Erase or be erased. Social media referrals to healthcare regulators in the United Kingdom 2017 to 2024

• Social media referrals to UK healthcare professional regulators are rising, particularly for doctors and nurses, but SM-related fitness to practise (FtP) hearings remain very rare (113 cases over 8 years). • Major themes in FtP hearings included, sexualised content directed to patients or colleagues, COVID-19 misinformation, breaches of patient confidentiality, and extreme racist or sexualised content, with erasure being the most common outcome. • Despite increasing social media concerns, most referrals do not progress to FtP hearings, suggesting most HCPs maintain appropriate digital professionalism. • Ambiguity in regulator guidance and fear of vexatious complaints contribute to healthcare professional anxiety about social media use, potentially limiting positive engagement in digital spaces. • Clearer guidance is needed with supportive regulator engagement, and further research on social media related referrals to protect HCP wellbeing and foster positive social media cultures. Objectives: Social media (SM) use both professionally and personally is prevalent across all healthcare professionals (HCPs). Its use amongst HCPs is particularly well evidenced across a variety of domains, including health promotion, clinical education, policy debate, and patient interaction. However, as this use increases there is an increasing perception that even normal day-to-day use by HCPs may result in referral to their regulator. Our study aimed to understand which HCPs were being referred to their regulator in the United Kingdom for perceived negative SM behaviours including which behaviours specifically warranted referrals to fitness to practise hearings. Methods: A retrospective case review following freedom of information requests to all HCP regulators in the UK was undertaken. Requests for information around cases involving SM from 2017 to 2024 were requested. Hand searching of outcomes was also done where possible. SM was defined as anything related to the use of applications including Facebook, Twitter (now X), Tik ToK, and posting on the internet in forums. Data analysis considered the number of referrals per year, and per regulator. A review of the fitness to practise (FtP) hearings and themes from the hearings was then undertaken. Results: There were a total of 189,913 concerns raised across regulators, and a total of 13265 FtP hearings over the 8 years from 2017 - 2024. Therefore 7% of referrals resulted in a FtP hearing. Over these 8 years there were 113 (0.85%) FtP hearings which were SM-related across all regulators, or 0.04% of SM concerns raised with regulators resulted in an FtP hearing. Suspension was the most common outcome followed by erasure from the register. Themes of FtP hearings were around COVID-19 misinformation, disclosure of confidential patient information onto social media, extreme and multiple racist posts, bullying, contacting a patient, highly sexualised content or sending this sexualised content to either a patient, colleague or child. Conclusions: This study may provide reassurance to HCPs who are significantly concerned regarding a looming threat of regulator referral for routine SM behaviour. However, rising referrals raised regarding doctors and nurses warrants specific further investigation amongst these populations, particularly concerning impact upon wellbeing and wider healthcare SM culture.