I have been keeping an eye on the cases emerging from the Fitness to Practice and other committees of the General Dental Council [GDC] for some time, I am sure other GDPUK readers will be interested to know what goes on each month. So, the aim will be to write summary monthly, in what we hope is a short lived blog.
Monthly breakdown of case types and outcomes
The month of March saw 59 hearings scheduled after one was moved back to start in April. There was 1 registration appeal which was granted. Of the remaining cases, 18 were new Practice Committee hearings, 6 were Practice Committee review hearings and 2 were health cases. Interim Orders held 14 new hearings and 18 review hearings. Broken down by registrant type, there were 48 dentists, 4 dental nurses, 4 dental technicians, 2 hygienists and 1 clinical dental technician involved in hearings.
Interim Orders handed out 8 new suspensions and 8 continuation of suspensions, placed 1 registrant on conditions and kept 7 on conditions. One suspension was revoked, 1 suspension was downgraded to conditions and 5 cases had no order. Of the new suspensions 6 of the 8 registrants were not represented and not present.
The Health Committee suspended 1 registrant and placed another on conditions. The Practice Committee erased 1 registrant, issued 2 suspensions, 2 extensions of suspension, and placed 2 registrants on conditions whilst 2 had their conditions extended. Four suspension orders were revoked, 3 reprimands were given, 3 cases were adjourned, 3 registrants were found not impaired, 1 case was referred back to the Investigating Committee, and in 1 case no misconduct was found.
March’s cases of interest
The erased registrant was neither present nor represented, but the case mainly related to failing to take appropriate radiographs, failures in treatment planning and record-keeping, lacking indemnity cover whilst treating patients on 4 days, and a failure to cooperate with the GDC.
In the ‘No Misconduct’ case the registrant essentially faced charges which related to not providing an estimate of costs for root canal treatment (although he did not actually invoice the patient for any of the treatment provided), not informing the patient of the risks of the proposed treatment and therefore failing to obtain informed consent. In fact, the registrant had only provided emergency treatment to try to relieve pain and infection. This was ultimately not successful and the tooth was removed by another dentist. The patient/witness actually complained to the GDC about something else, but this was not worthy of any charges so how this case actually came about is not clear from the determination. Despite having a confused recollection at times, the patient was still described to be a credible witness. Another matter which is not clear in the determination is why there were 3 experts involved - 1 for each party and a joint expert statement. The registrant admitted all the charges, but the panel found some aspects not proved and despite both the GDC and defence counsel accepting misconduct and impairment, the panel found neither on the basis that the treatment was emergency in nature rather than a definitive RCT procedure, and the failings not so serious as to be considered deplorable. A happy outcome here with the lesson of not assuming that because you have not charged a patient they won’t complain about you.
The case referred back to the Investigating Committee involved fissure sealants on a single patient, which the GDC-appointed expert Professor Deery (who is a paediatric dentistry consultant and Dean of Sheffield School of Clinical Dentistry) had concluded were appropriate after he had examined the patient, and that wear on the patient’s teeth was due to erosion rather than damage caused by the registrant. It was submitted that this evidence would change the view of the IC and that no realistic prospect of a finding of misconduct existed, begging the question did one exist in the first place? How the case came about, and on what the basis of the patient complained is not explicit in the determination but it is implied that the registrant may have perhaps been accused of creating damage in which to place fissure sealants or otherwise creating unneeded work for themselves. This case highlights the inherent issues with the lack of a clinical examination until a late stage, (if at all) in the FtP process and how assessors and experts creating charges purely on clinical records is a flawed concept. This case will have involved a significant waste of registrants’ money in reaching a Practice Committee that could have perhaps have been avoided with an earlier examination of the patient. Hopefully with the recruitment of dentally-qualified caseworkers cases like this can be avoided in future.
Mr N, who was neither present nor represented, was suspended following his hearing which included 73 individual heads of charge, many of which had several sub-headings. The GDC-instructed barrister may have missed Jonathan Green’s presentation at the Dental Protection Study Day last October where he stated that no over-drafting of allegations would take place following the embarrassment of the Kirschner case. In the determination the GDC-appointed expert, Professor Morganstein seems to advise that linings ought to be placed under amalgam restorations. With no representation there is no means of contesting such a view even though many GDPs would now not line amalgams, nor is there any conclusive evidence that they need to be. Professor Morganstein is apparently the Dean of the dental school at the University of Buckingham (I know what you are thinking…. and I’ve not heard of it either). I feel this case nicely highlights the problem with the GDC using experts who are focused on academia or in specialist practice opining on GDPs, and is directly contributing to the stealthy moving of standards in an upwards direction.
Finally, the long-running Carew case which I have been watching with interest due to the charge of:
· you failed to adequately record the clinical reason why a try-in was required……
has left me somewhat disappointed as this charge was withdrawn on day 1 of the hearing. It looks like we will never get to find out why this element of record-keeping was considered to have been essential.
This is a great initiative Vicky and actually, in the public interest, I believe the GDC should welcome it too, if it's serious about continual improvement.
It is a great mystery to many of us how/why some of these charges occur and also what has been done proportionately to ensure public protection - oppressively or gratuitously adding charges that are clearly hyperbole or misplaced actually brings the whole GDC into disrepute too. You'd never see the Crown Prosecution service do this, for example.
I also wonder if, as part of natural justice, those unrepresented should have representation appointed to them - even criminals get this legal courtesy as part of their human rights, don't they?
There also appears to be issues with Expert witnesses/reports and I do wonder IF there should be an agreed 'pool' of these and both parties agree the appropriate one FIRST before reporting or they are assigned randomly perhaps?
The role of Expert is clearly more important where the 'panel' are not experts themselves, either lay or different clinical spheres/expertises and as with Courts, no matter WHO engages them (GDC or Indemnity) their role is NEUTRAL and to add proportionality to any findings of fact, NOT to show bias for prosecution or defence, but to be focussed on fairness ultimately.
We also need to recognise that there are IDEAL, Average/reasonable, below Average and UNACCEPTABLE standards AND then there's CONTEXT !!!
Many of us dealing with Professionals in difficulty or further Education encouraging all to ASPIRE to IDEAL, recognise that some aspects/complaints are ACTUALLY local resolution issues, clinical governance matters or vexatious/malicious/inappropriate for the GDC to progress. Once the GDC has satisfied itself at first stage this person is not a Shipman, it should not be (or be perceived to be) a service designed to get any prosecution at any cost, because this undermines justice, fairness or proportionality and is NOT in the public interest !!!
The best protection patients have is our Professionalism and actually we want the GDC to remove those who cannot improve, IF they are a continual danger to the public and our reputation.
However we also want those who may have transgressed ethical/working standards to be reformed/helped to still contribute positively to dental care and society positively. We must help individuals who may have strayed or simply need some support in our increasingly isolationist and oppressive dental systems.
The patients' best interests (notice where that apostrophe is located!) are best met by taking that HOLISTIC approach to regulation of professionals - now read that paragraph above again, but this time look at it applying to the GDC instead of a registrant - we want the GDC to be reformed/helped to still contribute positively to society!
It's time to realise what is BAD for Dentists and their Teams, is often BAD for Patients and the wider Public too; likewise, what is BAD for Patients and the wider Public, is often BAD for Dentists and their Teams too. Professionalism intertwines both interests constructively, it should NOT be adversarial, defensive or unduly biassed.
For too long, central policy has ERRONEOUSLY pitched one against the other adversarially - it's time to correct those errors in all patients' best interests overall.
Yours also observationally,
Thank you for the positive feedback Tony. I hope the blog is well-received by all parties as I believe there is a lot we can all learn from these cases.
Thank you for this, you must have spent a lot of time on it. It is really interesting to see what's happening.
Thank you Victoria, you have obviously put a great deal of time into this blog and I am sure the profession will be grateful for your hard work. Although I am almost fully retired from practice now I really do worry about our new colleagues entering what is now a minefield when they do their best for their patients the varieties of dental care provision.
Please keep up the good work and anyone reading this please give your utmost support.
Great work and much appreciated that someone like you is out there devoting time and energy to this.
Hopefully Tony won't try to write as much as you do in reply each time.......