When I first became secretary of Birmingham LDC (local dental committee) in 2005, one of my first responsibilities was to attend a service committee hearing for one of our colleagues.
Concern had been raised by the Dental Practice Board (DPB) over a treatment plan by the colleague, and in front of a panel of his peers, evidence was heard from the DPB via a dental reference officer (remember them?), his defence organisation and the colleague himself. I was there as an observer to see fair play, and the outcome seemed to suit everyone. I gained some experience that day, but unfortunately I was never able to use it again. Since then, there has not been anything similar in our area.
Collectively the LDC with the old PCTs (Primary Care Trusts) across Birmingham created a PASS scheme (Practitioner Advice and Support Scheme), which was set up to do what it said on the tin. We were given a budget to start this and, to date, there has been little utilisation by the commissioners, and we still hold monies on account of providing services.
So when did it all change? Was it the move to Primary Care Trusts, the changes at the DPB, the 2006 contract, changes at the GDC (General Dental Council)?
Most probably a combination of all of these is the answer. When did the complaint and disciplinary process avoid passing go and head straight to jail, in a bizarre game of monopoly sort of way?
Are the colleagues of today less professional and lacking in fitness to practice than those of years gone by, or has something dramatically changed in a system that now appears to be failing everyone and is seeing a massive rise in costs of running this failure? Why has the UK become the most litigated, with regards to dentistry, across the world?
One wonders whether the avoidance of risk has added to the problem. Are commissioners within the NHS so concerned of blame, that they do not want to risk dealing with issues locally and fast channel it to Wimpole Street? Or is there a financial incentive not to fund local resolution, instead passing on the buck to the GDC, where dentists themselves will have to pay? How many of the complaints could have been sorted at a local level, if the simple basic of referring back to the practice’s complaint process had been followed?
There is perversity in a system that breeds fear within those regulated, too frightened to attempt procedures at the boundaries of their competency. However, commissioners moan when additional referrals into second care are deemed inappropriate. Contract reform may help, but will it remove this fear?
I understand a decade ago 70% of all contacts with the GDC from patients were referred back to the patient to seek alternative complaints processes, as the GDC felt they were not fitness to practice issues, what changed?
The profession were swayed on the level of evidence needed to be removed from the register, when we were told that if there was a possibility of erasure, the quality of evidence would need to be of a higher standard. Why has that changed?
When one examines the charge sheets for dentists appearing before fitness to practice committees, it appears that trawling patient records to galvanise the charge might have occurred. How else would one expect someone appearing in a process so expensive, whose fitness to practice is impaired allegedly by not recording the material used to fissure seal or the batch number of the local anaesthetic? It's like being caught above 30mph but the police raid your house to trawl your bank account for fraudulent activity.
So now we have a story that without substantial investment the GDC will struggle to continue with a system that appears to be failing drastically, two Professional Services Authority reports in a row show things are worsening at the GDC. It's pretty clear that throwing money at a failing system never works, it's why BDA chair, Mick Armstrong, has written to the health secretary asking for a fundamental review of our regulator.
I have wondered for some time how easy it was for the profession to work with the GDC. When I was working on John Milne's executive we met the chief executive regarding the removal of dentists from the register for late payment of the ARF (annual retention fee) resulting in performer's list removal and all the problems associated with that.
Parliament have said, late payers may be removed from the register but GDC gave itself stronger powers, could we persuade a change to mirror what the GMC (General Medical Council) allow, reminders before erasure. Sadly we were unable. Even our suggestions on how the payment may be moved to a different part of the year, where late payment can be chased before removal, has not been explored by the GDC.
What is remarkable is that at his recent meeting with Mick Armstrong, Bill Moyes admitted the GDC had not carried out any investigation into why the case volume had increased. How did the GDC stay oblivious for so long, whilst not the only factor, would they now consider the failed UDA contract a contributory cause?
Did the GDC live up to its directive of protecting patients by not speaking out or listening to the critics of a contract with such perverse incentives? Is the lack of clarity within the NHS dental service also partly to blame?
Who knows, because no one seems to have undertaken the research. Such lack of auditing and CPD (continuous professional development) would not be tolerated in our day-to-day practice.
So often the consultations emanating from the GDC appear structured to confirm its decision.
Some of its more recent consultations contain limited word counts. So much so, the BDA submitted its via a direct document as well as using the electronic format the GDC required the feedback on.
There has been huge frustration with the way the GDC collate the responses, with the direct access consultation it judged the response of the BDA and its 20,000 members as one submission.
We all know the background of Bill Moyes at the OFT (Office of Fair Trading) and how the OFT lent on the GDC over the direct access issue to make the profession more competitive.
Its report stated 'The OFT will closely monitor the outcome of the GDC's review of direct access, and we will review our position and consider the appropriate course of action once the GDC has made a decision following the conclusion of its review in spring 2013.' One looks with interest at this use of phraseology and intent.
To be effective a regulator must have the confidence of the regulated and the patients. Some of the issues discussed by Bill Moyes at his FGDP lecture in Malcolm Pendlebury’s memory are of interest. It is disappointing that he is so negative about the outcome when he stated that failure and bad performance were likely to increase. If this is the case then perhaps without change we should get used to ever increasing costs to our regulation.
Whilst the stated objective of reducing fitness to practice cases is one the profession will support, it is one that must be worked out collectively with the regulator, and references from its chair that dental care is a market place is not one many of the profession will agree with.
But it is clear the regulator needs to conduct its core business correctly before it can suggest the expansion Bill Moyes alluded to in his speech.
At the BDA we are lobbying Jeremy Hunt via a postcard campaign and encourage all members to get involved with a call to re-evaluate the profession’s regulation. I hope you have taken part in the BDA survey. Ask your MP to raise the issue in Parliament, I have, and a written question has been laid.
Whilst this may have started with an extortionate 64% rise in ARF, it has given the profession the opportunity to say enough is enough. It’s not about the money, the CQC (Care Quality Commission) and HTM 01 05 cost far more for most practices. It’s about throwing good after bad. Something has to change.
Tell us today how the General Dental Council should be reformed.
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