Dental Protection welcomes GDC improvements

Dental Protection has welcomed further improvements by the General Dental Council (GDC) that aim to reduce the impact on those subject to investigations, improve case progression, and make best use of limited resources in the absence of regulatory reform.

The GDC announced that it will close cases that mirror an investigation that is being carried out by another authority, and that it will not automatically open cases for matters referred to the GDC from the NHS, where the NHS is either investigating or managing the issues locally. The GDC is also reviewing and closing some older cases, those where there is no realistic prospect of establishing that a dental professional’s fitness to practise is impaired, following review and approval of the Registrar.

Yvonne Shaw, Deputy Dental Director at Dental Protection said: “We have long made the argument that reform to professional regulation is needed and we welcome the announcement by the GDC about the reforms they plan to introduce. The extent to which these reforms can make a positive impact for dentists and dental care professionals depends on the detail of how they are implemented and we look forward to working with the GDC on this.

“There are other areas where the GDC could make further progress and we continue to urge the GDC to take these forward. These include improvements to the tone of communications, IOC sanctions, decision making and decision timelines in Fitness to Practise processes.

“We also continue to campaign for the government to publish a timescale for reforming the GDC’s out of date legislation. The Dentists Act 1984 is now nearly 40 years old and sets out in prescriptive detail some of the ways in which an investigation should proceed. We believe that significant progress could be made with legislative reform including by giving the GDC more discretion to close cases sooner.”

Dental Protection: Interim Orders Committee guidance must be clear and comprehensive to avoid unnecessary conditions

Dental Protection has welcomed proposed changes to the guidance used by the GDC’s Interim Orders Committee (IOC), but says refinements are needed to ensure the IOC has the most comprehensive information possible, when deciding on whether an interim order is necessary.

The IOC is a statutory committee of the GDC which considers whether it is necessary to make an interim order to restrict the individual’s practice pending final determination of the matter by the GDC. A decision can be made to impose an order if the IOC is satisfied that it is necessary for the protection of the public, or otherwise in the public interest, or in the interest of the individual concerned. The IOC can impose a suspension (up to 18 months with six monthly reviews), conditions (up to 18 months with six monthly reviews) or decide that no order is necessary. Having such an interim order imposed can have a very significant impact on dental professionals and it is therefore important that such orders are used appropriately and proportionately.

Responding to the GDC’s consultation on proposed revisions to its IOC guidance and Conditions Bank, Dental Protection said there was a need for the IOC to be provided with further and comprehensive details as to specific allegations against the dental professional, to help the IOC decide whether there is a risk to the public. It said this additional information would help to ensure the IOC assesses the risk to public safety consistently, proportionately and appropriately.

Dental Protection called for further refinements to allegations relating to clinical cases, lack of indemnity or insurance, failure to cooperate with an inquiry, sexual misconduct and violence, working beyond scope of practice, and concerns about the health of a dental professional.

The leading defence organisation also said further clarity was needed in the definitions used in the glossary of the IOC guidance, including in respect of the term ‘reviewer’, which is unclear and could refer to the registrant, supervisor or reporter. It said the glossary, guidance and the conditions bank provide important supporting literature and must be clear in order to facilitate appropriate decisions.

Dr Raj Rattan, Dental Director at Dental Protection, said: “We support dental professionals with IOC processes and hearings day in day out. We see the impact these hearings have on their careers and wellbeing and appreciate the opportunity to contribute to this important consultation.

“Dental Protection has strong teams of experts, with considerable experience of IOC processes, who have taken the time to review the proposed changes. While we broadly welcome the proposals, we have highlighted some key areas that require further refinement. The IOC must have comprehensive and clear guidance and supporting literature, in order to make appropriate decisions. Interim orders can have career changing implications for members, so we must get this right.

“While we welcome the proposed amendments to the IOC Guidance, we would also welcome the GDC reviewing the processes by which registrants are referred to the IOC in the first instance. We remain committed to working with the GDC on this matter.”

Dental Protection’s full response can be found here.

Dental Protection: Further delay to GDC reform frustrating and disappointing

Dental Protection has said the ongoing delay to GDC reform is “frustrating and disappointing” and has called on the Government to commit to a specific timetable for improving dental regulation.

The call follows an update on Friday, which confirmed the priority for regulatory reform – which covers all regulated professions – would be Physician Associates and Anaesthesia Associates, followed by wider reform of the General Medical Council, then reform of the Nursing and Midwifery Council (NMC). There is no legislative timetable beyond this, but DHSC has indicated that they will prioritise delivery of regulatory reform based on criteria including the size of registrant base, the need for reform, and regulators’ readiness to implement the changes.

Even if GDC reform were to follow immediately after reform of the NMC, it seems very unlikely that it would come before the next general election, according to Dental Protection.

Deputy Director at Dental Protection, Yvonne Shaw, said: “Dental Protection has long argued for reform to the legislative framework that underpin the GDC. Vital changes to the 1984 Dentists Act, are seriously overdue. The Act remains outdated, requiring the regulator to conduct some of its operations in ways that are not always in the best interests of patients or professionals.

“The fitness to practise investigation process is an area in particular need of reform. This would enable the regulator to streamline its processes, improve efficiency, and reduce the number of investigations into less serious allegations, requiring the conclusion of investigations in a timely manner.

“The ongoing delay and uncertainty on GDC reform is frustrating and disappointing. We will continue to urge the DHSC to treat GDC reform as a priority. We are also calling on the Government to commit to a specific timetable for dental reforms, as soon as possible.”

Dental Protection introduces Company Protection

Dental Protection has introduced a new product, Company Protection, which allows incorporated companies to request assistance in the event they are alleged to be vicariously liable for the acts or omissions of a clinician working for the corporate and/or where the corporate is found to owe a non-delegable duty of care for the patients treated on its premises.  

This product sits separately and in addition to any individual practice principal membership with Dental Protection. In 2021, the defence organisation confirmed that it had extended the member benefits for practice principals with three or fewer un-incorporated practices to include additional protection against vicarious liability and/or non-delegable duty of care claims relating to treatment provided by dental practitioners and dental care professionals. Individual membership does not however extend to include assistance for an incorporated business, which requires its own protection.

Any incorporated dental company with employees and a gross annual turnover of less than £1.7m can apply for Company Protection. Subscriptions are based on the individual circumstances of the company; for example, the number of dentists and dental care professionals working within the company, the number of Dental Protection members, and the period of retroactive protection required. 

Company Protection benefits include redirection and defence of vicarious liability and non-delegable duty of care claims. If these claims cannot be redirected or defended, Company Protection also will pay compensatory damages. Company Protection includes a claims indemnity limit of £1m for each claim and in the aggregate, and up to 10 years retroactive protection. The product also includes access to expert dentolegal and media advice and support.

Yvonne Shaw, Deputy Dental Director at Dental Protection, said: “With recent legal challenges relating to claims arising from alleged vicarious liability and non-delegable duty of care, dental companies may now find themselves at greater risk of being the subject of a claim relating to the actions of employees or contractors. Many practice owners may not have considered that an incorporated practice is at risk of being the subject of a claim in its own right.

“Our new product Company Protection is a membership for the entity itself that allows directors/corporate officers to request assistance should a legal challenge be brought against the company/entity. This will offer some peace of mind for incorporated companies, providing the unrivalled defence, advice and support you can rely on from Dental Protection.”

Practices that are non-incorporated should visit Dental Protection’s Vicarious Liability hub for guidance on separate support with claims relating to vicarious liability or non-delegable duty of care. Those with a mixture of incorporated and non-incorporated practices, can view our FAQs. For companies with turnover >£1.7M please see: Healthcare Protection

For further information, or to join, visit: Company Protection (dentalprotection.org)

Dental expert witness vindicated in High Court appeal

A widely reported Third Party Costs Order (TPCO) against Mr Christopher Mercier, a dentist who undertakes expert opinion work, has been overturned by the High Court following an appeal supported by Dental Protection.

Mr Mercier acted as an expert witness in a dental negligence claim which went to Trial in December 2020 when Recorder Abigail Hudson heavily questioned his competence and actions in the court and later ordered him to pay over £50K in wasted costs.

Dental Protection considered the judgment of Recorder Hudson was wrong both in fact and law in many different respects and sought permission to appeal the decision.

Permission to appeal Recorder Hudson’s judgment was granted by Mr Justice Choudhury who pointed out that some of the language used in Recorder Hudson’s judgment was ‘regrettable’ and ‘unduly harsh’.

In allowing the appeal, Mr Justice Sweeting said the Recorder’s conclusion that Mr Mercier stepped outside the boundary of his expertise in giving expert opinion about breach of duty and causation in a personal injury case concerning allegations of negligence against an Oral and Maxillofacial surgeon, was wrong. Mr Justice Sweeting further stated that the Recorder’s views in her judgment were expressed ‘somewhat trenchantly’. It was largely as a result of the language used by the Recorder in her judgment that the TPCO received such widespread media reporting at the time.

Dr Raj Rattan, Dental Director at Dental Protection, said: “Expert witness work is a noble and rewarding duty and there is a growing need for a larger and more diverse dental expert witness pool. It is therefore disappointing to see an expert, who is performing the role to the best of his ability, be unfairly criticised and in such a public way. 

“Supporting the appeal was important in order put the record straight and restore the reputation of our member, as well as to prevent him from having to pay a significant amount of money in costs. As a not-for-profit organisation run for and owned by healthcare professionals, our default position is to always consider how we can help members; our support goes beyond guarding against financial loss. We can be flexible and responsive to changes in the dentolegal environment and assist with unforeseen issues such as this.

“Fortunately, this kind of criticism and treatment of expert witnesses is very rare. However, we would advise clinicians acting as expert witnesses in clinical negligence cases to always ensure they have adequate professional protection, so they can request assistance with issues arising out of medicolegal work.”

Dental Protection survey finds that communication tops list of what makes a great dentist

More than 4 in 5 young dentists regard good communication as a top skill for a great dentist, according to a Dental Protection survey.

In the snapshot survey of dentists who qualified in the last five years, 86% believe good communication skills are an extremely important factor in what makes a great dentist, followed by interpersonal skills (77%), high ethical standards (76%) and high clinical standards and competence (64%).

The list of what makes a great dentist is as follows, with the percentage of young dentists who consider each attribute as extremely important:

  1. Good communication skills – 86%
  2. Good interpersonal skills – 77%
  3. High ethical standards – 76%
  4. Managing patient expectations – 73%
  5. High clinical standards and competence – 64%
  6. Ability to cope with error – 57%
  7. Continuous education/ improvement – 53%
  8. Effective complaints handling – 44%
  9. Enjoying clinical work – 43%

Dental Protection said the figures show that young dentists ultimately understand the value of good communication skills in building trust, achieving informed consent and in reducing the risk of complaints and claims.

George Wright, Deputy Dental Director at Dental Protection, said: “The instinct of the early career dentist is spot on. While technical knowledge and competence are important, good communication is the predominant factor. It builds trust, which fosters an understanding of treatment options and promotes shared decision making and a positive dentist-patient relationship.

“Our experience over the years has shown that patients also place a high value on communication skills and are less likely to complain following an adverse incident, if they feel communication has been good.

“When patients experience poor communication, not only are they more likely to complain, but these complaints can easily escalate. Visiting a solicitor is often cited by patients as the only way they feel they can get an answer. Good communication also protects dental professionals by ensuring patients are fully informed when consenting to treatment, which minimises complaints and reduces the risk of litigation.

“From a business perspective, good communication helps to grow a practice’s goodwill as satisfied patients are more likely to make recommendations to others leading to practice growth and greater success.”

Dental Protection members benefit from bespoke workshops on communication skills and these can be accessed at: Prism from Medical Protection Society.

Dental Protection raises wellbeing concern as Interim Orders Committee hearings increase by 127%, GDC refers to five-year data

Dental Protection has raised concerns about the rapidly growing number of dental professionals being referred to the Interim Orders Committee (IOC), and the impact on wellbeing.

The IOC considers whether it is necessary to make an interim order restricting a dentist or dental care professional’s registration with the GDC. This happens in cases where the regulator determines such action is needed to protect the public interest, pending the outcome of an inquiry by one of the Practice Committees. The IOC does not investigate any allegations in ongoing cases.

The GDC’s fitness to practise and registration statistical reports show that while in 2019 67 cases were referred to the IOC, this figure more than doubled to 152 in 2021 – a 127% increase. The reports also show that an increasing number of these cases year on year were eventually closed with no further action. A quarter (25%) were closed with no interim sanction in 2019, rising to 39% in 2021.

George Wright, Deputy Dental Director at Dental Protection, said: “Dental Protection supports dental professionals from the moment a GDC complaint is received to its conclusion. We see the impact the investigation process has on the dental professional’s career, reputation and wellbeing. Having to face an IOC hearing during this process adds to this stress and we were concerned to learn that the number of hearings has increased at such an alarming rate in just two years.

“Even more worrying is that the growing proportion of these IOC hearings concluding with no interim sanction suggesting that the cases should not have been referred in the first place. It seems right to question whether the GDC’s processes for identifying suitable cases for referral to an IOC hearing is working as it should.

“Every effort should be made to minimise the impact the fitness to practise process has on the mental health and wellbeing of the professionals involved. This should include ensuring the system which determines the cases that need to be referred to the IOC is robust and is filtering out cases that should be concluded at an earlier stage. We would welcome working with the GDC on this issue.”

GDC Response

GDC Executive Director, Fitness to Practise, John Cullinane, said: “This is a clear example of why selective use of data can be problematic. The number of initial interim order hearings each year is actually stable, and 2019 is not a good baseline to use. Looking at each of the five years to 2021, data which is all publicly available, it is quite clear that 2019 is the outlier. The main reason for this was made clear in the 2020 fitness to practise statistical report (p16) – a process issue in Q4 of 2019 meant that a large number of hearings which should have taken place in 2019 actually took place in 2020.

“It’s also clear that 2019 is the outlier for no order outcomes, which otherwise over the five years to 2021 remain relatively stable. There are a whole host of reasons why a panel might not impose an order. For example, a change in circumstances or mitigations at the point of hearing from when a referral was made could correctly result in a no order. Equally, panels are independent and therefore it’s right that their view will not always align with that of the GDC.

“Interim order committees play a vital public protection role. They are responsible for considering immediate and serious risks to patient safety and public confidence while investigations are ongoing. They do this through an assessment of risk and deciding whether there is a need to suspend or impose conditions on a dental professional’s ability to practise, ahead of a substantive hearing. We are currently consulting on proposed updates to the IOC guidance which aim to ensure consistency in the assessment of – and approach to – risk, provide comprehensive guidance to panel members, and ensure decisions are proportionate and appropriate to the risks posed. I encourage everyone with an interest in this to read the proposals and respond to the consultation before it closes in early February.”

Five-year data: initial interim order hearings

  2017 2018 2019 2020 2021
No order 53 (40%) 67 (43%) 17 (25%) 52 (37%) 60 (39%)
Conditions 37 (28%) 47 (30%) 27 (40%) 47 (33%) 41 (27%)
Suspension 44 (33%) 42 (27%) 23 (34%) 43 (30%) 51 (34%)
Total 134 156 67 142 152

 

2021 FTP stats report (p17)

No order: 60

Interim conditions: 41

Interim suspension: 51

 

2020 FTP stats report (p16)

No order: 52

Interim conditions: 47

Interim suspension: 43

 

2019 FTP stats report (p16)

No order: 17

Interim conditions: 27

Interim suspension: 23

 

2018 annual report and accounts (page 82)

No order: 67

Interim conditions: 47

Interim suspension: 42

 

2017 annual report and accounts (page 44)

No order: 53

Interim conditions: 37

Interim suspension: 44

 

Our consultation on revisions to Guidance for the Interim Orders Committee and the Interim Orders Committee Conditions Bank is available online and closes on 2 February 2023

 

Dental Protection welcomes GDC’s commitment to dentists’ wellbeing

Dental Protection has welcomed the commitment by the General Dental Council (GDC) to conduct research into the number of deaths by those involved in fitness to practise proceedings and to publish their findings.

In a blog post Reporting the cause of death of registrants who have died while under fitness to practise investigation published this week, the GDC said that it plans to develop an accurate picture of the prevalence of suicide while a fitness to practise case is active, drawing on the work the General Medical Council has undertaken to gather and publish similar data for medical registrants. The first report of this kind will cover the period 2019 – 2021 and will be published by the GDC before June 2023.

The GDC also highlighted the importance of making “changes which aim to avoid or minimise unnecessary stress and to help ensure that people have the support they need and committed to “reviewing the mental health and wellbeing signposting that is offered to all participants as well as the training and support we offer to our own team”.

Dr Raj Rattan, Dental Director at Dental Protection, said: “We called on the GDC to draw inspiration from the positive steps taken by the GMC with regard to reporting the number of doctor suicides during the investigation process, and we are pleased that the GDC has committed to these positive steps.

“We also welcome the renewed commitment to minimising the impact that investigations have on the mental health and wellbeing of the registrants involved, including by improving the tone of their fitness to practise communications.

“Dental Protection supports dental professionals from the moment a GDC complaint is received, to its conclusion at a hearing. GDC investigations are lengthy and stressful for the dental professional and there are always concerns about the impact of investigations on professional careers and wellbeing.”

Dental Protection members benefit from our confidential counselling service. Find out more at: Counselling service for members – confidential and 24/7 (medicalprotection.org)

Dental Protection: Dentists should feel encouraged and empowered to undertake expert witness work

More dentists from NHS, private and mixed practice should consider putting themselves forward to provide expert opinion, according to Dental Protection.

The leading defence organisation says dental expert opinion is crucial in GDC investigations and clinical negligence claims and determines the standard to which dentists are held to. But it said a step change is needed to encourage and empower more dentists to take on the role, as courts and regulators report difficulties in finding appropriately qualified and trained individuals.

Dental Protection is calling on the GDC to consider if it could do more to promote expert witness training as part of a dental professional’s CPD, to give the role and training prominence and encourage more registrants to take up this work.

Dental Protection also said a more consistent approach to the instruction of experts is needed, where the different working practices in NHS, mixed and private practice are routinely acknowledged when experts are instructed for fitness to practise cases.

It said the development of a single register or list of experts that all parties can use, would also help to increase transparency and consistency.

Dr Raj Rattan, Dental Director at Dental Protection, said: “Dental expert opinion plays a critical role in civil and regulatory processes. Such opinion can dictate and determine the standards to which dentists are held, sway opinion and as a result have significant implications for a dentist’s career.

“Given the importance of expert work it is concerning that bodies such as the courts and regulators, report difficulties in finding appropriately qualified individuals to undertake it. The pool of dental experts is not as large as it could be, and there is no single centralised register of accredited experts. Instruction therefore often relies on word of mouth.

“Moreover, the barriers to undertaking expert work – including time constraints and unfamiliarity with legal processes – mean that expert work is often undertaken by dentists in the latter part of their careers when some may have retired from clinical practice and have more time to devote to it.

“Ongoing involvement in clinical work encourages dental experts to remain abreast of current clinical thinking, better understand the imperfections of the systems under which dental professionals work and the challenges these bring. 

“This is why it is also important that experts who are instructed are knowledgeable and have relevant experience of the NHS, private and mixed practice sectors.

“We need to see a real step change in this area and while the regulator has a key role to play, dentists can play an important part. Dentists in active practice should feel encouraged and empowered to seek the training to become an expert witness and put themselves forward for what is important work for the profession, patients and wider society.”

Brian Westbury, Academic Dean at the Faculty of Forensic & Legal Medicine, commented: “The Faculty of Forensic and Legal Medicine has Members and Fellows who are Dentolegal Advisers. They appreciate the need for a way of contacting experts who they know are of a proper standard and who are regularly revalidated. We are pleased to co-operate with both the defence organisations and the College of General Dentistry to set up such a register and maintain it.

“Our examination of the Diploma in Legal Medicine is taken by many registrants and non-registrants as a sound start to any medico / dentolegal career. It can form part of the pathway with further training for those aspiring to work as experts and who go on to register with the proposed list.”

Abhi Pal, President of the College of General Dentistry, added: “The College of General Dentistry considers it essential that those who are given the huge responsibility of providing opinion on a colleague’s performance in an official capacity have the appropriate training and experience to do so. This not only includes expert witnesses but also other dental professionals who provide performance reports.

“The College supports improved training and standardisation of dental expert witnesses as part of its mission of supporting careers and setting standards for the ultimate benefit of the profession and public. We intend to develop a register of suitably trained expert witnesses and assessors to support this work, and look forward to working with all stakeholders in the dentolegal field to achieve this.”

Dental Protection’s CGDent discount extended to nurses, hygienists, therapists and technicians

Dental Protection’s ‘CGDent Scheme’, under which members of the College of General Dentistry receive a discount on their Dental Protection subscription fees, is now available to dental nurses, dental hygienists, dental therapists, orthodontic therapists, dental technicians and clinical dental technicians.

The arrangement has been available to dentists since the launch of a partnership between the organisations in 2020.

Membership of the College is open to all registered dental professionals, and in line with the College’s vision to support the whole dental team, the partnership with Dental Protection has now been extended to College members in all registrant categories. Those holding a Postgraduate Certificate (or higher-level qualification) in a relevant subject are eligible for Full Membership and can qualify for a 5% reduction on their indemnity fee, and those admitted to Fellowship benefit from an 8% discount.

To take advantage of the reduced fees, College members should contact Dental Protection. Existing Dental Protection members should call 0800 561 9000 to get their relevant discount applied, and those who are not yet Dental Protection members should visit https://www.dentalprotection.org/uk to join. The discount will need to be requested each year at renewal to allow for verification of continued eligibility.

Dental Protection members who are not yet members of the College should visit https://cgdent.uk/membership