General Medical Council guidance on professionalism. How does this impact you?

It is generally understood by the profession that professionalism relates to behaviours inside and outside of the workplace so that the public will feel confident in the profession. Patients expect doctors to be honest, trustworthy, to act with integrity and within the law.

If a medical registrant doesn’t behave professionally, they could be investigated by their employer and ultimately the General Medical Council for breaches of expected behaviours.

But what about a situation in which a healthcare professional finds themselves in the wrong place at the wrong time. In this article we consider a real life case which had devastating consequences for a dental registrant and how we helped them navigate out of their investigations successfully.

Case study – Personal Misconduct

Person A was happily working at a reputable dental practice alongside nurses, dentists, hygienists, receptionists and other support staff. The whole dental team attended an office party in the evening outside of work where a good time was had by all. Some members of them went back to one person’s house to stay for the night. Two colleagues, Person A and Person B engaged in sexual activity.

WhatsApp messages after the night out and subsequent conversations at work between the colleagues, including between Person A and B suggested everyone was happy and that they had all had a good time on their night out.

A month or so later, Person A was invited to a HR meeting, without any notice, when they were informed Person B had made an allegation of sexual assault against them. This came as a complete shock to Person A. Person A was asked inappropriate questions by HR. HR asked them to explain why Person B would make the allegations. They said they were considering terminating their contract of employment, without following any process or explaining to Person A what process they were following. They also made inappropriate comments such as, whatever Person A said to them about the events would remain within their four walls. Person A quickly sought legal advice. We engaged with the Practice on their behalf and they kept their job.

The matter was then investigated by the police, NHS England and the General Dental Council. We assisted Person A in all these investigations. For the interview under caution we prepared a detailed statement on their behalf about the events which took place and submitted supportive statements from their colleagues, together with the WhatsApp message exchanges. More than a year later the police closed their case. The police confirmed there were many inconsistencies in Person B’s account which was not supported by other information. The police confirmed Person B had also described consent and had admitted Person A had said they did not need to do this.

By this time however, Person A had been subject to an interim orders hearing before the GDC, which following our submissions concluded there was insufficient evidence of risk to support an interim order of suspension. We then submitted a formal response to the GDC’s Rule 4 allegations which was requested even though the police had closed their investigation. The Case Examiners concluded the case with no further action.

Conclusion

The above hung over Person A for many years. They were however a popular and well respected colleague and so we were able to gather supportive material on their behalf relatively easily. Person A also acted quickly in seeking legal advice.

It’s important to obtain advice in relation to any personal or professional misconduct matter from specialists in healthcare professional regulation, as soon as possible. Ultimately, what is said to other parties, such the police, your employers and NHS bodies will be seen by the General Medical Council, so the tests they apply in considering fitness to practise need to be borne in mind when preparing any response.

GDC guidance on professionalism. How does this impact you?

The GDC is currently undertaking a review of its guidance and Standards for the dental team which set out the codes of practice for the profession. They are reviewing the principles of professionalism with a view to developing and refining what professionalism means in healthcare and dentistry today.

It is generally understood by the profession that professionalism relates to behaviours inside and outside of the workplace so that the public will feel confident in the profession. If a dental registrant doesn’t behave professionally, they could be investigated by their employer and ultimately the General Dental Council for breaches of expected behaviours.

But what about a situation in which a member of the dental team ends up being in the wrong place at the wrong time. In this article we consider a real life case which had devastating consequences for a GDC registrant and how we helped them navigate out of their investigations successfully.

Case study – Personal Misconduct

A member of the dental team “person A” was happily working at a reputable dental practice alongside nurses, dentists, hygienists, receptionists and other support staff. The whole dental team attended an office party in the evening outside of work where a good time was had by all. Some members of the dental team went back to one person’s house to stay for the night. Two members of the dental team, Person A and Person B engaged in sexual activity.

WhatsApp messages after the night out and subsequent conversations at work between the members of the dental team, including between Person A and B suggested everyone was happy and that they had all had a good time on their night out.

A month or so later, Person A was invited to a practice meeting with HR, without any notice, when they were informed Person B had made an allegation of sexual assault against them. This came as a complete shock to Person A. Person A was asked inappropriate questions by their HR team in which HR asked them to explain why Person B would make the allegations. They said they were considering terminating their contract with the Practice, without following any process or explaining to Person A what process they were following. They also made inappropriate comments such as, whatever Person A said to them would remain within their four walls. Person A quickly sought legal advice. We engaged with the Practice on their behalf and they kept their job.

The matter was then investigated by the police, NHS England and the General Dental Council. We assisted Person A in all these investigations. For the interview under caution we prepared a detailed statement on their behalf about the events which took place and submitted supportive statements from their colleagues, together with the WhatsApp message exchanges. More than a year later the police closed their case. The police confirmed there were many inconsistencies in Person B’s account, which was not supported by other information. The police confirmed Person B had also described consent and had admitted Person A had said they did not need to do this.

By this time however, Person A had been subject to an interim orders committee hearing before the GDC, which following our submissions concluded there was insufficient evidence of risk to support an interim order of suspension. We then submitted a formal response to the GDC’s Rule 4 allegations which was still requested even though the police had closed their investigation. The Case Examiners concluded the case with no further action.

Conclusion

The above hung over Person A for many years. They were however a popular and well respected member of their dental team and so we were able to gather supportive material on their behalf relatively easily. Person A also acted quickly in seeking legal advice.

It’s important to obtain advice in relation to any personal or professional misconduct matter from specialists in healthcare professional regulation, as soon as possible. Ultimately, what is said to other parties, such the to police and your employers will be seen by NHS England and/or the General Dental Council, so the tests they apply in considering fitness to practise need to be borne in mind when preparing any response.

The GMC’s Report On Doctors Who Have Died While Under Investigation Or Monitoring

I previously wrote about mental health and the GMC’s 2014 report which investigated the number of doctors who had committed suicide, or suspected suicide whilst under their fitness to practise to proceedings. It concluded that there had been 28 such cases between 2005 and 2013.

Following that investigation, the GMC instructed Professor Louis Appleby, professor of psychiatry to advise them on how they could improve the experience for doctors undergoing their fitness to practise processes. The GMC has now published its report, after implementing Professor Appleby’s recommendations. This reports suggests there had been 5 cases of suicide between 2018 and 2020, representing a reduction from the earlier figures.

So what changes has the GMC made?

Professor Appleby’s recommendations included providing staff training in mental health issues and exposure to frontline clinical practice. Noticeably, GMC staff are taking a more empathetic approach, for example when we have requested more time because the doctor is unwell. They have also reduced the number of cases being investigated through the early triage of cases.

In cases where the doctor is being investigated for health reasons, the GMC’s review did however identify that there is some tension between the role of the medical supervisor, who reviews the doctor’s health progress and the role of the health examiner, who provides a report on the doctor’s fitness to practise. The medical supervisor might suggest that the doctor should return to work which would also help alleviate some of the emotional and financial pressures on the doctor, however the health examiner might take a different view. Consistency is required and the GMC is reviewing the roles of their experts.

What else should the GMC consider?

The GMC’s 2014 report identified that almost half of the doctors who had committed suicide had been under investigation for over a year and sometimes for longer than five years. Whilst this indicates that being subject to a fitness to practise investigation in itself led some doctors to suicide, it also shows suicide numbers are likely to go up, the longer an investigation lasts.

Doctors often feel they are waiting a long time to hear from the GMC and they have no control over any of the timescales. The GMC could be investigating a matter for months, and sometimes years, they then provide the doctor with a short timescale of 28 days or 3 months, (depending upon the stage of the investigation) to provide their defence representation and evidence.

In other instances, the GMC might serve additional allegations late in the case. There might be good legal reasons for doing so, but consideration needs to be given to the emotional impact this has upon the doctor. The doctor thinks they know the case they are facing and then unexpectedly they are served with additional allegations. Just as the GMC expects doctors under investigation to work to timescales, they should themselves aim to work to shorter definitive timescales.

Although the GMC should be given credit for looking at ways to improve its processes to reduce the risk of suicide, it does need to focus on reducing the length of its investigation processes and working to stricter timescales itself, to help reduce the impact on the mental health of all doctors under investigation.

Dentists Are Vulnerable To Mental Health Issues Just Like Other Healthcare Professionals

Dentists, like others, suffer from stress, burnout and mental health issues. Due the number of suicides amongst doctors undergoing fitness to practise investigations, the General Medical Council started to look at ways to reduce the risk of suicide amongst its own profession. What can the General Dental Council learn from this?

Between 2005 and 2013 the GMC found there were 28 doctors who had committed suicide whilst they were undergoing fitness to practise investigations. Between 2018 to 2020 there were 5 cases of suicide. It would be interesting to see similar data being gathered by the General Dental Council.

Mental health issues are likely to increase the longer an investigation lasts

Dentists often feel they are waiting a long time to hear from the GDC and they have no control over any of the timescales. This understandably can lead to anxiety and worry. Dentists with no pre-existing mental health problems might very well have other significant pre-existing problems in their life. To add a career threatening investigation to the other burdens of life might well be too much for some to bear. For others, the investigation itself might be sufficient to throw an otherwise stable personality into disarray.

The GDC might investigate a case for months, and sometimes years, but then provide the dentist with a short timescale of 28 days or 3 months (depending upon the stage of the investigation) to provide their defence representation and evidence, further impacting their mental health.

In other instances, the GDC might serve additional allegations in the very late stages of the investigation, sometimes only months before the final hearing. There might be good legal reasons for doing so, but consideration needs to be given to the emotional impact this has upon the dentist. The dentist thinks they know the case they need to meet and then unexpectedly they are served with additional allegations. Just as the GDC expects dentists under investigation to work to deadlines, they should themselves aim to work to shorter definitive deadlines.

The risk that an investigation might of itself cause or contribute to a significant mental illness is not hard to see. The question is whether the General Dental Council sufficiently takes these human considerations into account in the way they work. After all, since an investigation might conclude with exoneration, it should in the public interest surely be conducted in a manner which mitigates the risk of lasting physical or psychological harm to the dentist.

The GDC should focus on reducing the length of its investigation processes and seek to the reduce the overall number of their investigations, in the same way the GMC has, to reduce the impact on the mental health and wellbeing of the dentists under fitness to practise investigations. Surely this would serve both the public and the dental profession much better.

The never-ending Libor scandal: why a public inquiry is now needed

By Rachel Adamson | The Banker

Almost 18 years after the London interbank offered rate (Libor) scandal first hit the headlines and sent shockwaves through the financial services industry, it has reared its head again this year. Our Director and Head of Fraud and Regulatory, Rachel Adamson, shared her thoughts with The Banker on the Libor scandal, and why a public inquiry is now needed.

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