Between 26 March 2026 and 18 June 2026, the General Dental Council (GDC) consulted on changes to how key mid-stage decisions in fitness-to-practise cases are made, with the goal of making them fairer, clearer, and more consistent.

The consultation was about updating the guidance used by GDC case examiners who decide whether concerns about dental professionals should proceed toward a formal hearing or be closed earlier.

In particular, the GDC sought views on proposed revisions to:

• Guidance for case examiners, and
• The “undertakings bank” (a set of agreed measures that can be applied to resolve cases without a full hearing).

Dental Protection welcomes the opportunity to respond to this GDC consultation and our complete submission is outlined below.

Consultation questions

Broadly applied revisions to the guidance

Clarity of meaning and language

We have scrutinised each paragraph of the proposed updated guidance with the objective that each point being made is clear. This has included the aim of using clear and commonly understood language, which is free of technical terminology, wherever possible.

To what extent do you agree that the proposed updated guidance makes its points clearly and, in doing so, uses clear and commonly understood language wherever possible?

• Somewhat agree

Significant changes to the guidance

In addition to the broad revisions referred to above, in the interests of ensuring the guidance up to date and supporting consistency of approach, transparency, and proportionality in decision making undertaken by case examiners, a number of changes have been made to the guidance. Areas of significant change are listed below, by section.

Preliminary and general considerations (paragraphs 11 to 39)

New or developed points in this section include:

• Paragraphs 11 to 19 now address both bias and conflict of interest which, although related, are distinct concepts.
• Paragraphs 20 to 32, addressing reasonable opportunity to comment, now include indicative timescales for what is ordinarily considered to be a reasonable opportunity. They also now feature guidance on considering whether a previous refusal to grant an extension undermines a reasonable opportunity.
• Paragraphs 33 to 37, addressing adjournments, have now been moved into the preliminary and general considerations section (from a later point in the current guidance). Changes have also been made to the structure and wording to improve clarity.
• Paragraphs 38 to 39, addressing reasons, have now also been moved into the preliminary and general considerations section (from a later point in the current guidance). Changes have also been made to the wording to improve clarity, and to include examples of where more comprehensive reasons should be provided.

In addition to ensuring the guidance is up to date, the aim of this review is to support consistency of approach, transparency, and proportionality in decision making by the case examiners.

To what extent do you agree that all of these aims are supported by the updated ‘Preliminary and general considerations’ section, including the changes listed above?

• Somewhat agree

Please provide reasons for your response:

The revised preliminary and general considerations section is clearer and better structured, and the changes help support consistency and transparency in principle. The distinction between bias and conflicts of interest (paragraphs 11–19) is helpful, as is the clearer treatment of prior involvement. The expanded disclosure expectations, including audio and video material, are also welcome.

The inclusion of indicative timescales for providing a reasonable opportunity to comment (paragraphs 20–32) improves transparency, and the guidance on considering whether refusals of extensions undermine fairness is a useful clarification. Moving the sections on adjournments and reasons into this part of the guidance (paragraphs 33–39) also improves accessibility and coherence.

That said, the indicative timescales remain tight in practice, particularly the 28‑day period for registrants and the 7‑day period to respond to complainant submissions. These deadlines can be unrealistic where public holidays or periods of leave intervene. Using working days rather than calendar days, or explicitly recognising public holidays when assessing reasonableness, would better support proportionality and fairness.

With greater flexibility around timescales, the section would more effectively support the stated aims.

Real prospect of the allegation of impaired fitness to practice being proved by a practice committee (paragraphs 40 to 110)

New or developed points in this section include:

• Overall, we consider the section benefits from clearer titles and improved structure.
• Paragraphs 50 to 55, addressing conflicts of evidence, have been expanded to reflect developments in case law and to provide more clarity on the limits of the case examiners’ filtering role.
• Paragraphs 56 to 83, addressing the statutory grounds, now closely reflect the equivalent section in the recently updated Guidance for the practice committees. This reflects a more complete and precise setting out of the grounds. This includes:
  
  - An updated section on convictions or cautions for a criminal offence which now features new subsections on considerations for case examiners in relation to declaring criminal convictions and cautions (70 to 72) and protected criminal convictions and cautions (73 to 77).
  - New sections on certain other outcomes for criminal offences (78) and determinations by certain other regulators bodies (79 to 83).

• Paragraphs 84 to 106, addressing current impairment, now closely reflect the equivalent section in the recently updated Guidance for the practice committees. This has resulted in:
  
  -New sections on insight (89 to 94), denial (95 to 96) and remediation (97 to 98).
  -A new section providing improved clarity on impairment on the grounds of public interest (103 to 106).

• Paragraphs 107 to 110, addressing the conclusion of the real prospect consideration, more clearly set out the outcomes which must follow different case examiner determinations at the real prospect stage of consideration.

In addition to ensuring the guidance is up to date, the aim of this review is to support consistency of approach, transparency, and proportionality in decision making by the case examiners. To what extent do you agree that all of these aims are supported by the updated ‘Real prospect of the allegation of impaired fitness to practice being proved by a practice committee’ section, including the changes listed above?

• Somewhat agree

Please provide reasons for your response:

The revised guidance is clearer and more structured, particularly in its treatment of conflicting evidence (paragraphs 50–55) and impairment (paragraphs 84–106) and reflects recent developments in case law.

In practice, however, the more prescriptive articulation of the three‑stage test is likely to lower the threshold for progression in borderline cases. The guidance now makes clearer that evidential conflicts should not prevent cases from proceeding and provides a more readily accessible route to impairment on public interest grounds, even where clinical risk is low and remediation is strong.

There is a risk that this framework will drive more cautious decision‑making by case examiners, with a greater tendency to refer cases rather than close them at an early stage. Even a modest increase in cases progressing beyond the case examiner stage would have a disproportionate impact on registrants in terms of stress, case duration and reputational impact, as well as increased defence costs and operational pressures.

Clearer examples of when public interest is not engaged, and emphasis on proportionate outcomes in low‑risk cases, would help mitigate this risk.

Allegation of impaired fitness to practise ought to be considered by a practice committee (paragraphs 111 to 164)

New or developed points in this section include:

• Overall, we consider the section benefits from clearer titles and improved structure.
• Paragraph 111 provides a new introduction, which more clearly sets out the two potential outcomes for this determination.
• Paragraphs 112 to 121, addressing consideration of whether undertakings are appropriate and the approach to offering undertakings, provide greater clarity. These paragraphs also draw comparable content from the conditions section of the recently updated Guidance for the practice committees.
• Paragraphs 122 to 125, addressing real prospect of erasure prohibiting undertakings from being offered by the case examiners, now make this point more clearly. These paragraphs also draw relevant content from the recently updated Guidance for the practice committees.
• Paragraphs 126 to 129, addressing the approach to offering undertakings, provide greater clarity. These paragraphs also draw comparable content from the conditions section of the recently updated Guidance for the practice committees.
• Paragraphs 130 to 135, addressing publishing details of the undertakings, provide greater clarity. The new paragraph 134 provides guidance about where case examiners may exercise discretion not to publish some or all of the details which are ordinarily published (i.e. where there is evidence to suggest publication is likely to cause significant harm to the registrant or a third party).

In addition to ensuring the guidance is up to date, the aim of this review is to support consistency of approach, transparency, and proportionality in decision making by the case examiners.

To what extent do you agree that all of these aims are supported by the updated ‘Allegation of impaired fitness to practise ought to be considered by a practice committee’ section, including the changes listed above?

• Somewhat agree

Please provide reasons for your response:

Overall, Dental Protection considers that the updated section supports the aims of consistency, transparency and proportionality, although it does not represent a significant substantive change from existing practice. The revisions primarily clarify and consolidate existing principles rather than introducing new approaches.

The revised introduction at paragraph 111 is helpful in clearly setting out the two potential outcomes at this stage. The expanded guidance on undertakings (paragraphs 112–121 and 126–129), including closer alignment with Practice Committee guidance, improves clarity and should support greater consistency in decision‑making. The clearer articulation that undertakings should not be offered where there is a real prospect of erasure (paragraphs 122–125) is also welcome and reflects established regulatory practice.

The additional guidance on publication of undertakings (paragraphs 130–135), including discretion not to publish where publication may cause significant harm (para 134), is a proportionate and helpful clarification.

However, the practical impact of these changes will depend largely on how they are applied. There is a risk that undertakings could be over‑used or treated as a default disposal. To support proportionality and consistency in practice, it will be important that case examiners are appropriately trained in the application of this framework.

There is also a risk that undertakings may become increasingly prescriptive in practice, with members feeling pressure to agree to intrusive or burdensome undertakings in order to avoid referral to a hearing. Care will be needed to ensure undertakings remain genuinely consensual and proportionate, rather than operating as conditions by another name.

Allegation of impaired fitness to practise ought not to be considered by a practice committee (paragraphs 174 to 202)

New or developed points in this section include:

• Paragraphs 177 to 178, addressing the outcome of no further action, particularly clarify that this may be an appropriate outcome not only where there is no real prospect on facts, but also where there is a real prospect that the statutory ground will be established but the evidence of insight and remediation addresses all concerns, and that there is minimal risk of repetition.
• Paragraph 184, which highlights that advice will unlikely be an appropriate outcome where the case examiners have identified public interest considerations.

In addition to ensuring the guidance is up to date, the aim of this review is to support consistency of approach, transparency, and proportionality in decision making by case examiners.

To what extent do you agree that all of these aims are supported by the updated ‘Allegation of impaired fitness to practise ought not to be considered by a practice committee’ section, including the changes listed above?

• Somewhat agree

Please provide reasons for your response:

Dental Protection believes this section largely reflects existing practice and that the changes improve structure and clarity rather than introducing new principles.

The clarification at paragraphs 177–178, confirming that no further action may be appropriate where there is strong evidence of insight and remediation and a low risk of repetition, is helpful and consistent with case law. It supports proportionate decision‑making and avoids unnecessary escalation where concerns have already been addressed.

We are concerned however about paragraph 184. While the guidance suggests that advice is unlikely to be appropriate where public interest considerations have been identified, this position is not clearly reconciled within the rules, which allow case examiners to issue advice. The boundaries between advice, no further action and other outcomes are not sufficiently clear.

There is a risk that once public interest is referenced, advice is treated as inappropriate by default, even in lower‑level cases. This may lead to inconsistency and disproportionate outcomes. Clearer guidance on when advice remains appropriate, particularly where public interest considerations are limited or marginal, would better support consistency and proportionality.

Publishing details of the warning (191 to 196)

While the discretion over whether warnings should be published is clearly afforded to the case examiners by the GDC Fitness to Practise Rules 2006 (“the Rules”), there is nothing in the Dentists Act 1984 (“the Act”) nor in the Rules which addresses for how long warnings should be published.

The GDC’s current policy position is that the case examiners have discretion to set the length of time for which warnings are published. The current Case Examiner Guidance Manual sets out the mitigating and aggravating considerations which case examiners should consider in the exercise of this (policy-granted) discretion, with warnings for cases with mitigating factors being published for “a shorter period (up to 12 months)”, and those with aggravating factors for “a longer period (of between 12 and 24 months)”.

With regards to the typical periods for which warnings are currently published, over the years 2023 to 2025, there was an average of 60 published warnings issued per year, and of those:

• 39% were published for 1-11 months
• 48% were published for 12 months
• 13% were published for more than 12 months (9% for 13-18 months, 4% for 19-24 months).

We are proposing to change our policy to remove discretion from the case examiners in favour of setting a fixed publication period of 12 months for warnings which the case examiners determine should be published. The draft updated Guidance for the case examiners reflects this proposed new policy position (particularly paragraph 192).

We are proposing this change of policy because:

• We consider that warnings should ordinarily be published, to support the application of the open justice principle and our aim that the GDC's regulatory proceedings should be conducted in an open and transparent manner. The updated draft Guidance for the case examiners makes clear at paragraph 191 that warnings will ordinarily be published for that reason.
• We consider the role fulfilled by warnings at the case examiner stage to be largely aligned to that of reprimands at practice committee stage. As with warnings, the Act and the Rules are silent as to for how long reprimands should be published, but our policy is that practice committee reprimands should be published for 12 months.
• We consider the publication periods for these two outcomes should be aligned and that the public interest would be served by the publication of warnings for a flat rate of 12 months.
• We also consider that a fixed publication period will ensure greater consistency of outcome between different cases.
• We do appreciate that some warnings are currently published for less that 12 months and so this change of approach will result in an increased publication period in some cases going forward. We consider, however, that the benefits set out outweigh any disadvantages that may arise.

We also note that we have developed paragraph 196, which addresses the circumstances where the case examiners may consider that it is not appropriate to publish some, or all, of the details of the warning, including where there is evidence which suggests publication is likely to cause significant harm to the registrant or a third party.

To what extent do you agree with our proposed policy change to set the duration of published warnings to a flat rate of 12 months?

• Somewhat disagree

In addition to ensuring the guidance is up to date, the aim of this review is to support consistency of approach, transparency, and proportionality in decision making by case examiners. To what extent do you agree that all of these aims are supported by the updated ‘Publishing details of the warning’ subsection, including the changes listed above?

• Somewhat disagree

Please provide reasons for your responses to these questions:

The proposal to introduce a fixed 12‑month publication period removes an important element of discretion that currently supports proportionality. The existing approach allows some calibration to reflect seriousness and context, and the data shows this discretion is being used appropriately, with a significant proportion of warnings published for less than 12 months.

A flat‑rate approach risks undermining proportionality by imposing the same reputational impact on lower‑level cases as on more serious matters. In practice, this may lead to increased dissatisfaction among registrants and reduce a willingness to accept warnings, particularly where there is a perceived mismatch between conduct and outcome.

There is also a risk that members may be more inclined to contest outcomes and seek hearings if publication consequences are effectively standardised, potentially increasing delay, cost and escalation without clear public benefit.

Retaining discretion for case examiners to set publication periods of up to 12 months, with clear guidance on relevant factors, would better support consistency, transparency and proportionality.

Appendix 1: Considerations in particular categories of cases (Appendix 1, paragraphs A1 – A175)

Significant changes have been made to Appendix 1 (replacing the case examiner indicative outcomes guidance), with the aim of:

• providing clearer guidance to the case examiners, with accompanying rationale where appropriate at the different stages of the case examiners’ consideration, and for the indicative outcomes in particular categories of cases.
• seeking consistency with the corresponding appendix in the recently updated Guidance for the practice committees, where appropriate.

Given the extent of changes to the sections in the appendix, we do not provide an itemised list of all changes made. However, the following sections have, in particular, benefitted from improvements:

• Sexual misconduct guidance (A5 to A18) has been significantly expanded to reflect the seriousness of this category of allegation.
• Discrimination and harassment guidance (A19 to A33) has been significantly expanded to reflect the seriousness of this category of allegation.
• A new section on integrity introduced (A56 to A60), highlighting distinct aspects of this category not previously captured.
• A new section on candour introduced (A70 to A77), highlighting distinct aspects of this category not previously captured.
• Non-cooperation guidance (A78 to A85) has been significantly expanded to reflect the seriousness of this category of allegation.
• A new section on breach of IOC or practice committee conditions, or breach of undertakings introduced (A86 to A91), highlighting distinct aspects of this category not previously captured.

In addition to ensuring the guidance is up to date, the aim of this review is to support consistency of approach, transparency, and proportionality in decision making by case examiners.

To what extent do you agree that all of these aims are supported by the updated Appendix 1 ‘Considerations in particular categories of cases’, including the changes listed above?

• Somewhat agree

Please provide reasons for your response:

Dental Protection welcomes the clearer, more structured guidance. The expanded sections (notably on sexual misconduct, discrimination and non-cooperation) and the introduction of integrity, candour and breach related categories are positive additions. The inclusion of rationale and closer alignment with Practice Committee guidance should improve transparency and continuity.

However, further refinements would strengthen consistency and proportionality:

• Weighting of factors: While relevant considerations are identified, there is limited direction on how to weigh seriousness, risk and remediation. More explicit guidance would reduce variability. In addition, brief case-based examples would improve consistency.
  
  
• Applicability and workability: Greater clarity is needed on when undertakings are realistically workable in the dental context. From engagement with the GDC, including recent workshops, it appears undertakings are comparatively underutilised. This reflects practical constraints in dental settings, particularly in single handed or small practices, where supervision, monitoring and compliance mechanisms can be difficult to implement in the same way as in larger, more structured clinical environments (for example NHS hospital settings). The guidance would benefit from explicitly addressing these contextual factors and providing more tailored examples of when undertakings are feasible in practice.

Overall, the revisions are a clear improvement, but additional direction on application, particularly around proportionality and the realistic use of undertakings, would better support consistent, transparent and proportionate outcomes.

Undertakings bank for the case examiners

In the interests of consistency, the development of the proposed updated undertakings bank was based on the template established by the conditions bank for the practice committees, which was introduced in January 2026.

The proposed undertakings bank for the case examiners has been adapted to reflect the distinct nature and purpose of undertakings identified by case examiners. One of the ways in which case examiner undertakings are distinct from conditions imposed by practice committees is that undertakings, while proposed by the case examiners, must be agreed to by the registrant before they take effect. As such, they are not restrictions imposed on a registrant’s registration but are rather commitments which the registrant undertakes to abide by for the period they are in effect.

To reflect this difference, we have amended the wording of the undertakings to be in the first person, and replaced instances of “You must…” with “I undertake to…” throughout the undertakings bank. We believe this language better-reflects the nature of undertakings

In addition to ensuring our materials are up to date, the aim of this review is to support consistency of approach, transparency, and proportionality in decision making by case examiners.

To what extent do you agree that all of these aims are supported by the proposed revised undertakings bank for the case examiners, including the changes listed above?

• Somewhat agree

Please provide reasons for your response:

The revised undertakings bank is clearer and more consistent than previous materials and aligning its structure with the Practice Committee conditions bank is sensible. The adaptation of the wording to reflect the consensual nature of undertakings, including the use of first‑person language (for example “I undertake to…”), appropriately distinguishes undertakings from conditions imposed by a committee and better reflects their legal status.

The revised format should support greater consistency and transparency by providing clearer expectations about the types of undertakings that may be proposed. In principle, this assists both case examiners and registrants in understanding what is being offered and why.

That said, the effectiveness of the undertakings bank will depend on how it is used in practice. As discussed, there is a risk that undertakings could begin to operate in a similar way to conditions if they are applied too readily or for extended periods. Care will be needed to ensure undertakings remain genuinely consensual, proportionate, and appropriate to the circumstances of the case, rather than becoming a default outcome.

Maintaining flexibility and judgement in the use of undertakings will be important to ensure they continue to serve their intended purpose and do not undermine proportionality in decision‑making.

Equalities Impact Analysis

We are committed to understanding the impact of our proposals on people or groups of people who have or share protected characteristics.

We are also required under the Equality Act 2010 to have due regard to the need to eliminate discrimination, harassment, victimisation, and any other conduct prohibited by or under the Act, advance equality of opportunity between persons who share a relevant protected characteristic and those who do not, and to foster good relations between people who share a protected characteristic and those who do not.

As part of these considerations, we ensure the equality and diversity implications of new proposals are considered. Our analysis has not identified any adverse impact on people who share protected characteristics, but we are seeking to gather further information on the impact of the proposals from respondents.

We would like you to consider whether our proposals have the potential to impact people based on their protected characteristics. Please note, you do not need to provide us with any information regarding your protected characteristics to answer this question. The protected characteristics identified by the Equality Act 2010 are:

• Gender reassignment.
• Marriage and civil partnership.
• Pregnancy and maternity.
• Religion or belief.
• Sexual orientation

We want to understand whether, and if so how, our proposals might advantage or disadvantage people.

Please consider the above protected characteristics and indicate for each whether you think the revised Guidance for the case examiners and Undertakings bank for the case examiners may advantage or disadvantage people in these groups. Please provide the reasons for your response:

Dental Protection is not best placed to assess the specific impact of the proposals on people with particular protected characteristics. We feel we cannot provide an answer that would give the value needed, but organisations with lived‑experience expertise may be better placed to comment in detail.

Contact

Should you require further information about any aspects of Dental Protection's response to this consultation, please do not hesitate to contact us.

Alice O Flynn
Policy and Public Affairs Officer
alice.oflynn@medicalprotection.org