Challenging times at the GDC

A QUALIFIED lawyer and mediator, Evlynne Gilvarry became chief executive of the General Dental Council in 2010. Prior to that she had been chief executive of the General Osteopathic Council and before that she held senior policy and management roles at the Law Society.

The GDC is proposing a 64 per cent rise in the annual retention fee for dentists. Why such a steep increase and why now?

We have very clearly set out in our consultation document that in the absence of an increase we will not have enough income to undertake core statutory functions. The ARF was last increased in 2010. Since then fitness to practise (FtP) complaints to the GDC have increased by 110 per cent. Without further significant investment in our FtP processes we will be unable to deal effectively with the very large increase in our caseload and so we must make adequate provision.

Fitness to practise is the most expensive area 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 have had to recruit more casework staff and more FtP panellists to clear a backlog of cases and to process new cases faster.

Can you understand the anger among dentists with the fee rise given the recent Professional Standards Authority review in which the GDC failed to meet seven out of 10 good regulation standards in fitness to practise?

We regard failure to meet the PSA’s standards as entirely unacceptable so we accept criticisms on this score. We want to reassure the profession that all our efforts are focused on tackling the problems that have resulted in us missing standards. We have increased resources to deal with the continuing surge in caseload and made other key changes to improve the performance of our teams. The achievement of a much better performance in fitness to practise is the number one priority.

What are the reasons behind the delays and other problems the GDC is encountering in the management of fitness to practise processes?

There are two key factors that have put pressure on our fitness to practise function. First, the very large increase in complaints we’ve received. The scale of increase over the last three years – 110 per cent - is a very significant departure from the patterns of the past. Large increases in three successive years have inevitably resulted in pressure on our teams and it has been difficult to recruit and retain staff in sufficient numbers to handle the load.

Secondly and most unfortunately, we have not yet secured the legislative change that is necessary to improve our outdated procedures. We had hoped that new legislation, enabling wide-scale change to our procedures would have been in the Queen’s Speech earlier in the summer, but this was not the case.

The Department of Health recognises that our legislation is out of date. Indeed, by an accident of history, the GDC’s legislation is even more antiquated than that of other regulators, particularly regarding fitness to practise. Although wholesale change is some way off we are working with the Department of Health on an interim change – the introduction of case examiners – which will help us to streamline and speed up the initial stages of fitness to practise. We hope to see the change in place by the middle of 2015. The introduction of case examiners will not only allow us to improve the way we handle cases but will also save us up to £2m a year.

How are you working to reduce the costs of fitness to practise procedures?

We are doing a lot to reduce FtP costs, primarily through a two-strand strategy. We are achieving greater value and significant savings through tighter management of the contracts with our external law firms. We have also significantly reduced our reliance on external firms and correspondingly our costs through the appointment of an in-house legal team. This process started in January 2014. We estimate that this team – by handling up to two thirds of our legal work – will save £1.2 million per year from 2015.

The next phase of the in-house development is to do advocacy in-house. We currently use an external team of barristers. This change will save even more money and we plan to have our in-house team of advocates in place by the end of the year. This will result in a 44 per cent saving on barristers’ fees.

Why do you think complaints against dentists reported to the GDC are rising?

Firstly, I think the GDC, in common with other regulators and public bodies, is experiencing the effects of a more informed and demanding public. We are doing more research with patients and the public to learn more about motivation for complaining.

Secondly, information on how to complain is more readily accessible. The internet plays a major role in this and we are seeing an increasing number of complaints being submitted online. We are also seeing a greater proportion of complaints coming from sources other than directly from patients – for example, from the NHS and other professionals.

Thirdly there is evidence that the major structural change that resulted in transition from PCTs to NHS England left some areas of the country with many fewer performance managers. As a result, we believe that some cases which might have been dealt with in the past through local resolution are now finding their way to us.

Lastly, we are told by the defence organisations that a recent change in the way lawyers are rewarded for handling claims against health professionals prompted a surge of referrals to the health regulators.

A recent advert in the Daily Telegraph for the Dental Complaints Service was likened by the BDA to those favoured by “ambulance-chasing lawyers”. What was the intention behind the advert?

The comparison with “ambulance-chasing lawyers” is mistaken and unfortunate. We have a duty as a regulator to ensure patients and the public, including those who receive private dental care, know where they can raise concerns if necessary. Promotion of the DCS is not a new development; we regularly run campaigns to ensure that the public and patients, as well as dental professionals and other advice bodies such as Trading Standards and Citizens Advice, are aware of the excellent service it offers.

At the heart of the DCS is the encouragement of local resolution and this happens in a large proportion of the cases it handles. The DCS consistently achieves very high satisfaction ratings with patients and with dental professionals. It is important to note that the DCS does not handle fitness to practise cases. Some of the commentary in the wake of the advertisement clearly showed confusion on this point.

The BDA has reported that in a recent survey 79 per cent of dentists were not confident the GDC was regulating dentists effectively. Do you feel the GDC has lost the trust of the profession and how will you win back the doubters?

We are determined to ensure that our performance as a regulator continues to improve. We have struggled to cope with unusually large increases in caseload in three successive years and we recognise that this resulted in our performance slipping. The measures we are taking – which include significant extra investment which must be funded by the dental profession – are precisely aimed at being an effective regulator. We hope that the profession will acknowledge the need for this extra investment, even though it means a significant increase in their annual registration fees.

The debate that has taken place since we began the consultation on the ARF increase is an opportunity to clear up some misapprehensions about the GDC’s role. Some of the commentary seemed to confuse our role with that of the BDA. We are keen to have a more active engagement with the profession on regulatory issues as we believe that this is the best way of building and maintaining trust.

It’s worth noting that the GDC’s 2013 registrant survey found that confidence in the GDC as a regulator remains high. More than two thirds (67 per cent) of the dental professionals who took part in the survey are confident that the GDC is regulating dentistry effectively. A corresponding survey of patients and the public said regulation of dental professionals is very important and nearly eight out of 10 (77 per cent) are confident that the GDC regulates dental professionals effectively.

Interview by Jim Killgore, editor of MDDUS Summons