Fit For Practice Research Articles

Fitness to practise will be fit for the future.

The Nursing and Midwifery Council is often in the news, and most coverage relates to outcomes of our fitness to practise (FtP) hearings.

Reflection on fitness to practise.

Aim The focus of this review was to identify the role of reflection in continuing dental education. By understanding the expectations that our statutory regulative authority has of their registrants there is an opportunity to help to shape the continued professional development activities undertaken by current registrants in the future.Objective Conduct a review of General Dental Council (GDC) Fitness to Practise cases which were given conditions (restrictions) between February 2012 and November 2015, identifying relevant emergent outcomes in relation the Fitness to Practise (FTP) process.Design A Framework Approach (FA) was used to interrogate the qualitative data generated from GDC cases, the data were reviewed by a secondary person to ensure inter-rater reliability. Ethical approval was not sought for this research project as the GDC cases are published and available for open access via the internet. However, this does not negate the need for consideration of those GDC registrants who have been reviewed by the FTP process, indeed information regarding their identities was removed during data collection, as individual identification as part of this research project may have impacted on these individuals (bearing in mind the principle of non-maleficence; do no harm) and disclosure of personal information would not have contributed to the findings of this review. Although FTP cases are in the public domain, the information is still sensitive to those registrants, therefore it was not possible to review those cases which were not available for public view. To ensure that individual identification of registrants did not occur for the available to view cases (n = 56), each case file was individually downloaded from the GDC website and immediately given an individual numerical identifier before the frame work analysis. For the purpose of this research only the data from the FTP cases which resulted in 'conditions' were subject to review, as these were cases where it was felt that the registrants were able to remedy their personal professional practices.

Orthodontic allegations raised against registrants by the General Dental Council.

An allegation calling a dental professional's Fitness to Practise (FtP) into question is probably one of the most stressful events a General Dental Council (GDC) registrant could face during their career. The practise of dentistry is experiencing unprecedented levels of complaints against registrants with orthodontics traditionally being seen as a low risk area. However, as a recently appointed clinical advisor and expert witness to the GDC, I can testify this may no longer be the case. The last twelve months has seen me provide advice on seven cases associated with orthodontics. This review of frequently occurring allegations in cases being investigated by the GDC should stimulate greater levels of awareness for all members of the dental team and increase the standard of care being provided to our patients.

NMC to examine impact of fitness to practise hearings.

A project to understand the impact of fitness to practise (FtP) investigations on nurses' mental health is about to get under way at the Nursing and Midwifery Council. The nursing regulator says it is committed to undertaking work to 'better understand' the link between mental health and the investigation process.

Now is the time to demand change to punishing FtP procedures.

Having undergone Nursing and Midwifery Council fitness to practise (FtP) proceedings after raising and escalating concerns, I read with interest your article about nurses facing FtP hearings being 'pushed to breaking point' (analysis, May 11).

An Online Survey Investigating Australian Radiation Therapists' Responses to Hypothetical Dilemmas Concerning Impaired Fitness to Practise

IntroductionImpairment in health care professionals has been identified as one of the determinants of fitness to practise (FTP), and practitioners have a legal obligation to notify regulatory authorities if they experience it. However, there remains confusion as to how radiation therapists (RTs) discern what constitutes impaired practice and how they would respond to such dilemmas. The aim of this study was to identify the range of responses to hypothetical professional impairment dilemmas, which may inform an educational strategy for improving reporting occurrences. MethodsA convenience sample of Australian RTs was invited to participate in an anonymous online survey that presented a range of FTP dilemmas relating to impairment, competence, and values/ethics. Participants were asked to describe how they would deal with such situations. Qualitative responses were coded using NVivo software. This article reports on the themes that emerged from the impairment dilemmas. ResultsOne hundred eighty-two RTs responded to the survey. The emerging key theme and subthemes included dealing with the situation, removal of the practitioner from the situation, stop working, avoiding responsibility, giving the benefit of the doubt, and carrying on with the workload. ConclusionsPractitioners' interpretations of the impairment dilemmas varied, which, in turn, influenced their suggestions of how they would deal with them. The continuum of responses supports a key tenant of the interpretive paradigm—multiple interpretations of social phenomena exist. Those seeking to improve practitioner understanding of their obligations under national law should consider a scenario-based approach to raising awareness of FTP issues such as impairment.

Doctors who pilot the GMC's Tests of Competence: who volunteers and why?

BackgroundDoctors who are investigated by the General Medical Council for performance concerns may be required to take a Test of Competence (ToC). The tests are piloted on volunteer doctors before...

Proactive Student Engagement with Fitness to Practise

Fitness to practise (FTP) is fundamental to health professional education and health service delivery, impacting on both practitioner and client wellbeing. Literature exploring FTP support policies primarily identifies retrospective student support and management. This study describes student perceptions of an innovative FTP policy which supports students and staff to proactively identify FTP management strategies prior to entering the clinical environment. Forty-nine final year physiotherapy students were surveyed regarding their perceptions of self-declaring FTP. Ordinal data from Likert scales were reported using descriptive statistics. Thematic analysis was undertaken for open text responses. The response rate was 88%. Forty-two percent of students stated that they had experienced FTP concerns during the course. Concerns included physical and mental impairment and clinical competence issues. The majority of students (80%) indicated that they were “comfortable” or “very comfortable” in self-declaring FTP issues. Confidentiality, positive relationships with staff and a supportive environment enhanced likelihood of declaration. Eight students (19%) met with university staff to develop management strategies and all rated these meetings as “helpful” or “very helpful.” Students had positive perceptions of self-declaring their FTP to enable early development of management strategies. This strategy successfully navigates sensitive ethicolegal issues, empowering students to take responsibility for their own FTP.

Australian radiation therapists' perceptions of the determinants of fitness to practise; a mixed methods focus group study

BackgroundThere is a lack of clarity as to what factors affect practitioners' fitness to practise (FTP). PurposeThe purpose of this study was to identify what radiation therapists perceived to be the key determinants of FTP and to establish the importance that they place on each determinant. MethodsA mixed methods approach using focus groups with a brainstorming activity was used for data collection. Qualitative analysis was informed by grounded theory, where the data was coded and assigned themes. FindingsThree focus groups were conducted with 21 participants. Twenty-one unique determinants of FTP were identified. Professional development, communication, competence, qualifications, ethics and professionalism were common themes in all focus groups. Knowledge, technical and professional skills were most frequently cited by participants as the three most important determinants. Self-awareness, values and ethics featured last on the list. Participants of higher seniority identified a greater variety of determinants with lesser emphasis on technical skills, when compared with junior participants. Nine determinant themes were identified initially and these were spliced to form three primary categories; Impairment, Competence, and Values/Ethics. ConclusionThe most important issues to radiation therapists were associated with technical and clinical competence. This indicates a need to further educate practitioners on the other determinants of FTP, such as values, ethics, probity, trust and criminal activity. Further investigation is required to assess practitioner behavioural responses to deviations from accepted practice and the socio-cultural context of FTP.

Series: For attending physicians; seeking to understand the diversity of medicine; fitness to practise (FtP) activities in U.K

Series: For attending physicians; seeking to understand the diversity of medicine; fitness to practise (FtP) activities in U.K

BBC sting continues to see fall-out with striking-off of pharmacist

A London pharmacist’s claim that he was making emergency supplies when he sold prescription-only medicines (POMs) to an undercover reporter was not plausible, a fitness-to-practise (FTP) committee ruled as it struck him off.

GMC: Time to Reconsider the Civil Standard of Proof

From 2008 the General Medical Council (GMC) fitness to practise (FTP) hearings adopted the civil standard of proof, based on leading counsel's opinion that account would be taken of the seriousness of the allegation. in light of case law from the House of Lords, this almost certainly does not represent the current state of the law with regard to the civil standard of proof.

Huge increase in regulator’s workload was to be expected

In her Voices column (reflections May 30), NMC interim chair Judith Ellis says she wants to increase the annual registration fee from £76 to £120 to help pay for a 48 per cent increase in fitness to practise (FtP) referrals over the past two years.

Motivational Interviewing: A Qualitative Examination of Factors Impacting Adoption and Implementation in a Community-Wide Setting

Motivational interviewing (MI) training frequently results in only minimal improvement in the proficiency of MI techniques. The purpose of this qualitative study was to examine factors influencing the adoption of MI across various substance abuse treatment settings. Twenty practitioners and administrators were interviewed using a semistructured interview focused on participants' experiences and attitudes toward MI. Content analysis revealed themes similar to the current literature such as the evidence-based practice's fit with counselor orientation and the need for ongoing training and supervision. Recommendations include consideration of MI for use by paraprofessional staff and a comparison of the program's mission and philosophy to the spirit and principles of MI.

The creation of risk‐related information

This paper aims to clarify the potential to use data on doctors and fitness to practise (FTP) cases held by the UK General Medical Council (GMC) for wider regulatory purposes, such as identifying risk factors. The paper aims to concentrate on how data are shaped by the GMC's functions and organisational concerns, and by the configuration and use of their electronic database. The GMC provided samples of their data, access to documentation surrounding the configuration and use of the database, and meetings with staff able to provide background on the database, GMC procedures, and the GMC as an organisation. The FTP database is designed to process cases within complex legal rules, and to provide for accountability. The database and its use are adapted to these purposes. Attempts to use it for other purposes are likely to find it difficult to use, the scope and quality of data uneven and some codes unsuitable. The register data are very narrow in scope. While combining register and FTP data to identify risk factors is by itself of limited value, the database can contribute to closer study of risks to patient safety from poorly performing doctors. The research was exploratory. It provides initial insights and the basis for further research. The data have potential policy use for the GMC, but it is essential to understand the limitations. The paper examines previously unanalysed influences on the GMC's data. It also develops new angles on questions in the regulation literature about organisational risks and the creation of risk data.

Fitness to practise targets not met despite 179 extra panellists.

Almost one third of the 4,000 fitness to practise (FtP) cases on the books of the Nursing and Midwifery Council (NMC) have not been completed.

Criminal and professional ‘guilt’

The Nursing and Midwifery Council's (NMC) Fitness to Practise (FtP) panel hears evidence about alleged poor practice on the part of midwives and nurses, and is a crucial feature of the UK government's plans for professional regulation (cf. Health and Social Care Act 2008). The NMC's disciplinary function is organized very much along the lines of the General Medical Council (GMC), which oversees medical practitioners. Criminal convictions are automatically notified to the relevant regulatory body: the ‘FtP hearings and decisions’ section on the NMC's website shows that in July 2009 a number of convictions were considered by the NMC in relation to the competence and conduct of NMC registrants. These included cannabis cultivation, actual bodily harm, child pornography, and false accounting, among others. However, an acquittal in a criminal case does not mean that the regulatory body will not take any action against a practitioner. A recent medical case in the Court of Appeal highlights this. Although it concerned a doctor, the same process would be applied had it involved a midwife or nurse.

NMC takes urgent action to ease pressure on complaints officers

Up to 30 extra staff are to be employed by the Nursing and Midwifery Council (NMC) within the next six months to help clear a backlog of 400 fitness to practise (FtP) cases.

Evaluating Operating Theatre Experience Student Nurses in South East Wales

Nurses following the traditional pre-registration programme used to be offered a theatre placement of up to ten weeks’ duration and it was during this period that they were able to develop key nursing skills in the care of the perioperative patient (Hughes 2003). Prior to the implementation of the Fitness for Practice (FFP) curriculum (UKCC 1999a), students in parts of Wales were denied a theatre placement. However, the new programme highlighted the need for closer links between academic and clinical educators and allowed students the opportunity to experience the perioperative environment.

Student attendance during college-based lectures: a pilot study

To identify the factors that influence attendance and absenteeism among a group of second-year nursing students during the theory component of the Fitness for Practice (FFP) curriculum. In 2004, a non-randomised questionnaire was used to elicit information about the factors surrounding absenteeism from 75 adult branch nursing students within the first FFP cohort. The questionnaire consisted of 48 questions and was designed to generate a mixture of quantitative and qualitative data. Absence was recorded for the first 91 weeks of the programme. The main reasons identified for absence included: illness, family commitments, dental and medical appointments, and impending assignment submissions. Other factors that might influence college attendance included a dislike of certain subjects, with ethics, law and social policy identified as the least popular subjects. Students also admitted to an increase in absence around the time when assignments are due for submission and occasionally pretended to be ill. Further studies should be undertaken with other pre-registration nursing student cohorts to compare the results with this research. There should be: an increase in self-directed learning; a 'family-friendly' approach to the curriculum by allocating self-directed study during school holidays; a reduction in the number of theory hours to coincide with students' external commitments and to assist them with the demands of studying; and time for private study before the submission of theoretical assignments.