Do employment issues in a dental or GP practice need to be referred to the regulator?

This is one of the most common questions I hear from practice owners and practice managers, in both dental practices and GP surgeries. An associate's work gets criticised. Two clinicians fall out badly. Someone makes a mistake with a patient. Different scenarios, but the question underneath them is usually the same: is this something we deal with ourselves, or something we have to tell the regulator about?

In the overwhelming majority of cases, it is something you deal with yourselves. That's what the regulators themselves say. For a practice owner, that means you need processes and resource in place to deal with these matters as they arise.

What the regulators actually expect

The GDC's guidance for employers is built around local resolution. It notes that managing complaints well at a local level is usually better for everyone, and avoids unnecessary escalation. In fact, the GDC itself recognises that a good number of the complaints reaching it need never have arrived at all, because they could have been resolved between the patient and the practice directly.

Source: GDC, Dealing with feedback and concerns

The GMC is more explicit about its reasoning. It states plainly that resolving individual complaints, or punishing doctors for past mistakes, is not its role. Its employer guidance is built around resolving concerns locally, to avoid duplication and reach a quicker outcome, while accepting that local resolution won't be suitable for every concern.

Source: GMC, Deciding whether to refer a matter to the GMC — guidance for employers

Where the line sits

Both regulators are ultimately concerned with fitness to practise: whether someone poses a current and ongoing risk to patient safety, public confidence or professional standards. The GDC treats referral as appropriate where a dental professional may not be fit to practise on grounds of health, professional performance or conduct, and where local action has failed, is impractical, or the concern is simply too severe. The GMC's framing for doctors turns on much the same question: is there a current and ongoing risk to public protection?

Sources: GDC, Dealing with feedback and concerns · GMC, guidance for employers

The threshold is about risk, not fault. A mistake, even a serious one, is not automatically a fitness-to-practise matter. The GDC is explicit that dental treatment can go wrong even where the people involved are properly trained and competent. The real question isn't whether something went wrong; it's what that tells you about the person's ability, health or conduct, and what risk remains. Where a clinician has understood what happened and taken steps to stop it happening again, that matters, because the GMC is explicit that insight and remediation affect its own assessment.

Source: GMC, guidance for employers

Local resolution matters, but it isn't an absolute prerequisite, and this is where practices need to be careful in the other direction. Both regulators encourage local action, but that isn't the same as saying you must always exhaust an internal process before referring. Where there's an immediate or serious risk to patients, or conduct too serious to manage locally, delaying escalation to finish an investigation first can be the wrong call. The GDC is clear that where patients or the public need protecting, the concern should be referred. The GMC treats an immediate patient safety risk, or an urgent or high-profile concern, the same way: as a reason to act straight away.

Sources: GDC, Dealing with feedback and concerns · GMC, guidance for employers

A point specific to doctors: the responsible officer

There's an additional consideration for doctors. The GMC expects employers to speak to the doctor's responsible officer when deciding whether to refer a concern, other than where there's an immediate patient safety risk or the matter is urgent or high profile. Employers are also expected to complete their own local investigation first and consider its conclusions, so that any referral that follows is fair, proportionate and accurate.

Sources: GMC, guidance for employers · The Medical Profession (Responsible Officers) Regulations 2010

A GP practice isn't generally a designated body in its own right. Each GP usually has what the regulations call a "prescribed connection" to a designated body instead, and for most practices that is currently NHS England, administered at a regional level. A bill before Parliament at the time of writing would move this to the Department of Health and Social Care and integrated care boards from around 2027, so this arrangement may change; worth rechecking nearer the time. For now, in practice, a conversation with the responsible officer usually means a conversation with a senior figure outside the practice altogether.

Source: The Medical Profession (Responsible Officers) Regulations 2010

That's exactly why the state of your internal file matters. Turning up to that conversation with a proper investigation, a clear chronology and a documented rationale is a very different experience to turning up with a half-formed account of what somebody thinks happened.

What usually gets mistaken for a regulatory matter

Disputes between professionals

The GDC addresses this head-on. It regularly receives complaints arising from disputes between dental professionals that raise no wider question about fitness to practise or patient safety, and it says plainly that the process is costly, protracted and stressful for everyone involved. Its own suggestion is that mediation, business resolution services or independent advice, through ACAS for example, may provide a more suitable outcome. The same logic holds in a partnership: disagreements about pay, contractual terms, rotas, lists or management decisions don't become regulatory matters just because the people involved happen to be registrants.

Source: GDC, Dealing with feedback and concerns

Performance and health concerns

A clinician whose work has been criticised is usually a performance management question, worked through with honest assessment, support and a structured review. It's worth asking whether this is an isolated incident or part of a pattern, and whether workload, supervision or induction played a part. The GMC expects employers to weigh that wider context, and specifically recognises that inadequate induction and support can contribute to disproportionate referrals for internationally trained doctors. Where health is a factor, this is a capability matter, not a conduct one: a health condition isn't in itself a departure from professional standards, and treating it as misconduct would be a mistake. That said, if a health issue creates a genuine and serious risk to patients, that can't be ignored either.

Source: GMC, guidance for employers

Patient safety concerns raised by staff

These are different from employment grievances, and the distinction matters. A clinician unhappy about their own employment position has a grievance. A clinician warning that patients are at risk because of staffing, systems or a colleague's practice is raising something else entirely. The GMC draws that same distinction, and asks employers how patient safety concerns raised by the individual have been handled, precisely so it can satisfy itself that a referral isn't being used as a response to someone speaking up. The GDC is equally clear that dental professionals must never be asked to sign a contract or agreement that would stop them raising patient safety concerns, which has direct implications for associate agreements, employment contracts and settlement agreements on exit.

Sources: GMC, guidance for employers · GDC, Dealing with feedback and concerns · GDC Standards, Principle 8

When the regulators should get involved

The short version: don't refer just because something has gone wrong, and don't hold back from referring just because it's an employment issue. Before deciding either way, look at the underlying risk and follow a defensible process.

A quick-reference summary of the points above, not a substitute for them — the detail (and the source links) is what makes a decision defensible.

In practice that usually means establishing the facts through a proper investigation, weighing the context (workload, supervision, support), considering how the professional responded and whether they showed insight, asking whether there's a current risk to patients and what safeguards are in place, and recording what was considered and why.

That last point matters more than practices tend to think. Advice taken at the point of decision, rather than reconstructed afterwards, is what turns a judgement call into something documented and proportionate, whatever the eventual outcome.