The GDC’s role is to protect patients and help to maintain the public’s confidence in dental services. This of course requires us to make difficult decisions, and we feel it is important to be transparent with you about the reasons for these decisions, where we can. This is why the GDC sees it as a great opportunity to take part in ‘ask the GDC’ as it helps us explain the decisions we take.
To start the series off, we have been asked a series of questions ranging from improvements to our fitness to practise function, requirements in the continued professional development scheme and our strap line.
What is happening with fitness to practise? Are your changes having any effect on numbers?
The most significant recent improvement change in fitness to practise has been replacing the Investigating Committee (IC) with case examiners, which became operational on 1 November 2016. Just like the IC, case examiners are the first independent decision makers in the fitness to practise process and they must decide, amongst other things, whether a case needs to be considered by a Practice Committee.
Case examiners work in pairs to make their decisions; one dental professional and one lay. We are now starting to see the impact of this change. In their first six months, 356 cases have been considered and of these, 28% of cases were referred to a Practice Committee hearing. In the 12 months prior to November 2016, the Investigating Committee referred 45% of the cases to a hearing.
We are still exploring why case examiners are referring a smaller proportion of cases. However, our robust auditing shows that the most serious cases are still being appropriately referred, that case examiners are looking to deploy other means of disposing of cases (like the use of warnings, advice and undertakings), which suggests case examiners are helping the GDC to regulate in a more proportionate way.
Another significant improvement is our new initiative for securing early clinical advice for fitness to practise cases. Instead of it coming from an external body, from October, we will employ clinical advisers, which will embed clinical opinion much earlier in the fitness to practise process. They will continue to work in general practice to ensure that their advice is current and relevant.
However, we acknowledge there is more to do. This is why we have just started an end-to-end review of fitness to practise, engaging with staff, stakeholders, and those that have been through the FtP process to fundamentally review our processes.
But getting better about what we do in fitness to practise can only ever be a small part of how we improve dental regulation. Unlocking improvements in regulation depends on all of us working better together to prevent harm from occurring. This has implications for dental professionals too, in terms of how reflective practise is used to make improvements in care, how the dental team work together to deliver the best possible care, and how patients are encouraged to give feedback to the practice, for example.
And it is this collaborative approach that will really unlock improvements for patients and professionals, and therefore translate into a fairer, more proportionate and efficient system of regulation.
When can we see some concrete information that you’re doing what you’ve said you will? Where is the timetable for change?
We will be publishing the next steps for how we are taking forward the commitments set out in Shifting the balance in the autumn, which will include clear milestones.
But we cannot do this alone and are relying on dental professionals and our partners to take the lead in some areas, for example, on ensuring high standards in complaints handling, and the development of effective clinical governance. The chief thing that is within our gift is the end-to-end review of fitness to practise. We started this work in July, will be engaging with registrants, patients and our partners in the October and November and will set out our timetable for this work more clearly in the autumn.
In the meantime, we have been moving ahead with some key projects that help us realise our vision for a better, fairer system of dental regulation, as set out in Shifting the balance. We have developed and consulted stakeholders on self-filtering and signposting for our website, and will be going live with them in the autumn. We are also launching enhanced CPD in the new year – January for dentists and August for DCPs – and will be further developing our approach to CPD to help develop a learning-based model of regulation.
If record keeping is such an area of concern for you, why aren’t you doing more to address it in your CPD requirements?
Good record keeping is important because it’s fundamental to good, safe patient care. This is reflected in the Standards for the dental team.
The current system of CPD is limited to logging hours spent, which is why we are working towards developing a system that is more sophisticated. As part of our commitment in Shifting the balance to provide more information to the profession, we will be interrogating our data to offer insights into where problems are arising, and one of the uses for that data will be to help dental professionals plan their CPD. This is part of our ambition to develop a model of learning-based regulation.
In the meantime, if dental professionals think there are areas of patient care that you think are important to both reflect on at an individual level, and more broadly, work together to improve, then we would both encourage and support you to do so.
Will you change your mission to ‘Working with the dental profession to protect the patient?’
The GDC’s mission, to protect patients and help to maintain public confidence in dental services, is set in law, and it’s therefore not within our gift to change. How we interpret our mission, however, is within our gift. We have been thinking hard about this recently, and we would like to work towards a model of regulation that is more supportive and collaborative – while of course remains focused on patient protection and public confidence. The plans that we set out in Shifting the balance reflect this model of working.
We will consider reviewing our strapline – protecting patients, regulating the dental team – to ensure it reflects this model of working.