Is it Fair to Refer?

With the recent case of Dr Arora joining a history of controversial decisions in the GMC, how far have we come from 2019’s Fair to Refer report, looking into fairness in the reporting or investigation of doctors from ethnic minority backgrounds?

Excellent to see a new piece from our Head of Professional Regulation & Healthcare @Deepika Raino exploring this in Healthmatters, co-authored with @Selva Ramasamy QC. It’s an important topic, and whilst we do not yet have Professor Singh and Martin Forde QC’s report in Dr Arora’s treatment, one thing is for sure – more needs to be done.

You can read Deepika and Selva’s full piece through the link below.

https://www.healthmatters.org.uk/BLOG/rndblog/blog1-a.php?pid=347&p=&cat_id=0&search=#comments

Maintaining Professional Boundaries Part 2

Working as a healthcare professional means that you will be in a position of trust and your profession therefore demands that you maintain appropriate and respectable professional boundaries between you and your patient. You might be treating someone who is emotionally or physically vulnerable, therefore the balance of power is often tipped in your favour.

In my last article we looked at a case involving a social worker who crossed professional boundaries, but what about a situation in which you might feel manipulated by your patient?

In this article we look at a real life case involving a clinical psychologist who found themselves manipulated by a patient, leading to them and members of their clinical team being investigated by the Health and Care Professions Council following a complaint by the patient when things did not go their way.

Case study

A clinical psychologist was looking after a patient with a complex history and abandonment issues stemming from childhood. The patient formed a close bond  with the clinical psychologist and only wanted to see them, insisting all their appointments were arranged with this clinical psychologist only. The clinical psychologist was an experienced and well respected member of their team but found this patient demanding and difficult. They found it easier to agree to the requests of the patient and so they arranged all their appointments for when they would be in clinic and could see the patient. They also accepted and exchanged cards and small gifts.

Slowly, however, overtime the patient’s requests became more demanding. The patient asked for more time and insisted the clinical psychologist make themselves available at short notice. The patient and their family would complain to them, if they were not available at short notice and were unhappy when the clinical psychologist took annual leave.

Taking into consideration the patient’s abandonment issues, the clinical psychologist started to make further allowances and made sure they were available, even when they were on leave. However, the demands increased. The patient sometimes waited outside their office, waiting for them to finish appointments with other patients. The patient also waited for the clinical psychologist by their car.

Although the clinical psychologist was an experienced practitioner they did not raise early issues with their colleagues, thinking they could manage the situation. By the time the clinical psychologist identified their relationship with the patient was not a healthy one, they had fallen into depression and internalised their problems.

The situation came to light by chance when the clinical lead answered an incoming phone call from the patient. The clinical lead then investigated why the patient’s appointments were not being booked through the central booking system and were instead being managed by the clinical psychologist directly.  It transpired that because the clinical psychologist worked part time, and had two different supervisors, it wasn’t picked up that the clinical psychologist was struggling. The clinical lead notified building security of the situation and arrangements were made to transfer the care of the patient to a different team. The plan was for the patient’s care to be weaned to another team, however the clinical lead came to know the patient had turned up at the clinical psychologist’s home looking for an explanation.

The patient complained to the HCPC about the clinical lead and the clinical psychologist. The investigation by the HCPC was lengthy as the patient raised many issues which needed investigating and answering. With the writer’s help, the clinical lead was eventually cleared of misconduct. The lead had prepared detailed notes which helped them. Sadly, the clinical psychologist did not return to work due to the impact on their mental health.

Conclusion

Maintaining professional boundaries will protect you as well as the patient. Listen to and look out for early alarm bells and seek objective advice as soon as possible to avoid matters from escalating.

Maintaining Professional Boundaries

As a healthcare professional you will often be in knowledge of intimate personal details about your patient or the service user. You might therefore develop a close relationship with each other. However, you must be careful not to find yourself in an improper emotional relationship. It might not always be obvious when treating a patient or service user whether you are crossing professional boundaries.

In this article we look at a real life case involving a social worker who thought they were doing their best to support a service user but instead found themselves investigated by Social Work England for crossing professional boundaries.

Case study
The social worker was allocated to work with a service user in crisis. They helped admit the service user into psychiatric care. The service user explained their problems had begun with work related stress. When providing support, the social worker liaised with the service user’s professional regulator; the NMC, the RCN and their employer. They submitted a report about the service user’s mental health along with recommendations. The social worker’s contract came to an end with the community team and the service user’s care was passed to another social worker.

The service user however contacted the social worker on Facebook, sending a friend request, which the social worker accepted. They formed a friendship and socialised together. The service user wanted the social worker to act as a witness in their regulatory and employment investigations. The social worker agreed and had some ongoing limited contact with the service user’s employer. The service user’s employer complained and the social worker was suspended from practising by Social Work England pending their full investigation.

The social worker contacted us when we helped them undertake a significant amount of reflective work on their code of practice and their actions. Through a period of reflective work they came to realise, amongst other things, that they’d not considered the service user might now have different expectations of other professionals involved in their care which could impact their therapeutic relationship. They accepted their ongoing involvement, although well intentioned, constituted work outside of their scope of practice, and although the service user had wanted their relationship to continue, they had crossed professional boundaries. They also reflected that they had overidentified with the struggles of the service user, which lead to this situation occurring in the first place.

Social Work England accepted the social worker had demonstrated sufficient insight, remorse and remediation and so decided not to refer their case to a fitness to practise hearing. They lifted the interim suspension but issued a warning, warning them to ensure they maintained clear professional boundaries in the future.

Conclusion
You might be treating someone who is emotionally or physically vulnerable. The balance of power is therefore often tipped in your favour. It is your responsibility to ensure that your patients/service users know you are not their friend, partner or family member. If a patient relationship looks or starts to feel uncomfortable, seek advice from your colleagues or others as soon as possible.

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 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 as to 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.

General Dental Council 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 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 as to the 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.

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