The General Dental Council is currently consulting on guidance for the early stages of disciplinary processes. Peter Ingle analyses their proposals
Many dentists’ first mental image of fitness to practise (FtP) will be of one of its quasi-judicial hearings. Here, registrants face a statutory committee made up of three independent panellists, including one dentist. By this stage it is likely that there will be legal representation and indemnifier involvement.
But long before cases reach such a committee, they will have passed through the initial assessment and assessment stages of the FtP process. These are the first two of a potentially four stage process, whose progress to conclusion is often measured in years. And as recently reported in GDPUK, the GDC have started another consultation on new guidance for those involved in assessing fitness-to-practise claims.
The GDC refers to all of those involved in the earlier stages of FtP as ‘decision makers’ which neatly skirts around their experience or qualifications. At this stage these decisions are largely made by clerical employees of the GDC who may have limited knowledge about healthcare or the law, let alone dentistry.
Despite this, their decisions can result in outcomes ranging from closure of the case with no further action, to investigation, or referring the case to one of the practice committees.
The GDC now proposes to introduce guidance for their decision makers, to be used at the two initial stages of FtP. It is this guidance that is subject to a 12-week consultation period and now open for comment. You can respond to the ‘Consultation on guidance for decision makers at the initial assessment and assessment stage’ here.
The GDC guidance focuses on issues such as sexual misconduct, discrimination, harassment and victimisation, and offensive behaviour as well as freedom of expression, and health.
There is some acknowledgement of the balancing act required when it comes to offensive behaviour and freedom of expression, where legal and public interest considerations may not always align.
The GDC describe this consultation as the final stage of a wider programme to review guidance for decision makers at every stage of the FtP process. An earlier part of this was the revised approach for single-patient clinical concerns, which has been broadly welcomed.
Reading the guidance documents and associated equality impact assessment (EIA), it would appear that one driver has been the GDC seeking to ensure that it cannot be accused of any breach of its public sector equality duty, which stems from the Equality Act 2010. The GDC in its EIA sets out in some detail how the new guidance will affect those with the eight protected characteristics.
The first stage of the FtP process is the initial assessment test. This asks if the case meets the threshold to advance to the next stage of assessment. As the document explains: ‘The bar in the initial assessment test is set at a deliberately low level to ensure potential risks are not missed by closing cases prematurely.’ In 2025, 19% of cases received by the FtP team were closed at this stage, which on average was completed in five days. At this stage the registrant would not be notified that they were under investigation.
Even at this level it is expected that those registrants representing a high level of risk should be identified and referral to the Interim Orders Committee (IOC) considered. Registrants may derive some comfort from reading that a final decision on this will be informed by legal advice.
The test for referral to the IOC is less clear than that for proceeding to Assessment, which is set out in three short and clear paragraphs. In contrast, ‘The test for the Registrar when deciding whether to refer a case to the IOC is whether it is appropriate to do so.’
The guidance lists specific concerns where referral to the IOC may be required, though it is not exclusive. Most of these will be alleged at this stage and potentially some way from confirmation or repudiation.
One longstanding criticism of FtP has come from a steady trickle of ‘how did it ever get to that stage?’ cases, including those where alternative routes to resolution were available and would have been more appropriate. The guidance specifically mentions the possibility of closing some cases and referring them to local resolution. However, the focus is on the NHS and health service bodies. Readers may wonder why it needs to be written into guidance that ‘there is an issue accessing NHS dental care due to contractual capacity’ is not a GDC FtP issue. It is also disappointing to see that referral to the Dental Complaints Service for some issues relating to private care is not mentioned. This seems a strange omission, given that the DCS is funded by the GDC, or in other words, the registrants.
There is a strain of double jeopardy that runs through the document. One example relates to conditional and absolute discharges. The guidance states that a conditional or absolute discharge is not deemed to be a conviction for any purpose other than the proceedings in which the order was made. Despite this the guidance states that: ‘In such circumstances, IAT will need to consider the underlying behaviour or actions which gave rise to the criminal proceedings.’ So, an absolute discharge from the criminal justice system, is not an absolute discharge from the GDC’s FtP system.
Social media activities appear to be one area where the GDC is willing to be lenient. This section states that, ‘the same standards apply when using social media as to other interactions’. However, it goes on to say that in some examples a case can be closed with the guidance being sent to the registrant as a reminder of professional expectations, and this may be appropriate in cases where the alleged matter is an isolated incident.
One of the more opaque sections of the guidance relates to the issues of offensive behaviour and freedom of expression. The guidance states: ‘Freedom of expression is not, however, an absolute right. A person's freedom of expression can be lawfully restricted where it is necessary and proportionate in order to protect the rights of others.’
In terms of whether a case should proceed in allegations of offensive language: ‘the meaning of the words used is an objective test, entirely independent of the registrant's state of mind or intention. Whether or not the registrant intended the words used to be offensive is irrelevant to whether they were, in fact, so.’
All of the above relates to the initial assessment stage. A further document looks at the next stage of FtP, the Assessment stage. In 2025, 42% of cases continued on from here to the next stage, Case Examiner.
It is here that the wheels fall off the FtP process. Despite streamlining some single issue cases, the average number of weeks from arrival to completion of assessment, whether that be closure of proceedings, or progress to case examination, has risen from 54 weeks in 2021, to 74 weeks in 2025. This is the stage at which registrants will be aware that they are under investigation, and the ‘punishment of the process’ begins.
In many ways the guidance at this stage and explanatory material is little different from that provided at the initial assessment stage.
To move to the third stage a case has to pass the assessment test - whether the registrant has caused harm to the public, given rise to a concern that would affect public confidence in the profession, or raised issues that suggest impaired fitness to practice.
One notable aspect of the guidance lays the ground for the GDC’s hard line on sanctions when dishonesty is found by a practice committee. The guidance states that it is a fundamental requirement under the standards that registrants are honest. The guidance continues: ‘As a result, allegations of dishonesty against a registrant are at the higher end of the scale of seriousness, even where it has not involved harm to patients, and even if it is unlikely to be repeated.’
These guidance documents apply only to the first two stages of FtP (there are already eight guidance documents for practice committees provided by the GDC). They cover most situations in considerable detail, and it could be argued that they are fairly prescriptive. Which begs the question, how can the GDC continue to defend taking, on average, 72 weeks to complete the assessment stage?