shifting the balanceIn part two of his article, Kevin Lewis looks at reflections, illuminations and tales of the unexpected from the GDC’s discussion document, Shifting the balance: a better, fairer system of dental regulation.

Having dissected out the key themes of Shifting the balance in the first of these articles, we will now turn our attention more specifically to the part that the General Dental Council (GDC) can play – and more interestingly, should play – in managing the interface with the public and the whole business of improving and developing professional performance in dentistry. 

If nothing is going wrong and the patients are happy, the fitness to practise (FtP) machinery becomes redundant and all that money being spent on legal costs can stay where it belongs – in the hands of registrants.

That is an attractive (if unrealistic) proposition. It is more likely that most of the current annual retention fee (ARF) revenue would still be collected, but deployed in other ways, even if the proposed rethinking of FtP yields the anticipated dividend in terms of less money being squandered on hearings that could and should have been avoided.

The lack of focus and control over costs and wastage in the past had led to hearings being unnecessarily long, and complicated by the inclusion of extraneous issues and charges which had little to do with the GDC’s essential function. The more the GDC celebrates the high proportion of cases that are disposed of short of a practice committee hearing, the more it draws attention to the magnitude of what has been spent on the minority of cases that do proceed to a hearing.

Customer service

Shifting the balance makes a strong case for improving customer care/customer service knowledge and skills as part of the ‘upstream’ quality assurance plan that would resolve concerns and complaints nearer to source, and without them going anywhere near FtP. The Dental Complaints Service does many things right, and one of them is to insist that complainants should in the first instance try to resolve any problems direct with the person or practice where they arose.

The GDC does appear to be unaware of the extent to which individual registrants may not be allowed by their employers/practice owners to respond to complaints themselves, especially in some corporate settings. But towards the end of this document the mist clears and it becomes clear that the GDC sees itself as the natural gatekeeper and traffic controller for all of the many different complaints systems operating around the UK. 

I am quite attracted by the idea that there could be a single portal from which both NHS and private patients could be directed down the lowest level, most appropriate pathway that can resolve their concerns swiftly and effectively, but surely the GDC’s rightful place is at the distal end of one or two such pathways, rather than managing the entrance foyer and directing the traffic?

I probably understand, in the context of the GDC’s precarious starting position in 2016 and the shadow of radical reforms to healthcare regulation looming large, why the GDC has tabled this proposal, but I am sure that I am not alone in finding it bizarre and a tad short on insight.

There is no point in the document tacitly acknowledging that the profession’s confidence in the GDC and trust in its competence had taken a bit of a knock (it uses different words, obviously) and then effectively saying ‘Now support us in our bid to spread our regulatory wings further than ever before and trust us to orchestrate the whole shooting match so that we can better manage our own budget, share the financial burden with others and protect ourselves from all that nasty ARF criticism’.

The GDC is clearly very excited by these proposals, in which it sees a golden thread that is tied firmly to its newly painted front door. But I wonder whether it would be quite as excited had (for example) the BDA come up with the same suggestions but placing itself at the centre of dentistry’s solar system?

There is an endearing naivety in the GDC’s implied presumption that every other organisation in UK dentistry is sat, twiddling their thumbs and waiting only for the call from the GDC. Each of them has a day job, a finite budget and their own operational challenges. The cynic might well say that it is not their job to solve the GDC’s self-inflicted problems.

A more constructive view might be that the events of recent years may have been the catalyst for forcing the GDC to engage more than ever before, but now that it’s happening we are all presented with a timely and perhaps unique opportunity to have some input into the way forward. One must remain mindful that there is a much bigger debate in the wings about the future of the whole of healthcare regulation rather than dentistry in isolation.

There is even a risk that a lot of the proposed work may end up being lost down a blind alley, and the ambition and scale of these proposals is viewed by some as a plucky fight for self-preservation on the part of the GDC.

Opportunities

But there are other opportunities to be seized and the GDC has commendably put its finger on many of them, such as better sharing of information and knowledge, learning from experiences and the need to improve mutual understanding of the roles played by the many organisations in and around dentistry, and their differing priorities and resources.

As if to prove its own point, the GDC laments the absence of a single ‘Royal College of Dentistry’ and refers to ‘The’ Royal College of Surgeons as if the ones outside England don’t exist, don’t count or are perhaps local satellite offices. Oops. 

Jigsaw

I mentioned in part one that dentistry is a complex field of multiple players, all of whom hold some pieces of the jigsaw – but none of whom hold them all. For example, indemnity organisations probably have the best overall view of what problems are arising, how often and why, and they will often know much more about individual registrants than the GDC ever will – but even they will have little knowledge on what is working well because nobody rushes to ring them when a patient sends their dentist a ‘thank you’ card. There are then huge challenges in terms of data sharing, confidentiality, commercial sensitivity and some widely divergent perspectives and agendas.

The GDC is offering to share what it believes to be the learning points from the complaints it sees and the FtP cases it handles, and hopes that this lead will be followed by others, and by collectively feeding all that knowledge back to CPD providers and registrants, it will inform a new culture of reflective development and join things up better than hitherto.

This is genuinely new thinking and the GDC should take credit for that, although the whole issue of CPD is more complicated, as I alluded to in my regular column in the previous issue of this publication.

And finally, a word of warning. Nobody – not even the GDC – has ever seen the box that the pieces of this jigsaw came in, which provides a picture of what the puzzle should look like once completed.  Jigsaws tend to get more exciting as the picture takes shape, and the early stages tend to be cautious and uncertain affairs.

Without sight of the box, things get even trickier. Somehow all the players in this crucially important game – the registrants and every other stakeholder in dentistry – will need to come to the table with an open mind, an acceptance that they don’t know all the answers and a willingness to put behind them all the confrontation and animosity of recent years.

As stated in my editorial column recently when this document first appeared, I find much more to like in Shifting the balance than to take issue with, but surprises are only ever a few pages away.  So read it, and think about it, because it really does matter.