Philip Newsome and Pat Langley ask if the increasing burden of compliance is a pain, or an opportunity?
There is little doubt that dentistry in the UK is now more heavily regulated than ever before. The raft of protocols and regulations imposed by the likes of the GDC and CQC is viewed by many in the profession with increasing frustration, cynicism and annoyance. The 2015 BDA survey ‘Is there a well-being gap among UK dentists?’ found that 47% of GDPs reported low levels of life satisfaction while 44% reported low levels of happiness. Whether or not this is a direct consequence of the current level of third party involvement in dentistry is debatable, but there can be little doubt that dentists feel under pressure from a variety of sources and that the need to comply with all kinds of externally imposed requirements can only add to this.
All of these frustrations are perhaps felt most keenly by independent practice owners who view such ‘interference’ as damaging their ability to manage their practices/businesses and by extension turn a profit. The conventional wisdom at play here is that rigorous regulation drives down revenue and profits.
The reality?
But is this really the case? Is there an argument that such regulations are actually good for business in that they force owners and managers to think long and hard about the services they provide and put into place systems and procedures, checks and balances which benefit the patient and ultimately the business itself?
Research carried out in 2014 by the US firm PA Consulting looked at how pharmaceutical companies dealt with external regulations and found that companies which embraced regulation were generally more successful than peers in terms of growth of total shareholder returns. On the other hand, companies that routinely underperformed tended to focus on the negative aspects of compliance and blamed regulators for slow growth, setbacks or lack of innovation. In April 2013 a prominent Harvard Business Review article which reviewed the business performance of 25,000 companies over a 44-year period concluded that there were only three rules for success.
The first rule was ‘better before cheaper’ in other words companies with long term successful track records focus more on improving the services and products they offer and by competing on differentiation rather than price. The second rule in the study was ‘Prioritise increasing revenue over reducing costs’ that is always try to find and appeal to more customers who spend more money with you than always looking at ways to reduce costs. The third rule was ‘There are no other rules.’
UK regulations
With this in mind let’s examine the sort of regulations dentists in the UK have to deal with and see if they encourage the type of mindset advocated in this HBR study.
The GDC’s publication Standards for the Dental Team comprises nine principles ‘registered dental professions must keep to at all times’ namely:
• Put patients’ interest first
• Communicate effectively with patients
• Obtain valid consent
• Maintain and protect patients’ information
• Have a clear and effective complaints procedure
• Work with colleagues in a way that is in patients’ best interests
• Maintain, develop and work within your professional knowledge and skills
• Raise concerns if patients are at risk
• Make sure your personal behaviour maintains patients’ confidence in you and the dental profession.
It would be difficult to see any of the above as being detrimental to the long term success of any business, especially when viewed in the context of the discussion above. There may currently be issues in how the GDC seem to be policing those dentists deemed not to be adhering to these principles but that is a separate issue. The principles themselves form the basis for any successful service oriented business.
The same can be said for the core CQC protocols. These are encapsulated in the following five questions which are asked of any health care provider.
• Are they safe?
• Are they effective?
• Are they caring?
• Are they responsive to people’s needs?
• Are they well led?
Once again, it is difficult to see how any of these are incompatible with any well-run dental practice. If the focus in the practice is on providing high quality dental care to patients who appreciate the service they receive, return over and over again and refer friends and family then surely these are questions that management should be asking of themselves and their staff.
I am sure that many readers will be aware on the reality TV show Undercover Boss. This is obviously not exactly reality but nevertheless the idea that management sees for itself just what is being offered to the public is often very revealing. The questions posed by the CQC are often the very same questions undercover bosses ask of their own businesses and so is it that unreasonable for us to ask them ourselves?
Taking responsibility?
We understand why large numbers of dentists resent what they see as outside interference in their practice lives and as we all know many are not shy at voicing their frustrations. A letter published in the British Dental Journal in 2013 summed up the feelings of many, ‘Forty years ago my job description was dental surgeon; today my job title is performer and provider of primary dental care for the local PCT, lead in child protection, lead for cross-infection control, radiological protection supervisor, health and safety supervisor, fire warden, lead for information governance, lead for staff training, and environmental cleaning operative. I have probably left a few out.’
It is interesting that the writer of this letter sees all these tasks as their own personal responsibility and perhaps this is where the fundamental problems lays. Traditionally, dentists have never been very good at letting go of responsibility, in other words, delegating. It is unrealistic to think that any person can assume the burden of overseeing every aspect and function carried out within the practice. Successful leaders know this (CQC question #5 ‘Are they well led?’) and organise duties and responsibilities accordingly.
The fact is that while many dentists do not like being told what to do, the need to comply with a variety of regulations is here to stay and the worse thing you can do is try and fight it or perhaps, even worse, avoid it altogether. Everything points to the fact that if you embrace it you will end up with a more successful business in the long run.
Philip Newsome BChD (Hons) MBA PhD FDS RCS (Ed) MRD RCS (Ed) graduated with Honours from Leeds University Dental School. After several years in general practice he returned to Leeds as a lecturer in conservative Dentistry. In 1986 he left the UK to work at the Faculty of Dentistry of Hong Kong University. In 2013 he was awarded an honorary Fellowship of the Faculty of General Dental Practice (UK) for his contribution to the profession of dentistry. His main area of academic interest is in the factors that lay behind success in dental practice. . He currently divides his time between the UK and Hong Kong, where he maintains a thriving private practice.
Pat Langley is CEO of Apolline which provides a unique, bespoke, hands-on support service to dental and medical practices by combining innovative management and operational support solutions with expert guidance on all matters relating to regulatory compliance. Before founding Apolline in 2010, Pat worked for many years both clinically and in governance for Denplan and later Oasis Dental Care. Website: www.apolline.uk.com
