Patient and Family Stories in Fitness to Practise

Fitness to Practise is the process UK health professional regulators use to address the thousands of concerns they collectively receive yearly about their registered healthcare professionals. This study asks, ‘What can we learn from listening to patient and family stories of engaging with fitness to practise?’ Stages include: a scoping review; a document analysis; thematic analysis of how seven regulatory professionals administer the process; and narrative analysis of seven patient and family member narratives and stories of engaging with the General Medical Council, General Pharmaceutical Council and the Nursing and Midwifery Council. Narrative portraiture methodology was used to systematically analyse and present verbatim data, presented as ‘Interludes’ to maintain the centrality of patient and family member voices. Ethically, this work was especially concerned with the layered vulnerabilities patient and family member participants faced. This required great care in methodological design, rapport building, interviewing, debrief and analysis, including considering what it means to do justice for participants’ stories. The primary contributions of this work include extending the reach of narrative portraiture methodology; being one of the few studies to research regulatory perspectives to holistically understand the administration of fitness to practise. It is also one of the first in-depth studies of patient and family experiences of engaging with fitness to practise from those who have considered raising concerns, to those whose concerns reaching a formal hearing. The research demonstrates that being heard matters to these publics, as does action. Overall, the patient and family participants in this research sought not only to achieve a sense of personal justice, but to also benefit others in the future. Some were moved to activism without a sense of procedural justice. Therefore, the primary recommendation for regulators is to seek to understand the lifeworld experiences of a health event and its meaning alongside the experience and impact of prior investigatory processes to understand the expectations the public have of a regulator so this knowledge can be acted upon within a regulator’s remit.