The General Dental Council (GDC) is responsible for the registration of dentists, dental hygienists, dental therapists, dental technicians, clinical dental technicians, orthodontic therapists and dental nurses in the UK. If a complaint about a registrant is made to the GDC, it is statutorily obliged by the 1984 Dentists Act to investigate.
Although I knew the processes involved in the GDC's investigation of complaints prior to working for the DDU, I knew little of the intricacies, or of the proposed changes to combat the problems encountered over recent years with rising complaints. We now look in more detail at the procedures, and the changes proposed by the much publicised Section 60 order.
The complaints process
When a complaint is received by the GDC it is first handled by a triaging system, the purpose of which is to remove matters which would not be appropriate for the GDC to investigate. Those matters assessed to be worthy of further investigation are then passed on to the GDC's casework team. If the complaint is about a clinical matter caseworkers usually seek the advice of a clinician in order to gain a better understanding of the complaint and decide if it warrants a referral for investigation by the Investigating Committee.
If the case is referred to the Investigating Committee, the registrant is invited to respond to the allegations raised by the caseworker. At this stage the DDU would normally instruct a solicitor to ensure legal advice is sought in the formulation of the response. The Committee (a panel of three, one registered dentist, one lay person and one DCP) then meets in private to consider the matter.
Following their consideration the Investigating Committee may take one of the following actions:
- take no action
- adjourn the case in order for the Registrar to carry out any enquiries the Investigating Committee specifies
- issue a letter of advice to the Registrant regarding their future conduct, performance and practice
- issue advice to any other person involved in the investigation on any issue arising in the course of the investigation
- issue a warning to the Registrant regarding their future conduct, performance and practice (warnings may be published or unpublished)
- refer the case to a Practice Committee: Health, Conduct or Performance (where the Investigating Committee refers the allegation or allegations to a Practice Committee, they also, if appropriate, refer to the Interim Orders Committee).
If a case is referred to a Practice Committee, the GDC will instruct a solicitor to further investigate and present the case at the hearing. Expert reports will be considered from both parties in relation to the allegations before a final decision is made.
Recent changes – the Section 60 order
In January 2016 the Westminster and Holyrood parliaments approved a Section 60 Order. This will allow legislative changes to the 1984 Dentists Act description of the Fitness to Practice process and allow the GDC to introduce Case Examiners.
The GDC have stated that, 'Case Examiners will streamline and improve our fitness to practise procedures in a number of important ways: by agreeing undertakings with dental professionals, more complaints will be dealt with without the need for a Practice Committee hearing; increasing transparency and fairness by seeking representations from a dental profession if the GDC intends to issue a warning and reviewing decisions in certain circumstances.'
My experience with GDC proceedings is limited to two years, and during that time I have had several cases conclude following receipt of the clinical advice which doesn't criticise the member's treatment of the complainant. However, I have also seen several cases proceed to the Investigating Committee and then on to one of the Practice Committees, often with allegations unrelated to the initial complaint.
Although early use of clinical advice provides the caseworker with invaluable information, the advice might highlight aspects of the care of the patient unrelated to the complaint itself. Many of the cases I have assisted with have progressed purely because of poor record keeping, and failure to follow accepted guidelines on the use of radiographs and antibiotics.
My personal thoughts on GDC procedures before becoming involved with the legal aspects of dentistry were that only the complaint itself would be analysed. If a patient complained about treatment which failed prematurely, I thought only that treatment would be scrutinised.
In reality the first part of any investigation involves requesting the full clinical records relating to the complainant. Those records are then analysed and compared to the current guidance on record keeping, radiographic practice, antibiotic prescribing practice and so on by the Clinical Adviser.
Unfortunately those guidelines, most of which were originally developed to serve as the standard to aspire to, are now being used as the standard for acceptable, rather than best, practice. Why? Because currently the majority of guidelines used in dentistry only provide for 'best practice'.
The first part of any investigation involves requesting the full clinical records relating to the complainant.
Although guidelines for acceptable practice are anticipated from the Faculty of General Dental Practice (FGDP), they are yet to be published, and until they are, the current guidelines are used as a comparison, particularly during the early stages of an investigation.
The latter stages of an investigation then introduce the opinions of expert witness regarding acceptable practice, and the Committees then decide whether the care provided by the registrant fall seriously below that accepted standard, taking those expert opinions into consideration.
Consultations and conclusions
The GDC are currently consulting on draft guidance on how they will approach warnings and undertakings for Case Examiners before the legislative changes come into effect. Although the introduction of Case Examiners should streamline the current processes, and expedite potentially more serious cases, as things stand they are also likely to rely heavily on current guidance as the standard against which to judge a registrant's care.
I am fairly new to GDC investigations, and it has really opened my eyes to how thorough they are. Even with the current problems at the GDC aside, they are thorough for a reason; to protect the public. Our job at the DDU is to protect our members, but unfortunately there is no sure-fire way of predicting which patient may complain to the GDC.
There is however a way to ensure you increase the likelihood of reducing the risk of a complaint progressing through the various stages; ensure you are aware of all of the current guidance relating to your practice, and record your reasons if you deviate from that guidance.
Regular audits of your practice will also help identify any areas where you may be vulnerable to criticism should the worst happen, enable you to implement changes at an early stage, and also demonstrate that you are constantly assessing your own practice and striving to improve.
Eric qualified in 2001 at Manchester University, gained the MFGDP (UK) in 2006 and a Masters in Medical Law (LLM) in 2015. As well as being a dento-legal adviser for the DDU, he works in general practice and as a clinical teaching fellow at Manchester University.
See more by Eric Easson