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Improving patient, family and colleague witnesses’ experiences of Fitness to Practise proceedings
Improving patient, family and colleague witnesses’ experiences of Fitness to Practise proceedings

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1.1 Experiences of people during screening and investigation

People found that the Fitness to Practise process was quite distressing and repetitive, having to repeat their story over and over again:

The first quote reads: ‘OK. So just to be clear when you’re having all of these conversations with the General Osteopathic Council you’re having a number of conversations, but essentially are they about the same things that had happened to you or are they different people talking about different aspects of it?’ The second quote reads: ‘I think about the same things. I can just remember just going over and over and over it with different people.’
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The first quote reads: ‘OK. So just to be clear when you’re having all of these conversations with the General Osteopathic Council you’re having a number of conversations, but essentially are they about the same things that had happened to you or are they different people talking about different aspects of it?’ The second quote reads: ‘I think about the same things. I can just remember just going over and over and over it with different people.’

When there were changes in staffing at the regulator this also had a negative impact on people’s experiences:

The quote reads: ‘Yeah, and then in the meantime the caseworker, if you like, changed. So she went on long-term sick leave. And so somebody new was introduced who wasn’t familiar with, you know, who hadn’t taken the witness statement and had to become familiar with the contents. It just didn’t feel the same anymore in the sense that it sort of became a bit more impersonal. You know, there were still very polite. Communication was open channels: you can ring, you can email. The replies were, you know, didn’t have to wait long. But it sort of just became logistics. It just became that, dealing with logistics.’
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The quote reads: ‘Yeah, and then in the meantime the caseworker, if you like, changed. So she went on long-term sick leave. And so somebody new was introduced who wasn’t familiar with, you know, who hadn’t taken the witness statement and had to become familiar with the contents. It just didn’t feel the same anymore in the sense that it sort of became a bit more impersonal. You know, there were still very polite. Communication was open channels: you can ring, you can email. The replies were, you know, didn’t have to wait long. But it sort of just became logistics. It just became that, dealing with logistics.’

What happens during screening and investigation?

During screening and investigation, regulators may ask themselves certain types of questions to help make a decision. For example, Nursing and Midwifery Council (2023a) may ask:

  • Do we have a written concern about a nurse, midwife or nursing associate on our register?
  • Is there evidence of a serious concern that could require us to take regulatory action to protect the public?
  • Is there clear evidence to show that the nurse, midwife or nursing associate is currently fit to practise?

They will also verify facts, explore whether there is enough supporting evidence, consider anonymous concerns, context, and seriousness about the concern that has been raised (Nursing and Midwifery Council, 2023b).

Click on the plus signs to read the examples.

Interactive feature not available in single page view (see it in standard view).

Experiences of people whose cases were closed

Many cases were closed before proceeding to a hearing and these people had their own individual experiences.

We surveyed 62 people whose case was closed prior to a hearing. Only 6 said they had a single point of regulator contact to help them after raising a concern:

The quote reads: ‘The member of staff at the General Optical Council was very supportive and I believe that her approach helped me as much as it was possible.’
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The quote reads: ‘The member of staff at the General Optical Council was very supportive and I believe that her approach helped me as much as it was possible.’

Others felt it was unclear who they could contact about the case.

People whose case was closed before proceeding to hearing were often disappointed and frustrated:

The quote reads: ‘It is distressing. But what is more distressing is the fact that they closed my case without recourse. I couldn’t even appeal it. I am still dealing with the repercussions of this only 2 years later.’
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The quote reads: ‘It is distressing. But what is more distressing is the fact that they closed my case without recourse. I couldn’t even appeal it. I am still dealing with the repercussions of this only 2 years later.’

However, people felt it was important to raise a concern for the purposes of public good, despite finding the retelling distressing:

The quote reads: ‘Retelling the story was the proper thing to do. I disregarded any emotions as I felt public safety was of greater concern than me reliving that unfortunate event.’
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The quote reads: ‘Retelling the story was the proper thing to do. I disregarded any emotions as I felt public safety was of greater concern than me reliving that unfortunate event.’

Support after raising a concern

Many reported that they got most of their support from their friends and families (who were also the people who helped them at the time of the event):

The quote reads: ‘I haven’t needed external help. I talked to friends and family which helped me.’
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The quote reads: ‘I haven’t needed external help. I talked to friends and family which helped me.’

Some regulators offer access to an independent counselling service (Victim Support) but our participants often reported that this was not helpful and they have preferred advice independent of the regulator on how to progress their concern:

The quote reads: ‘I sought legal advice and also went to newspapers and TV, going to TV got my point over more. Perhaps some guidance from a solicitor on duty to assure if you are doing the right thing as you are feeling very vulnerable.’
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The quote reads: ‘I sought legal advice and also went to newspapers and TV, going to TV got my point over more. Perhaps some guidance from a solicitor on duty to assure if you are doing the right thing as you are feeling very vulnerable.’

This tells us that support from the regulator (a consistent, single point of contact), independent advice, and personal networks are crucial to help people at all stages of the Fitness to Practise process. Family and friends are often important in challenging times of life. However, they may also suffer emotional stress and witnesses may not involve them for fear of this. 

There are independent support services (outside of the regulator) available, and many regulators provide information about how to access these. Figure 1 shows some examples of services that are available across the UK and those specific to different nations. 

Click on the ‘i’ on each flag to read the resources available in each part of the UK.

Figure 1
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In our research, participants did not mention using the independent support organisations in Figure 1, so it is unclear how useful this signposting to such organisations may be. People often sought support from their social networks or services independent of the regulator.