Editor: what is being done about the large increase in the cost of fitness to practise?
Evlynne: We are doing a lot, primarily through a two-strand strategy. About 18 months ago we renegotiated our contract with external law firms and from that we made significant savings. In addition we appointed contract managers who manage these contracts rigorously – and that has saved us significant amounts of money.
'About 18 months ago we renegotiated our contract with external law firms and from that we made significant savings'
The second strand was the appointment of a new in-house legal team who started in January 2014 with the aim of handling a quarter of cases. They soon took 50% of cases and by the end of next year it will be two thirds of cases. The result has been very significant savings and there is the potential to increase those savings by increasing the size of the team and taking on more of the caseload. The General Dental Council’s (GDC’s) in-house legal team, we project, will save us £838,000 by the end of 2014 and then £1.2 million per year from 2015.
It also gives us greater control. We can train our own lawyers.
The next phase of the in-house development is to do advocacy in-house. We currently use an external team of barristers. This change will save even more money and we hope to put in place our own team by the end of the year.
It is a huge bill, but I do think we have taken significant steps to reduce the sum of money as far as possible; and because of the increasing caseload the imperative to do this is even greater.
Editor: Why has there been such a large increase in the number of complaints?
Evlynne: It is the same for all professions. The various ombudsmen are seeing a big growth of complaints too. This tells us there is a more demanding consumer and a more informed consumer. We are studying this carefully. Some 60% of complaints are for clinical issues. In the past the majority of complaints related to conduct. We are also seeing a greater proportion of complaints coming from the non-public – for example informants, the NHS or some professionals. These are usually more serious issues and cost more and last longer.
We are doing a lot of research with the public to find their motivation for complaining, if they know where to complain and so on. In 2011 the percentage of people who had a concern and would like to have complained but did not – jumped sharply. But it is hard to pin down. There are many variables to consider.
Editor: Was the public research about complaints behind the rationale for the placement of the advertisement in the Daily Telegraph?
Evlynne: It was a promotional campaign for the Dental Complaints Service (DCS). We have done this for a long time.
The surprise and anger in the profession about this, surprised us too. There is nothing unusual about promoting the DCS, we’ve been doing this for years. So why this particular campaign should have created such feeling is slightly mysterious. But the commentary about the campaign shows clearly to us that there is great confusion in the profession about fitness to practise and the Dental Complaints Service. Our fitness to practise requirements are statutory and we are obliged to run them, they cover matters of impaired fitness to practise to both private and NHS care. The DCS is non-statutory and offers a unique service where people can bring complaints about private dentistry, about service, about overcharging and so on. The DCS team is highly trained to recognise fitness to practise matters and refer them immediately. The DCS is very successful, but if we do not promote it, people do not use it. The DCS is very popular with both dental professionals and the public and most complaints are resolved within five days.
‘The GDC has been promoting the Dental Complaints Service for years’
We are looking at how we can migrate techniques from the DCS and employ them in fitness to practise. But we are rather stuck at the moment with out-dated fitness to practise statutory procedures and we desperately need legislative change to alter those procedures.
The cost of 37 Wimpole Street
Evlynne: People have talked about the GDC moving from the West End of London. We have this building on a very long lease for a peppercorn rent of only £5,050 a year. There is no logical reason to move while we enjoy this beneficial amenity. So we are renovating 37 Wimpole Street.
Editor: You mentioned a change in legislation: are people working on that?
Evlynne: The Department of Health recognises that our legislation, and that of many regulators, is out of date. By an accident of history, ours is even more antiquated, particularly regarding fitness to practise. The Department of Health has worked to fix this through consultations and reports aimed at a new design for fitness to practise. In March this year the Department of Health produced draft proposals for changes to the law. We were so hopeful these changes would be included in the Queen’s speech for the last parliamentary session, but they were not. This would have allowed us new legislation by as early as 2016. But now we have to wait until after the next general election and the future is vague.
‘We hoped the legislation would be mentioned in the Queen’s speech to parliament, but it was not’
However, the new blueprint is very exciting and promising. It is a completely new way of working, rewriting rules for training, standards, fitness to practise, and so on. With this legislation, we can simplify fitness to practise, making it much more efficient for all parties and include the opportunity for early resolution of complaints – even more serious ones – as long as the professional shows insight and a real understanding of what went wrong and the patient is happy with that. Currently, the Department of Health is tidying up the proposed bill so that it is watertight and shipshape for the statute books. But there is a delay and the best thing for the profession now is for us to join together to lobby government to not lose sight of this legislation, so that the GDC has an opportunity to do things better, more humanely, in less time, at less cost and less stressfully.
In the meantime, and after a lot of lobbying, the Department of Health is about to publish a Section 60 order that will give a very important single opportunity to change legislation. Please lobby for this.
If the Section 60 is passed cases might be resolved like this:
- Someone complains about you;
- You provide a response;
- A case examiner assesses the information and decides there is a real case to answer;
- In return for you acknowledging that a problem exists, you will undertake to do X, Y or Z remediation;
- Your remediation is monitored by the GDC.
The Section 60 order is a real opportunity for us to save conservatively £2 million a year. The savings we could make with this new legislation (the bill) will be much more.
Editor: Why do you think dental professionals are so upset with the General Dental Council?
Evlynne: No one would be more pleased than us if there was a constructive debate on all these matters. If there is an advantage to this situation, it is that people are thinking about regulations and thinking about their associations and people’s language suggests that people still think we are here to look after them. But the remit of the General Dental Council has evolved.
This is our opportunity to set out the kind of body we are and the kind of body we want to become because we recognise the need for improvement here – absolutely. We want to have a partnership with the profession and it is one based on respect and based on confidence. We are not here to look after the professions’ businesses, but we need a partnership. We want to achieve a partnership by becoming as efficient as we possibly can, and by having our legislation amended so we can work with up-to-date modern procedures rather than ones designed 15 years ago. And lastly we need an active dialogue. In a calmer atmosphere we want to show that we are here to do the very best for patients, and we can only do that with a strong relationship with the profession. We need a new dialogue and a new debate and the profession needs to be part of that. This is the offer we are making.
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