Less of the same, please

It is amazing what a few days off can do for the soul; an excellent neurone refresher, too, I find. Something to bear in mind for the year ahead, perhaps?

In the wake of the Leveson Inquiry, yet another group of unsuspecting innocents are bracing themselves for a dose of statutory regulation, and perhaps waving a fond goodbye to the last remnants of any kind of self-regulation. It isn’t often you see the words ‘unsuspecting innocents’ and ‘journalists’ all in the same sentence, is it?

But noting the wavering entente between Dave and Nick after the Leveson Report was published, I am offering to help. Your luck is in lads, because there is an off-the-shelf form of regulation that has already been successfully applied across an extraordinarily diverse range of sectors.

It’s called the Care Quality Commission. The beauty of the concept lies in its simplicity, because you can assess and regulate humungously large hospitals, infinitessimally small dental practices and private care and nursing homes, using exactly the same assessment criteria. By way of a practical illustration, CQC inspectors can catch MRSA and C.difficile within minutes of walking into two of the above environments, and spend a lifetime in a dental practice without the slightest risk of doing so. This means the inspectors can very quickly work out where they are – which has to be a help.

Case study
There is no need to re-invent the wheel when working out how best to regulate the British press. When they cross the line of acceptable behaviour, they only ever do it in the public interest, you know – not just to make money.
I am being serious – it is all there in the CQC Standards and Compliance Guidance ready to go when Dave and Nick want to start regulating the paparazzi:
• Respecting and involving people who use the services
• Ensuring users have their rights, privacy, dignity and independence respected
• Allowing users to have their views and experiences taken into account
• Recognising the diversity, values and human rights of users
• Understanding the holistic needs of the users and considering the impact of the service upon them
• Giving users confidence their human rights are respected and taken into account
• Obtaining a valid consent from users of the service and giving users the right to change their mind
• Safeguarding and protecting users
• Respond in a person-centred way
• Ensuring that all staff members are honest, reliable, trustworthy and treat the people who use the service with respect…

I could go on but it is difficult to type when tears are streaming from your eyes.

It still seems a bit of a nonsense to expect or believe that the fine detail of the CQC framework would translate seamlessly from major multi-site hospitals to residential care homes and from there to primary care dental practices. But it is less of a nonsense to expect that the high-level principles might do so.

The bits of last year’s OFT report that made perfect sense were the high-level principles. The bits that were barking mad were in the fine detail because they revealed a profound lack of understanding of dentistry. But the longer you work in and around the dental profession, the more one comes to realise that the world and his dog assumes – and worse than that, they actually believe – they know enough about dentistry and its delivery to be able to tell us what to do and how. It is not so much they are so unthinking, patronising and disrespectful that sticks in the craw, but the arrogance they show when insisting they know it all, we know nothing and dentistry is not important enough to treat differently anyway.

Dentist-free zones
NCAS used to have quite a bit of real-life GDP experience at its disposal, but most of that was shed and replaced with salaried services experience. But the NCAS advisers do still include a history graduate, so you can relax. As you are reading this, PCTs are shedding dental advisers like leaves off the trees. Why would they need people who understand, and have first-hand experience of primary care dental practice, when they can get advice from people who don’t? Into this vacuum of real dental knowledge, self-opinionated purveyors of virtual dental knowledge are sucked. Tragically, they seem to thrive for a while if they learn the right jargon and can look and sound convincing enough.

The proposals for the future shape of the GDC follow a worryingly similar course, where any input from dental professionals is increasingly minimised, marginalised and kept at arm’s length and, to rub salt in the wound, others even get to select which arms. The development of policy is apparently impeded and rendered impure if breathed upon by anyone who has seen the inside of a dental school. Can nobody see that a regulatory environment in which the GDC and bodies such as CQC are disconnected from the people and places  they are meant to be regulating, can never properly serve the public interest because you cannot regulate something you do not understand in the first place. You certainly can’t do it proportionately, nor in a way that allows the regulator, and those being regulated, to move forwards without friction. CQC, even at this early stage, does mostly seem to appreciate that fact, but the GDC is caught up in the maelstrom that is healthcare regulatory reform and the future direction is more in the hands of others than those of the GDC.

Of course, it is an easy trap to fall into. Most people probably think they know a thing or two about dentistry because they have been there and had some. There is even a Ladybird First Reading book, Going to the dentist, so you can sound authoritative even if that’s the closest you ever get. In contrast, there is no equivalent handy title like Going to the colo-rectal surgeon or Mary has a blepharoplasty, so fewer people will be claiming to be expert in these two fields.  At least, probably not at the same time.

Start here
So, for 2013, I have a message for any of those would-be experts who impede, frustrate and unnecessarily complicate the running of dental practices and the delivery of dental care. If you want to talk about dentistry or meddle in dentistry, start by applying for a place at a dental school. If you haven’t got a string of top grades at A level, don’t bother applying because entry is one of the most competitive of all university courses. Over the four or five years that follow, you will need to show you have the right balance of academic ability, practical expertise and interpersonal skills. And, if and when you finally manage to graduate, you will have earned the right to be listened to when you pontificate on dental matters. And when you have tried to run a dental practice of your own, you will have earned the right to voice an opinion on that, too. Until then, do us all a favour and stick to what you know.

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