As I’m sure you’re aware, the GDC is currently consulting on a 64% increase (£945) of its annual retention fee (ARF) for dentists, and a 6.7% increase for dental care professionals (£128).
As a registrant council member (I am a dentist based in Leeds) I want to take this opportunity to put some of the issues being faced by the GDC into context, and perhaps dispel some myths at the same time.
I was appointed to the council last year, along with the first lay chair, William Moyes, and I was already aware that regulation was changing. We are not here to ‘represent the profession’; we are here to protect patients. The balance of regulating the profession and protecting patients has considerable challenges.
On the whole patients say they’re satisfied with their dental treatment. But complaints are going up for all healthcare regulators, we must better understand why. We need to hear from patients and the profession. Finding out about complaints is part of our work going forward.
The ARF was last increased in 2010. Since then fitness to practise complaints (FP) to the GDC have increased by 110%. Without significant further investment in our FP process we’ll be unable to deal effectively with the increasing caseload. This is the most expensive part of our work. If a case reaches a hearing, the cost is around £19,500 per day and the length of a hearing ranges from a third of a day to 35 days.
We are investing substantial sums to tackle these problems in FP, many of which were highlighted in the recent Professional Standards Authority (PSA) report. Failure to meet the PSA’s standards is entirely unacceptable and all our efforts are focused on tackling the problems.
This has already involved recruiting more staff and more FP panelists to clear cases and to process new cases faster, more robust management of staff performance, and improvements to our IT and related systems.
But there is also an urgent need for legislative change. All of us were disappointed at the lack of a bill in the Queen’s speech. But we are now working with the Department of Health on an S60 Order to introduce a very significant change to our FP process. This change – the introduction of case examiners – will not only allow us to improve the way we handle cases but will also save us up to £2m a year.
Our decision to propose the ARF increase stems almost entirely from the huge increase in complaints now being brought to the GDC, and the subsequent cost to FP.
Patients have a right to complain, and the GDC has an obligation – where appropriate – to investigate.
I know many of you have been surprised to learn of the costs involved in FP. Going forward we’ll continue to be as transparent as possible about this. We know there is a need for efficiency savings and we are keeping all our costs under review making savings wherever we can.
We are already making considerable savings in legal costs by building up an expert in-house legal team. We plan to bring more legal work in-house to reduce costs.
The patient’s voice
It is a key role of all healthcare regulators to ensure the patient’s voice is heard. Indeed, it is at the heart of the recommendations by Robert Francis QC, in his report published in 2013 in the wake of the Mid-Staffordshire scandal. It’s of great importance that bodies, like the Dental Complaints Service (DCS), are known to patients.
The types of complaints about private dental care being dealt with by the DCS are not dealt with by any other organisation – other than bringing issues to the GDC – it is the only body in existence to deal with private dental complaints in this way. Rather than increasing the GDC’s workload, it is very effectively dealing with complaints that might otherwise end-up at the door of the GDC’s, much more costly, FP department.
The prevention agenda
We’ve heard just how good local resolution can be from both dental professionals and patients and we actively encourage it. We are already working with NHS England and other stakeholders across the four countries of the UK with a view to encouraging earlier, local resolution of complaints. We are also analysing patterns of complaints and, where necessary, will be providing advice to the profession on how to prevent concerns being raised.
We can’t just respond to complaints, we must understand the reason for the increase as well. The council is developing a prevention agenda, and we will be looking at why complaints are increasing. We will be doing thorough analysis of this work, not only to try to help us deal with complaints better, but also to ensure the profession is operating to the highest possible standards.
Similarly to our work on Standards for the dental team, we will be in on-going discussions with the professional bodies to help us understand the best way forward. In developing the standards we listened to patients and the profession and this is reflected in the nine principles. Principle five is all about complaints handling; what patients expect and the standards expected of you.
Ultimately, the key test of the GDC, and all healthcare regulators, is the standard of the professionals it regulates. The challenge for us, as the regulator, and you, as the profession, is to make the prevention agenda work.
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