Hospital-based restorative dentist and GDC registrant council member, Margaret Kellett, addresses the current issues facing the General Dental Council
Few of you will have missed the news that the General Dental Council (GDC) is currently consulting on a 64% increase (£945) of its annual retention fee (ARF) for dentists and a 6.7% increase (£128) for dental care professionals, nor will you be unaware of the reaction this has sparked amongst the profession.
As a registrant council member, I want to take this opportunity to put some of the issues being faced by the GDC into context, and perhaps provide further information about the regulator at the same time.
Changes
I was appointed to council last year, along with the first lay chair, William Moyes, and I was already aware that regulation is changing. There is clarity now that a regulator of health is not established to ‘represent the profession’; in the modern environment where public safety is to be assured the GDC and indeed all healthcare regulators are here to protect patients. The balance of regulating the profession and protecting patients has considerable challenges.
On the whole, patients say they are satisfied with their dental treatment. However, over the past four years numbers of complaints reaching the GDC have continued to rise. This increase is seen across the sector and does not only affect dentistry. Here at the GDC, along with all healthcare regulators, we must better understand why complaints are increasing so dramatically. We need to hear from patients and the profession. Finding out about complaints is part of our work programme going forward.
Increases
The ARF was last increased in 2010. In the last four years, Fitness to Practise complaints (FtP) to the GDC have increased by 110%. Without further significant investment in our FtP processes, we will be unable to deal effectively with the very large and continuing increase in our 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 FtP, many of which were highlighted in the recent Professional Standards Authority report. There is no doubt that the report was critical of the GDC. Failure to meet the PSA’s standards is entirely unacceptable and all our efforts are focused on tackling the problems. We are working to improve efficiency and to reduce costs but FtP remains the main challenge for the GDC.
This has already involved recruiting more staff and more FtP panellists to clear a backlog of cases and to process new cases faster; more robust management of staff performance; and improvements to our IT and related systems.
Confinement
The GDC is confined by the Dental Act and there is an urgent need for legislative change. All of us were disappointed at the lack of a much anticipated bill in the Queen’s Speech designed to modernise all of Healthcare Regulation. We are now working on an alternative plan for dentistry alone with the Department of Health.
The work will deliver a S60 order to introduce a very significant change to our FtP processes. This change – the introduction of case examiners – will not only allow us to improve the way we handle cases but will also save up to £2m a year. Without a S60 order we are unable to make changes to the legislation that sets out the regulation of FtP processes.
Our decision to propose the ARF increase stems, virtually entirely, from the huge increase in complaints now being brought to the GDC and the subsequent cost to FtP.
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 FtP. Going forward, we will continue to be as transparent as possible about these. We know there is a need for efficiency savings and we are keeping all our costs under review and will make 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 our costs further.
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 is of great importance that bodies like the Dental Complaints Service (DCS) are known to patients. The DCS facilitates conciliation of complaints at an early stage if possible.
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 dealing – very effectively – with complaints that might otherwise end-up at the door of the GDC’s, much more costly, FtP 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 know that patients are confused about how to complain and we must have a system that works for them.
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 as part of this 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 dental profession is aware of potential risk areas of practice and can operate to the highest possible standards.
Similarly to our work on Standards for the dental team, which launched in September last year, we will be in ongoing 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 as a dental professional.
Ultimately, the key test of the GDC, and indeed all healthcare regulators, is the standard of the professionals it regulates. The challenge for us, as the regulator, and for us as the profession, is to make the prevention agenda work.
Margaret Kellett, dentist registrant member, General Dental Council.
