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Enhancing confidence in fitness to practise adjudication - research report

17 May 2011 | Professional Standards Authority
  • Research Papers

We asked Research Works to explore people’s experiences of fitness to practise across a range of regulatory bodies, with a focus on adjudication. This report was published in May 2011.

We commissioned research to understand the experiences of people who had complained to regulators about health professionals, many of whom had subsequently acted as witnesses at the hearing. We found that people found the ‘complaints system’ as a whole very confusing, and did not know what to expect from a professional regulator’s processes. They typically did not feel well supported and communication from the regulator was not considered adequate. There is much that regulators could do to improve the ‘customer service’ throughout the process and to help prepare witnesses for the hearing.


We commissioned this research to explore what more could be done to improve the experiences of complainants and witnesses in the fitness to practise function. This is important because they are one of the main sources of complaints for regulators, without which many concerns would go unreported.


We were asked by the Secretary of State to provide advice on modernising and improving the efficiency of fitness to practise adjudication among the health professional regulators. This followed the decision by the Government not to proceed with the establishment of the Office of the Health Professions Adjudicator (OHPA). OHPA was to take over the adjudication function for the GMC in the first instance, with a view to expanding to the other eight regulators we over see in time. 

This research formed part of a suite of published reports.

Research brief

We asked Research Works to explore people’s experiences of fitness to practise across a range of regulatory bodies, with a focus on adjudication. The research focused on different stages of the process, including pre-hearing preparation, experiences on the day, and communication throughout the process. It also considered overall satisfaction with the final outcome.

This was a qualitative study with 25 in-depth interviews both with people who had participated as witnesses and with people who did not complete the process. Participants were recruited from England, Scotland and Wales, and had participated in proceedings carried out by the GMC, GDC, GPhC and NMC.


Overall, taking a complaint from investigation through to a hearing was viewed as stressful, daunting and unpleasant. Levels of stress were generally influenced by the length of time it took to complete the process.

From the outset, people needed more information about who to complain to about what, and what they could expect from the regulator’s processes including the different possible outcomes. Formalising the complaint involved a lot of paperwork, and participants felt that better support from a dedicated member of staff would have been helpful. Clear information, such as process maps, about the different stages of the process, along with regular communication, would improve people’s experiences throughout.

Hearings were an unfamiliar and daunting experience for most, and thorough preparation would have been welcomed to help them cope with the hearing and resist intimidation. People reported feeling like they were on trial, and some, particularly those who did not get the outcome they’d been hoping for, felt like they had had to fight to be believed throughout the process. There was a general perception that the regulators lacked empathy and that the traumatic nature of the experience was not acknowledged.

Next steps

We held a seminar with the regulators to share the findings of the research alongside the main points from our advice to the Secretary of State, and commissioned further research on public perceptions of alternatives to hearings in fitness to practise proceedings