GENERAL CHIROPRACTIC COUNCIL The UK’s Regulatory Body Dr Christina Cunliffe 1

GCC Professional Conduct cases The data that follows is a selection of the issues that have arisen in cases considered by the GCC’s Professional Conduct Committee These are findings and so are greater than the number of cases

Nature of allegationTotal Failure to maintain appropriate records (B7)29 Inappropriate and/or excessive treatment / treatment plan (including promoting undue dependence on care) (S3.2 & C1) 15 Inappropriate use of ionising radiation / failings relating to IRMER (E7)13 Abuse of trust / abuse of position / mislead the public / undue influence (C1)12 Failure to review / reassess treatment / modify treatment plan (S3.3)11 Failures relating to communication (B1)9 Failure to gain appropriate consent for examination / treatment (B3 – B4)9 Failings relating to publicity material / marketing / promotion (C4)9 Undermining public confidence in the profession / bringing the profession into disrepute (E3)9 Practising without appropriate insurance (E9)9 Failure to carry out appropriate initial consultation / examination / re-examination (S2.3-S2.4)9

Consistent themes....  failure to maintain appropriate records  inappropriate advertising / marketing  professional boundaries  inappropriate use of ionising radiation/ failings relating to IRMER  inappropriate and/or excessive treatment / treatment plan (including promoting undue dependence on care)  failure to review / reassess treatment / modify treatment plan.

Interim Suspension Orders  An allegation that your ability to practise as a chiropractor is seriously affected because of a physical or mental condition  Allegations of a sexual nature  Certain criminal convictions (for example, convictions for crimes motivated by racial or sexual discrimination)  Dishonesty  An inappropriate relationship with a patient  Inappropriate use of x-rays  Misuse of alcohol or drugs  Practising without the necessary insurance  Verbal or physical abuse of patients or the public.

Sanctions GCC’s Guidance on Sanctions - decision is fair, consistent and sufficient to protect the public. Sanctions available to the PCC are:  Admonishment  Conditions of Practice Order for a period of up to three years  Suspension from the register for up to three years  Removal from the Register. When deciding what sanction to impose, the Committee will always consider the least severe option before considering harsher ones. The sanction that will be agreed and imposed by the PCC is the minimum necessary to protect the public.

Guidance on sanctions The GCC has issued guidance for the Professional Conduct Committee to take into account when a sanction is to be imposed.

Admonishment  evidence that the behaviour would not have caused direct or indirect patient harm  evidence of insight into failings  the behaviour was an isolated incident, which was not deliberate  a genuine expression of regret or apologies  the respondent was acting under duress  previous good history  no repetition of the behaviour since the incident  evidence that rehabilitative or corrective steps have been taken  relevant and appropriate references and testimonials.

Conditions of practice  there is no evidence of harmful deep-seated personality or attitudinal problems  there are identifiable areas of a chiropractor’s practice in need of review, retraining or assessment  there is no evidence of general incompetence  there is evidence of a willingness to have, and the potential to respond positively to, further training and assessment  patients will not be put at risk either directly or indirectly as a result of continued registration with conditions  the conditions will protect patients during the period they are in force  it is possible to formulate appropriate, practicable

Suspension  there has been a serious breach of the Code of Practice or Standard of Proficiency and the misconduct is not fundamentally incompatible with continued registration. Therefore removal from the register would not be in the public interest. However, the breach is so serious that any sanction lower than a suspension would not be sufficient to serve the need to protect the public interest.  the case involves deficient performance where there is a risk to patient safety if the chiropractor’s registration is not suspended, and the chiropractor demonstrates potential for remedying the situation or for retraining.  there is no evidence of harmful deep-seated personality or attitudinal problems  there is no evidence of the repetition of similar behaviour since the incident  the committee is satisfied the chiropractor has insight and does not  pose a significant risk of repeating the behaviour  it is possible to decide on appropriate, practicable and assessable actions that have to be undertaken during the period of suspension.

Removal  particularly serious departure from the principles set out in the COP/SOP, that is, behaviour fundamentally incompatible with being a chiropractor.  a reckless disregard for the principles set out in the COP/SOP and for patient safety.  doing serious harm to others (patients or otherwise), either deliberately or through incompetence; particularly where there is a continuing risk to patients an acceptable level of treatment or care).  abuse of position or trust  violation of a patient’s rights or exploiting vulnerable people  offences of a sexual nature, including involvement in child pornography  offences involving serious violence that have resulted in a custodial sentence.  dishonesty, especially when it is denied, persistent or covered up.  acting without integrity and abusing professional standing.  persistent lack of insight into the seriousness of their actions or the consequences.

Due process - unique aspects Our processes are common so are standard for common law countries - the only unique aspects relate to appeals A decision made by the GCC that a Chiropractor is unfit to practice due to health reasons can be appealed to an internal appeal tribunal An appeal against a decision by the GCC that a Chiropractor is unfit to practice due to relevant misconduct can only be made to the High Court of Justice Our processes are currently being re-examined along with those of all other health regulators by the Law Commission and it is likely they will be streamlined In particular it is the GCC’s policy to streamline investigations by removing an investigating committee and replacing it with 2 case examiners

Law Commission – request for changes Changes to streamline processes - replace the Investigating Committee, set up of Adjudication panel Proper system of appeal – Where all key decisions can be subject of an internal appeal before embarking on external avenues Flexibility in the use of powers – ability to delegate some powers