What is the GDC really doing to prevent future deaths?

November, around Armistice Day is an appropriate time to remember those that have died, so it is timely that the GDC has finally produced its report into deaths that have occurred during fitness to practise investigations GDC publishes report on causes of death during fitness to practise investigations .

Astonishingly, for an organisation that expects registrants under scrutiny to demonstrate insight into the reasons for that scrutiny, the report fails to acknowledge or mention that HM Coroner sent a formal “Prevention of Future Deaths Report” to the GDC on 5.8.23. There has been pressure from individual registrants and groups such as the GDPUK community demanding that the GDC takes action to prevent suicide where it can.

Suicide is rarely caused by one thing or a single event, for example a GDC investigation. Many of the human factors that contribute to suicidal ideation also put registrants at risk of an FTP investigation in the first place. Business and financial stresses, personal relationship troubles all distract registrants from giving of their best every day in their practice. These human factors interfere with clinical judgment and the relationship with a patient. It is common in these circumstances that clinical care falls below an acceptable standard and/or that complaints are not managed constructively. Both of these can lead to referrals to the regulator, and the vicious circle continues. It is well known that practitioners under investigation make more mistakes than others.

What can the GDC do to make a real difference to the mental wellbeing of registrants under investigation whilst at the same time doing its job which is to protect the public via the FTP process?  For a start, it must significantly speed up the investigation stage ie the time it takes for the papers to reach the Case Examiners, the first statutory decision makers.

The GDC will say that it needs reform of the Dentists Act, but that is years away and may not happen during this parliamentary cycle. The GDC has made changes to the initial assessment stage of FTP investigations and these changes have speeded up early decision making initial inquiries pilot. These changes should be welcomed, but this is not the real story. Nor is it the hearing stage, where a registrant has been referred to a professional conduct committee.

The absolute disgrace is the delays in the pre–Case Examiners stage where the initial assessment has determined that a formal investigation is needed. This investigation stage can take anything from nine to eighteen months for a straightforward clinical case. These horrendous and harmful delays must be addressed urgently.

There is no reason for this delay other than the extraordinary inefficiency within the GDC FTP team. A registrant can submit their letter of observations and the next thing they hear is some nine months later the papers are being prepared into a bundle to go into the queue for Case Examiner decision. That next step can take as little as a month but could be considerably longer. By this point, the GDC and the registrant have known that an investigation is ongoing for more than a year or eighteen months. This is not acceptable, is verging on cruel, and in the context of the recent report, dangerous for the mental wellbeing of some registrants.

It is not unusual for cases to be put to one side and forgotten about when a case worker leaves, or for a file to be simply left alone in the ‘too hard’ basket. If registrants adopted this approach to complaints the GDC would be highly critical.

It is virtually impossible for a dentist or DCP to forget about this ongoing process. It haunts them on a daily basis. The toll on the mental health of the respondent and their family cannot be underestimated, and whilst nothing is published about this investigation, the practice(s) where the registrant works have been contacted by the GDC for additional information- fishing to see if the practice(s) have any further information to add to the allegations. The dentist will have had to tell their local NHS team. Adding to the misery, the local NHS team may launch its own separate investigation, duplicating the effort, with the NHS investigating the same facts and seeking the same assurances the GDC wants in terms or audit, reflections and insights. This only adds the stress of the case. It is time that one organisation defers to the other rather than duplicating the work and stress on the dentist.

In spite of the fine words from the Chief Executive in his blog of 12th November, and in the GDC report about how it recognises that an FTP investigation is a trigger for mental health issues and listing the steps it has taken, not one of the fine words have addressed the worst delays of all, the delay between commencing an investigation and a Case Examiner decision. Stakeholders have been raising concerns about this delay for years and years.

No serious action has been taken to reduce the delays to an acceptable minimum. The Professional Standards Authority is toothless. It is far from clear what pressure the non-executive directors, the Council members, have been able to bring to bear on the executive to account for these delays. The Council papers fail to mention how long cases take to progress from assessment to Case Examiners, only talking about the numbers of cases. The only tell-tale sign is a note in the April 24 Council papers pointing out the delay at Case Examiner Stage will take 18 months to clear. Of course, that doesn’t take into account the length of time the case has been open before it got into that queue which will take 18 months to clear.

Lastly, the report doesn’t mention the way decisions are made to keep open a case in the first place, because that requires a consideration of what ‘misconduct’ and ‘current impairment’ really look like, but that’s the subject of another blog.  Both the delays and the decision-making process need urgent attention if the GDC is to be taken seriously while it wrings its hands over these tragic suicides.