I think it’s fair to say 2011 was a bad year for the General Dental Council. Not only did it lose its chair, Alison Lockyer, in May 2011, but it then faced an investigation into its fitness to practise function; a serious allegation for a body whose statutory duty is “to promote high standards of professional conduct, performance and practice.”
In June 2011 the Department of Health asked the regulators’ regulator – the Council for Healthcare Regulatory Excellence (now the Professional Standards Authority) - to investigate. By that time CHRE had, of course, already raised concerns regarding the GDC’s handling of fitness to practise cases and in particular the delay in bringing cases to a conclusion.
Ironically given that one of the concerns that had been expressed in relation to the GDC was the delay in the exercise of its fitness to practise function, it took the PSA almost 20 months to report back to the Department of Health, with the final report being published in February 2013. In the end the PSA concluded that “notwithstanding…the fact that improvements can still be made…we do not consider based on the evidence that the GDC has failed or is failing to carry out its statutory functions.”
However, hot on the heels of the PSA’s report following the Lockyer affair came the publication of the PSA’s 2012/2013 annual report in June 2013.
In its annual report, the PSA concluded that the GDC was still not meeting all of the ‘standards of good regulation’. The PSA highlighted that the GDC had made good progress in relation to its handling of fitness to practise cases. In particular, the report noted that the GDC had employed more staff to triage cases at an early stage; had introduced an audit system to check whether key performance indicators are being met and to improve consistency in the decision-making process; had increased the pool of potential committee panel members to ease with listing cases; was obtaining clinical advice earlier in the process; and had improved its case management process.
However, the PSA concluded that the GDC was still failing to progress cases quickly enough. In particular, the PSA noted that: “We are still concerned about the length of time taken for a decision to be made about an interim order.”
It is now over six months since the PSA’s annual report was published, and it would appear that there has been a significant shift in emphasis by the GDC.
The GDC’s Annual Report for 2012 includes statistics for its fitness to practise function. The report states that, in 2012:
- the GDC received 2,278 cases (up from 1,578 the previous year);
- in relation to full fitness to practise cases, the Professional Conduct Committee (PCC) considered 115 cases;
- around two-thirds (74) of the cases considered by the PCC ended with the registrant facing erasure, suspension or conditions;
- in relation to interim orders – the area in which the GDC faced particular criticism in the PSA’s annual report – the Interim Order Committee heard 52 interim order applications.
The GDC will not publish its own annual report for 2013 until July 2014, so we do not yet know how many complaints the GDC received in 2013. However, the GDC does publish details of the cases which it has considered on its website. An analysis of this information gives a surprising result.
Since it takes around eighteen months on average from a complaint being made to the GDC to it being considered by the PCC, you might have expected an increase in the number of PCC decisions in 2013 given the increase in complaints made to the GDC in the previous year. However, this does not appear to have happened. In fact, the number of cases concluded by the PCC appears to have fallen – from 115 in 2012 to 73 in 2013.
Assuming that the GDC publishes all of its cases on the website, what might be behind the apparent drop in the number of cases that the PCC heard in 2013?
One explanation might lie in the improvements that the PSA acknowledged that the GDC has made in its handling of fitness to practise cases before they get to the PCC. An improved triage system and better – and more consistent – scrutiny of cases at an early stage may have led to a fall in the number of cases proceeding to a full hearing. Less serious cases, or cases where there is insufficient evidence of misconduct, might have been weeded out by a more robust triage system. There is some evidence to support this, since it would appear that the PCC only made a finding of ‘no impairment’ in one case in 2013, compared to 18 such findings in 2012.
Another explanation might be a change in focus by the GDC. The GDC’s handling of interim order cases came in for particular criticism by the PSA in its 2012/2013 annual report. Regulators do not like being criticised, and are prone to knee-jerk reactions in the face of criticism – with the risk of plugging one leak only for another to spring up elsewhere.
So, when the PSA criticised the GDC for its failings in the processing of interim order cases, did the GDC react by bringing more interim order cases? On the face of it the answer would appear to be ‘perhaps’. In 2013, 67 interim order application decisions were published on the GDC’s website compared to 52 interim order hearings the previous year.
However, it is the timing of those interim order applications which raises eye-brows. Of the 67 reported interim order cases in 2013, two-thirds (44) were heard in October, November and December alone. It seems that the GDC became very busy with interim order applications in the final quarter of 2013.
This raises two questions. Is it pure coincidence that the number of interim order applications increased so markedly after the PSA’s annual report was published in late June 2013? And has this new-found concentration on interim order applications caused a decline in the number of full professional conduct committee cases being heard?
We will have to wait until July to find out the true picture in relation to the GDC’s fitness to practise activities for 2013. However, expect to see an increase in the number of interim order applications. This might go some way to plugging the leak identified by the PSA. The question is, will this change in focus lead to a leak springing up somewhere else in the fitness to practise system?