Professionals undergoing fitness-to-practise proceedings in the UK and the effects on their mental health: a narrative review
Authors: Leal P , Heaslip V , Ellis-Hill C 
Published: November 2022

Abstract

Introduction
Approximately 2% of health and social care professionals undergo fitness-to-practise proceedings through the UK professional regulatory system. Very little research has been carried out in this area even though it is increasingly being recognised that the mental health of registrants (including pharmacists, nurses, doctors and social workers) can be adversely affected by the process.

Aim
This review aims to address this gap through scoping the current literature on fitness-to-practise proceedings and regulation processes on four health and social care professional groups in the UK.

Methods
We performed a narrative review of the literature published between 2000 and 2021. A total of 1839 abstracts were initially identified (following PRISMA). After screening these abstracts, 412 full papers were obtained. Further screening resulted in a total of 32 studies included in this review. The following information was extracted from each included study: overall design and methods employed, population characteristics and key findings, and following the application of critical appraisal checklists potential limitations were noted. Ethical approval was obtained through Bournemouth University’s Research Ethics Panel (reference 16302).

Results
Of the 32 research studies we identified, 30 were single profession (for example 1, 2, 3), five explored the prevalence and nature of misconduct, six investigated the registrant characteristics and factors that are associated with an increased risk of appearing before a fitness-to-practise committee, nine examined the effectiveness of regulation, 10 tentatively assessed the impact of complaints and regulatory investigations on the welfare of registrants. Only two studies were multi-professional. Studies employed both quantitative and qualitative research methods to investigate the subject of regulation including: postal questionnaires (N=6), structured and semi-structured interviews- face-to-face and telephone (N=11), focus groups (N=3), case and document analysis (N=16), multivariable regression analysis (N=1) and, topic analysis (N=1). Mixed methods approach was followed by four studies. Most of the studies reported outcomes related to one or more of nine fitness-to-practise aspects of research interest including: complaints, gender, ethnicity, length of service, practice setting, nature of misdemeanours, attendance at hearing, legal representation and regulator fitness-to-practise decisions. These aspects are relevant to the registrant experience of the fitness-to-practise proceedings and ultimately the effectiveness of health and social care professional regulation. Opportunities for workforce development are limited by a narrow, legalistic accusatorial regulatory system that pharmacy and other care professionals are subject to.

Discussion/Conclusion
There is little understanding of the impact of UK Statutory Regulatory Bodies’ fitness-to-practise procedures upon pharmacy and other care professionals who go through the system. Empirical research related to the emotional and psychological effects on care professionals is sparse. To date, no research has been undertaken in relation to the impact of de-registration on health and social care professionals.

References
1. Hanna A, Hanna L-A. Topic Analysis of UK Fitness to Practise Cases: What Lessons Can Be Learnt? Pharmacy [online] 2019;7:e130.
2. Phipps D, Noyce P, Parker D, et al. Pharmacists subjected to disciplinary action: Characteristics and risk factors. Int J Pharm Pract 2011;19(5):367-373.
3. Tullett J, Rutter P, Brown D. A longitudinal study of United Kingdom pharmacists' misdemeanors- trials, tribulations and trends. Pharm World Sci 2003;25(2):43-51.