Lucy Jane Williams v The General Dental Council
| Jurisdiction | England & Wales |
| Judge | Mr Justice Ritchie |
| Judgment Date | 07 June 2022 |
| Neutral Citation | [2022] EWHC 1380 (Admin) |
| Docket Number | Case No: CO/552/2022 |
| Court | Queen's Bench Division (Administrative Court) |
[2022] EWHC 1380 (Admin)
Mr Justice Ritchie
Case No: CO/552/2022
IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
ADMINISTRATIVE COURT
On appeal from the Professional Conduct Committee of the General Dental Council's decisions made on 5th November 2021 and on 19th January 2022
Royal Courts of Justice
Strand, London, WC2A 2LL
Robert Kellar QC (instructed by Hempsons Solicitors) for the Appellant
Rebecca Harris instructed by the Respondent
Hearing dates: 18 and 19 May 2022
Approved Judgment
Parts of the hearing below were heard in private pursuant to Rule 53 of the General Dental Council (Fitness to Practise) Rules 2006 on the basis that reference was made to the Appellant's private life at the date of the index events. On that basis parts of the PCC's determination are redacted and are contained in a confidential private determination. That includes parts of the determination that are subject to this appeal. The Appellant also relies upon material that was received into evidence in private session for the purposes of this appeal.
At the outset of the hearing an application was made by the Appellant, which was supported by the Respondent, for non-disclosure. The Appellant sought an order that there shall not be reported, disseminated or otherwise disclosed to the public any copy of the private determination (or transcript of the private hearing) of the Professional Conduct Committee or the contents of the expert evidence referred to exclusively therein whether or not mentioned in court or contained in a document referred to in court, without the permission of the court or the written agreement of both parties (or their solicitors). I made an order in those terms.
It follows that that the public version of this judgment has been redacted as appropriate where I refer to material that was referred to in private session below.
The Parties
At the time of the relevant events the Appellant was a qualified dentist working in England and Wales.
The Respondent is the regulatory body for dentists.
Bundles
For the appeal there were 6 lever arch bundles and skeleton arguments from each party.
I was also provided with supplementary bundles containing the relevant NHS (General Dental Services Contracts) Regulations 2005 (hereinafter called the Contracts Regulations) and the NHS (Dental Charges) Regulations 2005 (hereinafter called the Charges Regulations) and the guidance thereon and the General Dental Services Contract held by the relevant practice (the Practice).
Terminology
I shall use the following terminology in this judgment:
(1) PCC: Professional Conduct Committee.
(2) UR4: upper right 4 th tooth.
(3) LR4: lower right 4 th tooth.
(4) GDC: General Dental Council.
(5) COT: course of treatment.
(6) TP: treatment plan.
(7) UDA: unit of dental activity.
Introduction
The Appellant was charged with a long list of professional misconduct allegations by the Respondent. The PCC hearing lasted 27 days and 16 witnesses gave evidence. The fact findings were made by the PCC on 5th November 2021. The sanction decision was made on 19 January 2022. The PCC decided to erase the Appellant from the register of Dentists thereby banning her from practicing in the field for which she qualified and trained.
The Appellant does not appeal all of the PCC's findings. The list of those which are not appealed and so are left standing is included in the table below and includes one finding relating to dishonesty. However, she does appeal all of the other findings of dishonesty made against her and the decision to erase her from the register of dentists.
The Issues
Whether there was a failure in cross examination of the Appellant by the Respondent at the hearing to put the necessary assertions of fundamental facts to the Appellant so as to permit her a fair opportunity to answer the allegations of dishonesty such that the findings of the PCC on dishonesty were achieved without due or fair process.
Whether the appealed findings of dishonesty are wrongly made on the evidence or otherwise unfair.
Whether imposing the sanction of erasure was inappropriate, disproportionate, wrong or not in accordance with the relevant guidance.
Charges and chronology of the regulatory proceedings
The factual background to the regulatory issues is set out below. It is not in dispute.
The Appellant is the daughter of two dentists. She worked as a dentist's assistant in her mother's dental practice between 2000 and 2010. Whilst she did that she gained a certificate in dental nursing (2002), a certificate in oral health education (2003) and one in dental radiography (2005). She gained a qualification in pre-clinical science in Bratislava in 2009. She was a sales representative for a German dental products company for a short period between 2009 and 2010. She trained dental nurses between 2012 and 2013. She achieved a BDS degree from Peninsular Dental School in July 2016. She achieved a qualification in advance veneer restorations in Vienna in 2016. Between 2016 and 2017 she worked 4 days pw in foundation training with W, a dentist in the Glamorgan area. Whilst W did NHS and private dental work, the Appellant only did NHS dental work.
The Appellant became pregnant in late 2016 and gave birth on 8 June 2017 to a son. She returned to work on 24 July 2017.
In the background, whilst this was going on, in around 2014, her mother sold her practice to PRD who took it over. The Appellant took her first job in September 2017 at PRD's practice, the Practice, in effect taking over her mother's old role, 3 days per week.
No contract was provided to the Appellant by PRD. She was an independent associate dentist working at the Practice. She was set UDA targets. I am unclear as to precisely how she was paid. She had to pay a percentage of the lab fees incurred for her clinical work, the Practice paid the rest. The Practice had a contract with the NHS to provide NHS dental work to patients amounting to 18,000 UDAs pa. That work is paid for by the NHS after claims are made in four bands: numbered 1–4. The patient pays a fixed sum contribution to the cost of the work in each band, which is low. Some patients are exempt from paying anything at all. No copy of the NHS contract with the Practice governing the work in the relevant period was put before the PCC.
The Practice was busy. The Appellant often saw 40–60 patients per day over a 9 hour shift with 30 minutes allocated for lunch and one 10 minute coffee break. She often took no lunch. A daily list from late July 2018 was in evidence. It looks exhausting. Assuming an average of 50 patients per day over 8 hours and 20 minutes, each appointment would be 10 minutes long. The daily list evidenced this, most patients were indeed listed at 10 minute intervals with handover time included in that 10 minutes. The practice often saw 150 patients per day. A full complement of dental staff was 3 dentists but in October, the month after the Appellant joined, the other associate dentist left and her space was not filled for 3 months so the Practice was down to two dentists. The Appellant would often work late. Some of the nurses were not so happy about having to assist her after hours.
By all accounts the Appellant's relationship with PRD was difficult. After working for him for 11 months, on 24 August 2018, he threw her out because the Appellant advised one of the patients whom he had treated in the past to make a complaint to the practice manager (who was PRD's wife) because PRD had failed to spot a high number of diseased teeth over the course of quite a few years. He came to hear of this, perhaps through a nurse and that very day required the Appellant to leave work.
After being expelled, between September 2018 and March 2019 the Appellant worked as a locum dentist at various dental practices. Whilst she did so she made various complaints to NHS England about PRD (her mother complained about PRD too) and he made complaints back about her to the GDC. She of course had no access to his practice clinical records. He had full access to all of her clinical records.
In September 2018 the Appellant started an MSC at Bristol Dental School and in 2019 the Appellant became a clinical supervisor at Peninsular Dental school.
From May 2019 to March 2020 the Appellant worked as a locum at SPA dental group.
By July 2019 the Appellant and her mother had set up a new dental practice providing private dental care. The Appellant was a partner. According to her CV she was working there and also working as a locum at SPA dental (for a period of 8 months).
In 2020 she obtained a diploma in dental implantology and in 2021 she was working towards an MSC in implantology (the CV ends there).
On this evidence no one could or did assert at the hearing that the Appellant was a slacker. She was clearly a committed and hard working dentist with wide ranging qualifications. However, she has been erased due to the PCC findings of dishonesty, inappropriate practice events and failures of integrity arising in the first 11 months of her working life.
Two complaints were made against PRD involving 12 patients and the allegations were wide ranging. Some clinical failings were admitted. The result of the investigation is not relevant to this judgment.
The Legal structure for dental professional Standards
Guidance
S.26B of the Dentists Act 1984 states:
“ 26B.—Guidance
(1) The Council shall prepare and from time to time issue guidance as to the standards of conduct, performance and practice expected of registered dentists.
(2) Such guidance may make different provision in relation to different cases or classes of case.
(3) The Council shall keep such guidance under review and may vary...
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