A supportive system

CUMBERSOME, inefficient and failing to put patient safety at its heart. That is the damning verdict on the current model of dental professional regulation – delivered by none other than the regulator themselves.

The General Dental Council have been subject to sustained criticism from various corners of the profession in recent years, and this latest statement would appear to be some form of mea culpa. The current regulatory model, the GDC say, has become “unsustainable” with “significant change” needed to secure their long-term future.

Their solution calls for a fundamental rethink of how dental professionals are regulated, building on investment and improvements already underway. Their ambitious new programme, Shifting the balance: a better, fairer system of dental regulation, was published in January 2017 and the consultation closed in April. It develops a number of themes set out in a 2016 corporate strategy document which detailed how they would become an “efficient and effective regulator”.

This future vision promises a fairer, more focused system where only the most serious complaints are handled by the GDC. This in turn would reduce stress on dentists while putting patients first and perhaps even relieving budgetary pressures. So can it deliver?

Multi-pronged approach

The major theme in Shifting the balance is the notion of moving “upstream” (the word appears more than 30 times) which essentially means a move away from enforcement to prevention and partnership working. This would go hand in hand with more proportionate use of the regulator’s powers, thus saving money by minimising “expensive” enforcement action. Enforcement powers, the GDC say, will only be used when dental professionals put patients at serious risk or damage public confidence in dentistry. They want to “support and empower” the profession and build a more collaborative relationship with the dental team, focusing on a number of different channels to achieve their vision.

Serious cases only

The GDC say many of the issues raised with them could be better resolved by other organisations. In its future vision, they would deal only with the most serious cases while lower level issues would be dealt with elsewhere, usually in the practice or care setting. The report states: “We want to work with the profession to ensure that resolution is sought and found in the most appropriate place. This involves ensuring patients know how, and feel confident, to raise their concerns by the most appropriate route. It also means working to maintain high standards in complaint handling across the profession.”

Most practices, they say, operate effective complaints handling systems but more work needs to be done to strengthen so-called first-tier complaints resolution. The GDC hope to achieve this through measures such as their profession-wide complaints handling initiative, as well as adding complaints handling guidance into registrant welcome packs. It is also hoped more complaints can be resolved locally by encouraging more patients to complain directly to their practice with the help of an “approachable and welcoming culture in practices”.

While this is a notion many would welcome, its success relies on big changes being made across the healthcare system as the GDC admit “there are limited processes in place to reroute these matters to a more appropriate body.”

Building partnerships and education

The success of the regulator’s vision relies on improving links with major UK partners like the NHS, professional associations and systems regulators. The GDC hopes these partners will help “embed standards within practice” and “increase our intelligence picture”, for example by sharing data showing which standards commonly cause dentists difficulty. The GDC hope to develop methods to link standards to performance management and appraisal. Partner organisations would also hopefully facilitate local complaints resolution, thus lightening the GDC’s workload.

Improved education is also an important part of the GDC’s future vision, including plans for more meaningful CPD. Research they commissioned in 2011 found “there was very little evidence to suggest that current models of CPD have an impact on the quality of care delivered, performance or competence”.

An enhanced CPD (ECPD) model aims to encourage professionals to “take a cyclical approach to their CPD, involving planning, undertaking and reflection, using a personal development plan”, all within the same five-year cycle. Under this scheme non-verifiable CPD would be removed and the number of required hours would be cut to 100 for dentists and 75 for most dental care professionals.

The GDC is keen to encourage “professional ownership” of CPD, with their role being a supportive one, “providing data, intelligence and information to assist professionals in determining their development needs.” Implementation is not expected before January 2018.

This “professional ownership” idea has broad support amongst the profession according to the May 2017 Shifting the balance response document, but with some concerns over practicalities for independent practitioners and dental nurses. Similar support was also reported for the suggestion of peer review processes and interactive CPD which would see greater collaboration amongst registrants.

Fitness to practise

Improving the fitness to practise process is a priority for many dentists, as reflected in a recent British Dental Association survey which found 71 per cent of respondents wanted the process to be made “fit for purpose”. The way the GDC manage their processes has undergone what they describe as “transformational improvements” in recent years, but they admit they are still tied by “some legal constraints”.

One improvement measure was the introduction of case examiners in November 2016. They have the power to agree undertakings with practitioners with the aim of reducing the number of cases that proceed to investigation. It is too early to say whether the promised £2 million annual savings will be achieved.

The response report also highlights strong support for an effective self-triage mechanism to help filter complaints submitted via their website, as well as improved education for the public about the regulator’s role. Shifting the balance states: “Patients raise many issues, concerns, complaints and feedback about dental services for which our fitness to practise powers are not well suited. We need, working with the profession and partners, to develop ways of ensuring that these concerns can be appropriately raised and resolved, by the right body, at the right time and at the right cost.”

The GDC also hope to refocus their processes by tightening up their definition of “serious misconduct” and linking impaired fitness to practise more closely to patient risk and public confidence in dental services. They also plan to carry out an “end-to-end review of the fitness to practise process”.

Potential benefits

In addition to financial savings and an increased focus on safety, it is hoped the GDC’s plan could reduce practitioners’ stress levels.

Indeed, MDDUS CEO Chris Kenny believes fitness to practise reform plays a vital role in this. In a statement following the launch of Shifting the balance, he welcomed the “ambitious and radical plan” and urged the GDC to implement it swiftly, fairly and consistently. He said: “The often unjustified threat of regulatory action can destroy careers and reputations and lessen public confidence. That serves neither patient nor dentist. We support all steps that will make the complaints and regulatory processes less stressful for dentists and reduce the number of unjustified final hearings.”

The potential benefits of the GDC’s plan are many and it can only be hoped they find enough support to deliver a regulatory system that better serves dentists and patients alike.

Joanne Curran is an associate editor of SoundBite