Fitness to practise & do’s and do not’s of using social media

The do’s and do not’s of using social media in the context of health and care professions, and how social media can result in fitness to practise issues arising.

The ongoing case of Orthodontist John Mew, whose “mewing” techniques have racked up nearly two billion TikTok views, has again shone the spotlight on the care healthcare professionals must take when using social media.

General Dental Council (GDC) professional conduct committee heard Dr Mew seeks to treat children with “head and neck gear”. It reported that, Lydia Barnfather, representing the GDC, said comments made by Dr Mew, who claims to help “alter the cranial facial structure”, on his YouTube channel were “pejorative” about orthodontists. Dr Mew’s techniques have sparked an online trend of sharing results on social media platforms like Reddit.

Social Media and Fitness to Practise

Health and care professional regulators in the United Kingdom have four main functions: setting standards, maintaining a register, setting standards for and quality assuring education and training and investigating and hearing allegations that a registrant is not fit to practise.

The relevance of social media in the context of fitness to practise touches on a number of these functions; setting standards, investigating complaints and registrant’s fitness to practise.

Healthcare regulators expect healthcare professionals and workers to uphold their standards and codes, including acting professionally and lawfully at all times.

This applies to the use of social media as much as it does to other aspects of professional conduct. Specific standards will vary between regulators but broadly speaking, standards of conduct in relation to use of social media includes not:

sharing confidential information inappropriately;
posting pictures of patients and people receiving care without their consent;
posting inappropriate comments about patients;
bullying, intimidating or exploiting people;
building or pursuing relationships with patients or service users;
stealing personal information or using someone else’s identity;
encouraging violence or self-harm; and/or inciting hatred or discrimination.

It is important to note that from a regulatory perspective, standards expected of healthcare professionals and workers do not change because they are communicating through social media rather than face to face or through other traditional media.

Sanctions & regulatory action

The fitness to practise process for the UK’s health and care professional regulators is broadly similar.

If a complaint is made to the regulator about a registrant, their regulator can initiate an investigation that may result in the regulator taking action against that person’s registration.

In order to manage fitness to practise cases, all regulatory bodies record the nature of the case or the allegations within a case. Each case that passes through the fitness to practise process will be categorised under one or more labels, depending on the regulator.

In the context of fitness to practise and social media, not all healthcare regulators are equal.

Research by the Professional Standards Authority found that:

“…only three of the regulators (GMC, GPhC and NMC) mention social media in their category lists. The GPhC lists it once, whilst the GMC has two specific social media categories ‘Fail to maintain trust -social media’ and ‘Breach of confidentiality -social media’. The NMC has made social media into a category with branches of sub-categories…”

Fitness to practise cases relating to social media complaints and incidents that breached standards are comparatively low. For example, research conducted in relation to the General Dental Council (GDC) found that 2.4% of fitness to practise cases published on the GDC website over a three-year period were related to breaches of the social media guidelines.”

More importantly, all the GCD cases looked at in the research were proven and upheld. This is of course no indication of findings relating to other healthcare regulators but, the point is, the significance of misusing of social media by healthcare professionals and workers should not be underestimated. The full range of sanctions and regulatory action is available to healthcare regulators, including suspensions and strike off orders.

Advice – Do’s and Don’ts

Do:

act professionally
treat people with respect
maintain confidentiality and privacy at all times
maintain proper professional boundaries
think before you post, privacy settings do not mean that something will remain private and a statement that these are your own views means little in practice

Don’t:

bully, harass or intimidate
unlawfully discriminate
post inappropriate comments
share information about patients or their care
get drawn into negative, unconstructive discussions

Regulator’s Guidance

General Medical Council (GMC): https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/doctors-use-of-social-media/doctors-use-of-social-media | GMC social media case studies
Nursing and Midwifery Council (NMC): https://www.nmc.org.uk/standards/guidance/social-media-guidance/
Health & Care Professionals Council (HCPC): https://www.gmc-uk.org/-/media/documents/professionalbehaviourcasestudies-dc10903_pdf-73316932.pdf
Social Work England – https://www.socialworkengland.org.uk/concerns/guidance-documents/fitness-to-practise-guide/
General Dental Council (GDC) – https://www.gdc-uk.org/docs/default-source/principle-4/guidance-on-using-social-media.pdf?sfvrsn=abf03a63_2
General Pharmaceutical Council (GPhC) – https://www.pharmacyregulation.org/sites/default/files/demonstrating_professionalism_online.pdf
General Optical Council (GOC) – https://www.optical.org/en/news_publications/Publications/ebulletin-/ebulletin-april-2019/social-media.cfm
General Osteopathic Council (GOsC) – https://www.osteopathy.org.uk/standards/guidance-for-osteopaths/social-media/

In upholding the appeal, Alan Bates, sitting as a Deputy Judge of the High Court, said:

Failure to assess witness credibility and reliability The panel did not sufficiently evaluate the general credibility and reliability of key witnesses, whose evidence was essential to the charges. It failed to consider factors such as contradictions between witnesses' accounts and whether their testimonies should be approached with caution. This omission undermined the panel's ability to justify its conclusions.
Lack of explanation for preferred evidence The panel failed to provide adequate reasons for preferring the complainants' evidence over the appellant nurse's and the paramedic's. Simply stating a preference for certain witnesses' accounts without detailed justification left the appellant without a clear understanding of why her evidence was rejected.
Errors in evidence evaluation The panel assessed each charge in isolation without considering broader patterns or contextual evidence. It failed to recognize that inaccuracies in one allegation (contradicted by CCTV) could cast doubt on the reliability of witnesses' accounts in other allegations, leading to flawed conclusions.
Improper handling of contextual evidence The panel neglected to evaluate the behaviour of the complainant nurses during the investigation, which was relevant to determining their credibility. Additionally, it overlooked the appellant nurse's claims that the allegations were fabricated to remove her from her managerial position.
Insufficient reasoning for findings The panel provided inadequate reasoning for its findings of misconduct. It did not fully explain how the evidence supported its conclusions, including why the NMC had met the burden of proof for each disputed allegation. This failure left the appellant with unsubstantiated conclusions, undermining the credibility of the process.

Lessons

This case highlights several critical considerations for fitness to practise tribunals. One key lesson is the importance of thoroughly evaluating the credibility and reliability of witnesses, particularly when their testimony is central to the charges. Without such assessments, the accuracy and fairness of the tribunal’s findings can be compromised. Witness accounts must be examined not only in isolation but also in a broader context, taking into account patterns and inconsistencies to achieve a holistic evaluation.

Additionally, tribunals must provide clear and rational reasoning for their decisions. Merely preferring one witness’s account over another without detailed explanations can lead to procedural unfairness. Ensuring transparency in decision-making fosters trust in the process and supports robust outcomes. Tribunals must also maintain procedural fairness by upholding the burden of proof on the prosecuting body. Accused parties should never feel pressured to disprove allegations, as fairness is crucial to preserving the system’s integrity.

Finally, the impact of procedural delays cannot be underestimated. Prolonged proceedings can cause undue harm to the accused, affecting their career and reputation. Timely resolutions are essential to upholding justice while minimizing unnecessary stress on all parties involved. By focusing on these principles, fitness-to-practise tribunals can enhance the fairness and effectiveness of their proceedings.

Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.