Safe, sorry and still struck off: why dishonesty leads to erasure

Jonathan Meadows explains why dentists can be struck off for dishonesty even without a finding of risk to patients – and why restoring public trust takes more than admitting wrongdoing.

Here is a question worth asking before you ever need the answer. Can a dentist who has admitted what they did and apologised for it, and against whom there is no finding of risk to patients, still be struck off?

For a dentist recently erased from the register for dishonesty after writing his own job references, the answer was yes.

I was not surprised. I used to prosecute for the GDC and I now defend the professionals I would once have charged. From either side of the room, the pattern is the same. Dishonesty very often ends this way.

What does surprise me, again and again in practice, is how rarely the reason is properly explained to the people it affects.

It is natural to assume a hearing asks one question: am I a safe practitioner? Registrants prepare for it accordingly, with courses, audits and testimonials from patients. That work matters. But it answers only part of what a committee is asking.

The rest sits in two words that appear in almost every fitness to practise decision and are almost never explained: public confidence.

What actually happened?

For anyone who missed the report, the facts are short. In April 2023 a dentist was recruited by a dental practice and asked for referees. They gave the email addresses of two dentists they had worked with before. The addresses were not their’s. The candidate had created them, and when the practice wrote asking for references, they wrote the replies themself.

It came apart by chance, after the dentist had left the practice. The owner was talking to an associate who happened to be married to one of the supposed referees. The email address was wrong. Both dentists later confirmed they had given no reference, and would not have been prepared to give one.

The dentist in question did much of what registrants are told to do.

They admitted the dishonesty at the outset, apologised to the fellow practitioners and to the public, and had no previous adverse fitness to practise history. Written reflections and CPD were produced after some 22 months under interim suspension. The dentists’ own counsel asked for a 12-month suspension with a review.

The committee found no evidence to support impairment on public protection grounds. There was no finding that they were a risk to patients, yet they were erased anyway – on the public interest alone.

What led to erasure?

Two things did it. The first was the nature of the lie. This was not a panicked answer to an awkward question. It meant creating two false email addresses, writing two false references and sending each to the practice owner. The committee called it premeditated, not a ‘spur of the moment’ decision, and counted financial gain against them.

The second was the why.

The dentist told the committee they could not remember their dishonest act. They gave no reason for them. And the committee kept coming back to that gap. Without an explanation, it had concerns that the tendency to act dishonestly was deep-seated, and it could not be satisfied the risk had gone away.

Its finding on risk is telling. The risk of the clinician repeating this specific conduct was low. But there was a likelihood that they would behave dishonestly in the future.

That is the difference between an admission and insight. An admission tells a committee what happened. Insight tells it why, and what has changed since. The registrant could give them the what but not the why. And 22 months out of practice did not fill the gap.

What is public confidence, exactly?

Committees and lawyers tend to use ‘the public interest’ and ‘public confidence’ interchangeably, and I do the same here. Strictly, public confidence is one part of the public interest, but in a dishonesty case it is the part that decides the outcome.

It is not public opinion. It is not public anger. And it is not punishment.

Here is how I explain it to clients: the first time you sit in a dentist’s chair, you know almost nothing about the person holding the drill. You have not seen their degree. You have not checked their references or tested their honesty. But you open your mouth anyway, because they are on the register.

That trust was not earned by the individual. It was lent to them by the profession. Every dentist practises on borrowed trust, and the regulator’s job is to protect the loan.

Read this latest decision with that in mind and it stops being a puzzle. The committee concluded that ‘public confidence would be undermined if a finding of impairment were not made in this case’. No risk to patients was needed. The question was never whether the dentist was safe. It was what it would say about dentistry if they stayed.

Is public confidence simple to determine?

No, and it is worth being honest about that.

There is no agreed definition of public confidence, or of what behaviour or regulatory action affects it. What the public interest requires in any given case is a matter for the professional judgment of the committee.

The nearest thing to a test comes from Giele versus GMC (2006). The High Court held that the decision should ‘reflect the views of an informed and reasonable member of the public’, appraised of all the circumstances of the case.

Even the regulators’ own research concedes the difficulty. In 2022 the University of Plymouth reported to the GDC and other regulators on how seriousness is judged in fitness to practise cases. One of its conclusions was this: ‘The range of different ways in which public confidence is interpreted by individual decision makers suggests that the concept is nebulous and ill-defined.’

Nebulous and ill-defined. That is research commissioned by the regulators, describing the concept on which careers turn.

Does a dishonesty finding make erasure inevitable?

No. The courts have built real limits into the idea, and healthcare cases have fought over every one of them.

The hearing itself counts for something. In a Scottish appeal, PSA versus NMC (2017), the Court of Session recognised that the ‘rigorous regulatory process which resulted in a finding of misconduct’ can be taken into account as going some way to upholding professional standards and public confidence.

There is a public interest on the registrant’s side too. A committee must weigh not only public confidence in the profession, but the public interest in allowing a competent dentist to remain in it. Lord Hoffmann put it memorably in Bijl versus GMC (2001). Public confidence, he said, ‘should not be carried to the extent of feeling it necessary to sacrifice the career of an otherwise competent and useful doctor who presents no danger to the public in order to satisfy a demand for blame and punishment’.

Remediation and mitigation also still matter, and the outcome must be proportionate. A committee’s decision must go no further than is necessary to meet the GDC’s legitimate aims.

So, erasure is not inevitable. But my advice to anyone facing a dishonesty charge is to assume that suspension is the realistic floor, and that the argument is about how far up from there the committee goes.

Why is dishonesty treated so differently?

Because it is not treated as a problem with your dentistry. It is treated as a problem with you.

A clinical failing can be fixed. The GDC committee said that dishonesty is ‘by its very nature’ difficult to remediate.

It cannot be managed either. Conditions work by controlling a risk while a registrant improves. Nobody can supervise honesty. Both committees concluded that conditions could not address the dishonesty or the public interest.

Public confidence is the profession’s reputation, held in trust by every member of it, and judged through the eyes of an informed and reasonable member of the public. It is real. It is ill-defined. And in a dishonesty case it weighs heavily against anything a registrant can say in mitigation.

A committee that does not know why a dentist lied cannot be confident that he will not lie again. Owning up is necessary, but it is not enough.

How should dental professionals approach fitness to practise cases?

Prepare to prove that you are both safe and worthy of public trust. The latter needs an honest account of why it happened, what was going on at the time and what is different now.

Turn up to the hearing. A registrant who stays away gives up the only chance to show insight or argue for a lesser sanction.

And take advice before you write to the regulator, not after.

The recent case was really about paperwork. It was about whether the public could still trust the name on the register.

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