is undertaken. This is clearly a feature which has to be in place in the system because if it comes to the attention of the council that there is an extremely dangerous individual practising who is harming patients as we speak then they must be closed down. It is similar to being suspended on full pay in an employment situation expect… there is no pay. This is extremely significant because imagine a business owner who is suspended immediately from an IOC whose FTP hearing takes months to come through following an investigation. In essence the business could be ruined and they could see themselves in financial ruin with no ability to generate income and a loss of good will for the practice. That is not to say the system does not need to have this facility in place but it does mean that you had better get it right almost every single time. It also means, as has been applied to the legal system ‘it’s better to let 100 go free than lock up 1 who is not guilty’. The damage done to an otherwise guilty person by a suspension for interim orders is devastating and has happened. We must get this right. The fact that an IOC can sit without representation from the dentist is also extremely significant and perhaps something which needs to be revisited.
- A further difficulty and problem with the process now is that conundrum of the expert witnesses. I think it I reasonable to state that many excellent expert witnesses have now decided not to work within the GDC expert framework for several reasons, not least the remuneration of the expert themselves. Some experts that I have spoken to have also complained that they have felt pressurised into providing reports in a particular way and it’s clear on reading expert reports and in some of the issues that have arisen through FTP which have been published in the determinations that experts do not understand the neutrality of their position and therefore bias their reports towards the ‘prosecution’ instead of providing neutral evidence. This would be an entirely flawed system and should it happen in a criminal case or a civil case the expert would be liable to significant repercussions as a result of their biased participation in the case. I have a not inconsiderable experience of expert witnessing in the past and it was clear from the declarations that had to be made and ultimately throughout the expert witnessing that my duty was to the court and not the person paying the expert witness fee. This causes a huge problem in cases where the GDC take cases further forward than they ever should due to impartial expert advice.
A larger issue here though is that a profession that has no confidence in the regulator is unlikely to regularly provide excellent quality experts to assist in the sanction of practitioners whose fitness to practice in genuinely unacceptable.
A further issue related to the process would be the inability to appeal to findings at Investigating Committee level. In my case the evidence was out before an Investigation Committee and although that committee was extremely strong in its words and actions in many aspects, it provided me with two lines of advice (and therefore a FTP history) with which I fundamentally and wholly disagree. I had no representation at the Investigation Committee hearing of any kind, can see no deliberation or notes and have no right to appeal. I have to carry with me now a FTP history for the rest of my career (although confidential in theory), which I would have to declare for further job prospects, this is unfair.
The final though and the biggest problem with the process seems to be the lack of communication between the GDC and other dental bodies. Informal communication and discussion between the profession as a whole would surely help to lead to resolution of issues and problems associated with the FTP process. Any streamlining of the process at this stage would lead to a reduction in cost which could ultimately lead to a reduction in ARF and a much more positive feeling within the profession.
In the future posts related to my lecture I hope to address these issues and suggest perhaps some overriding problems associated with philosophy of regulation and how we might address these.
Blog Post Number - 956
If you would like to read the previous posts in this blog series they are below:
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