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Targets and contracts
3rd Feb 2006
John Chope, GDC Councillor and GDP, wonders whether or at what point the GDC should become concerned about contract provisions that could disadvantage patients. Questions were asked at the last General Dental Council (GDC) meeting whether the new GDS contract was inherently unethical and thus a matter of concern for the council. This prompted a flurry of formal correspondence with the GDC, letters coming from the acting chief dental officer (CDO) for England, the British Dental Association (BDA)and the Dental Practitioners Association (DPA). In his letter, Barry Cockcroft (CDO) described UDAs as a form of currency providing a less direct relationship between activity and remuneration than the current system which he noted was responsible for dentists ending up in front of the conduct committee and practice owners adopting sliding scale remuneration for associates. Both the BDA and DPA were concerned about the risk to patients of a GDS contract with harmful provisions including targets. The GDC responded by explaining that their jurisdiction was the regulation of individual registrants whose personal responsibility was to behave ethically irrespective of the situation they had placed themselves in. The ethical standard that is expected is described in Standards for Dental Professionals. This states that registrants should ‘put patients’ interests before your own or those of any colleague, organisation or business and never ask for, nor accept, any payment... which may affect or appear to affect your professional judgement.’ The new Principles of Dental Team Working guidance also states ‘make sure that… you do not allow financial or other targets to have a negative influence on the quality of treatment or care.’ Whether in the public or private sector, should the GDC intervene, beyond addressing the individual registrant, where the practice conditions (including the contract of service) create an environment that appears to lower standards of patient care? Any contract where dental earnings are linked to dental activity could encourage the unscrupulous to act contrary to patients’ interests. It could require the Judgement of Solomon to define where such a contract veers far enough away from patients’ interests to overstep the boundary of reasonableness. Perhaps the GDC will be asked to make that judgement. Certainly the GDC would be concerned about any evidence of a contract that actually required registrants to breach its ethical guidance. This is undoubtedly a complex issue and the Standards Committee has been asked to advise on what priority it should receive within the council’s programme of business.
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