Dental Protection response to DHSC consultation: Urgent action needed to reform GDC

Dental Protection welcomes the commitment by the Department of Health and Social Care (DHSC) to modernise the laws that underpin the work of the GDC and other professional regulators.

As part of the consultation outcome – Reducing bureaucracy in the health and social care system: call for evidence – DHSC has committed to launching a consultation in early 2021 to modernise the legal framework of the nine health and care professional regulators. This commitment to regulatory reform would extend to dentistry and the General Dental Council (GDC).

Dr Raj Rattan, Dental Director at Dental Protection, said: “Dental Protection welcomes the commitment by DHSC to modernise the work of regulators such as the GDC, with the aim of reducing the bureaucratic burden on dental professionals.”

“The high level proposals set out by the government are a welcome step in the right direction. But words must be followed by action. It has been nearly 10 years since the DHSC first proposed fundamental legal changes to allow GDC to take a more proportionate approach to investigating concerns about dental professionals. The vast majority of GDC investigations are closed without action, the end result being that far too many dental professionals go through a stressful process each year, while the patient who has made the complaint also endure a lengthy process with what is for them a disappointing outcome.

“Dentists and patients alike cannot be forced to endure another 10 years of delay on something so important. A clear timeline for next steps must be set out. Reforms to the Dentists Act could give the GDC more discretion to not take forward investigations where allegations clearly do not require action. The current powers of the GDC were framed more than 30 years ago – when a very small number of complaints were received, and the GDC could investigate each and every one. Now, over one thousand dental professionals are referred to the GDC each year, with very few coming close to the threshold of serious concern that the GDC was established to address.

“It is absolutely right that regulators are able to focus their efforts on the small minority of healthcare professionals that might meet their thresholds for concern and that they are able to  reduce the burden and avoidable costs of unnecessary investigations.”

Care Quality Commission and GDC issue joint statement regarding life support training for dental professionals

The Care Quality Commission and General Dental Council (GDC) have released their annual life support statement in light of Covid-19, which can be read here. It is recommended that dental professionals undertake life support training every year. However, it has been recognised that access to accredited training may have been affected by the pandemic.

Resuscitation Council (UK) recommends cardiopulmonary resuscitation (CPR) training for dental teams. Their document Quality Standards: Primary Dental Care states: “Dental practitioners and other dental healthcare staff should update their knowledge and skills in resuscitation at least annually.”

Together, the Care Quality Commission and GDC recognise that Covid-19 social distancing can make accessing accredited training difficult. This includes Basic Life Support (BLS) and Immediate Life Support (ILS).

Providers and individual dental professionals should continue to make every effort to complete accredited BLS/ILS training annually. However, if this training is unavailable due to current Covid-19 restrictions, appropriate alternative provisions, in accordance with relevant government guidance, should be made.

For example:

  • E-learning.
  • Self-directed study.
  • Team-based scenario training in the clinical environment.

Records and evidence of efforts made to access training and to update CPR knowledge and skills should be maintained.

Two in five dentists now fearful of investigations arising from Covid-19 disruption

Dental Protection is calling on the General Dental Council (GDC) and the Professional Standards Authority (PSA) to do more as fear of investigations arising from Covid-19 and disruption to care, is becoming a growing concern for dentists’ mental wellbeing.

In a Dental Protection survey of nearly 500 UK dentists, conducted during October, two in five dentists (40%) said fear of investigations arising from difficult decisions made during Covid-19, or disruption to care, was having most impact on their mental wellbeing. This is up from 33% in the May 2020 survey.

This follows reports that 19 million fewer dental treatments – which includes check-ups and appointments for emergency treatment – were offered in England between March and October 2020, compared to the same period in 2019. 

Dental Protection is calling on the GDC to consider guidance for its staff detailing how to take the context created by Covid-19 into account when considering complaints about dentists, similar to that issued by the GMC in September. It is also calling on the PSA, which oversees the work of all professional regulators of healthcare in the UK, to consider more detailed guidance on when an investigation would be conducted or not.

Raj Rattan, Dental Director at Dental Protection, said: “While dental professionals tell us there are a range of issues impacting on their mental wellbeing – from concern for the health of family, friends and colleagues, through to loss of income and adapting to new ways of working – we are particularly concerned to see that fear of regulatory investigation due to Covid-19 disruption has increased since we surveyed our members back in May. Dentists remain focussed on looking after their patients and providing high quality care. Concerns about the prospect of unfair action being taken against them for decisions taken in circumstances beyond their control is an unnecessary distraction and only exacerbates the stress that many are experiencing at this time.

“We feel the GDC could do more to reassure dentists and reduce the stress this is causing. In September, the GMC issued specific guidance for its staff detailing how to take the context created by Covid-19 into account when considering complaints about doctors. While we have some concerns as to whether this guidance will stand the test of time, it was a welcome gesture and offered much needed reassurance to doctors. The GDC could consider something similar and we will continue to engage with them on this. We also believe dentists would welcome clear guidance from the PSA which would demonstrate in greater detail how the regulators will ensure a proportionate approach will be taken down the line. This is important, as it will likely be a number of years before Covid-19 related complaints against dentists might be handled and at this point memories of this difficult time may have faded.

“The prospect of a regulatory investigation down the line is clearly taking its toll on dentists’ mental wellbeing, and we hope that both the GDC and the PSA will consider what more can be done to reassure dentists who are doing their very best for their patients.”

Responding to Dental Protection’s call, GDC Executive Director, Fitness to Practise Transition, John Cullinane, said: “In March of this year we, along with the other professional health and care regulators, made a commitment that environmental and human factors relating to Covid-19 would be taken into account in fitness to practise investigations and we stand by that commitment as we have throughout. We continue to make this clear in all our discussions with stakeholders and it is disappointing that any of them would imply there is cause for concern. This has been, and continues to be a challenging time, and we all have a shared interest in providing reassurance that professional judgements will always be looked at in the context in which they were made. As long as professionals assess risk appropriately, and make professional judgements accordingly, there should be no reason for concern. Our fitness to practise decision-makers are aware of our commitment and we continue to review our guidance to them to ensure they have a lasting point of reference.”

 

The recent survey conducted by Dental Protection ran from 28 September-19 October 2020 and achieved 497 responses from dental members in the UK.  The May survey referenced ran from 18-29 May and achieved 506 responses from dental members in the UK.

GDC sets reduced budget and unchanged ARF for 2021

The General Dental Council met on Thursday of last week and took a number of key decisions including the approval of its plans and budget for 2021. Perhaps most striking, due to the significant uncertainty thrown up by COVID-19 and Brexit, the regulator has planned on the basis of a 10% income risk for 2021 and has accordingly reduced its budget for next year by 6.5%. The annual retention fee (ARF) will, however, remain unchanged for 2021.

Speaking after Council, GDC Chief Executive and Registrar, Ian Brack, said: “Covid-19 has been very challenging for the dental sector and the country is now experiencing the long-expected second wave of the pandemic. This is expected to impact on the professions we regulate, and we do not know how this will affect the register.

“The GDC has no option but to continue to undertake its statutory duties but faces very great uncertainty. Some of the risks we face include smaller numbers joining the professions and larger numbers leaving, disruption to the flow of overseas registrants as a consequence of our exit from the EU, and the potential delays in students qualifying to register due to interruptions in education caused by the pandemic. In addition to these income risks we have considerable uncertainty in relation to significant elements of expenditure – for example in relation to legislative change relating to overseas registration. For these reasons, we have sought to maximise our resilience and the flexibility of our plans whilst continuing to provide certainty for dental professionals in relation to the fee.” 

For further information about the decisions taken in the recent Council meeting, read the post-Council update from GDC Chair, Bill Moyes.

GDC publishes 2019 fitness to practise statistical and insight reports

The General Dental Council (GDC) has today published several reports which provide statistics and examples of fitness to practise case handling undertaken during 2019, available to read at https://www.gdc-uk.org/education-cpd/fitness-to-practise-learning. 

The statistical report provides a quantitative picture of fitness to practise in 2019. In addition, the regulator has also published six short insight reports covering decisions at the initial assessment stage for quarters three and four of 2019, including spotlight reports on concerns relating to consent and record keeping.

The reports show that of all the concerns received in 2019, only 36% made it to a case examiner – the first stage at which a sanction may be imposed on a dental professional. The reports also reveal a further year-on-year increase in concerns raised by dental professionals, from 10% to 13% of the total, including ‘blue on blue’ cases – separate to those which are categorised as ‘whistleblowing’ by professionals.

Executive Director of Fitness to Practise Transition at the GDC, John Cullinane, said: “What is clear from these reports is that the large majority of concerns received by the GDC are assessed and completed without sanction, but they also highlight that early engagement in the process will typically end in a smoother resolution to any concern that’s raised, which ultimately must be in everyone’s interests. The increase in referrals by registrants also highlights an important issue; while we of course need to avoid any discouragement of whistleblowing or the raising of serious issues affecting patient safety or public confidence, matters such as employment disputes or grievances – which we are seeing on an increasing basis – are not for the regulator to investigate or resolve. 

“There’s some really useful insights to be gained here for dental professionals, particularly from the case examples in the short reports, so I’d encourage everyone to take a look.”

The full reports are available to read on gdc-uk.org.

GDC publishes 2019 registration report

The General Dental Council (GDC) has today published a statistical report detailing the registration of dentists and dental care professionals, providing a snapshot of register data as of 31 December 2019.

The report provides statistics from the GDC Registers, including the total number of dental professionals by title and the equality and diversity profile of the Registers. It also provides annual statistics relating to additions and removals, and the categories of those changes.

In analysis of the data, the regulator says it has identified an under-reporting of equality, diversity and inclusion (EDI) information by dental professionals, and is calling for professionals to check if their data is complete.

GDC Head of Regulatory Intelligence, David Teeman, said: “Whether dental professionals choose to share this EDI data is entirely a decision for them. However, of course, the more complete our EDI data, the better able we are to identify, explore, understand and respond to potential issues that correlate with EDI across everything the GDC does. It is for this reason that we are going to be talking more about the importance of this over the coming months.”

The full report is available on the GDC’s website.

GDC appoints three new council members

The General Dental Council (GDC) has announced the appointment of three new members to its Council, following a competitive recruitment process earlier this year.

Donald Burden began his career as a general dental practitioner before moving into educational and clinical roles within Queens University Belfast and Belfast Health and Social Care Trust (BHSCT). He now holds a combined role of Clinical Director for Dental Services in BHSCT and Director of Queen’s University Dental School.

Laura Simons is an experienced non-executive director with a background in consumer affairs, campaigning and professional regulation, and brings a wide range of skills and experience drawn from working in consumer organisations of varying sizes and complexity. She joins the Council as a lay member.

Mike Lewis is a professor of oral medicine at Cardiff University and a consultant in oral medicine at Cardiff University Health Board. He has previously held the role of Dean at the School of Dentistry, Cardiff University and was Director of the Clinical Board for Dentistry at CUHB.

The GDC has also confirmed the re-appointment of three existing Council members, Sheila Kumar, Crispin Passmore and Caroline Logan.

Announcing the new and re-appointments, GDC Chair Dr William Moyes, said: “I am delighted to welcome Donald, Laura and Mike, who bring with them a wealth of skills and knowledge. They replace Kristie Moons, Margaret Kellett and Geraldine Campbell, who have contributed greatly to the work of the GDC since their appointments in 2013, and to whom I extend my heartfelt thanks.

“Our new appointments, in addition to the re-appointments of Sheila, Crispin and Caroline, will ensure Council can continue with its important work with the benefit of strong expertise and experience, helping us to achieve our goals in what continues to be challenging and uncertain times.”

Council members serve for maximum terms of office which guarantees frequent opportunities for others to join the GDC. The regulator’s next round of Council recruitment will commence early next year, and in the lead up to that search the GDC will once again be actively encouraging applications from dental care professionals and those from BAME backgrounds.

To learn more about the work of Council, visit gdc-uk.org.

GDC thematic review on preparedness for practice finds no safety concerns

The General Dental Council (GDC) has today published the findings from its first education quality assurance thematic review, which focused on the preparedness for practice of UK trained dental students at graduation. While finding areas where preparedness could be enhanced, the review found no evidence to suggest graduates are unsafe.

As part of an updated approach to its quality assurance of education and training, the regulator introduced thematic reviews, which are designed to examine broad cross-sector issues. The first such review, which also includes an independent rapid evidence assessment, focused on the subject of preparedness, following concerns raised by stakeholders in recent years.

Some key findings include:

  • Both trainees and supervisors feel there should be more clinical experience at undergraduate level, although the review found there are barriers which prevent this from happening
  • There is no evidence to suggest graduates are unsafe
  • Supervisors and trainees have different expectations when it comes to new dentists’ skills and abilities
  • There may not always be shared understanding around what a safe beginner looks like

Head of Education Policy and Quality Assurance at the GDC, Ross Scales, said: “While inspections remain an important part of how we assure the quality of education and training for individual programmes, thematic reviews provide a new and useful tool, enabling us to more effectively look at wider issues. This review provides valuable, evidence-based insights into a critical issue.

“A shared understanding of what we mean by ‘safe beginner’ is clearly very important and we will be looking at how we can better define this to ensure a common view. The findings around the amount of undergraduate experience, particularly for complex skills development and the use of ‘real world’ settings, are equally valuable and I look forward to working with our partners in education to explore how changes could be made to improve the preparedness of new dentists.”

To read the full report, as well as the rapid evidence review, visit https://www.gdc-uk.org/about-us/what-we-do/research/research/detail/fitness-to-practise/preparedness-for-practice-of-uk-graduates-2020

BSDHT and BADT contact GDC concerning overseas dentists registering as Dental Therapists and Hygienists without practical assessment

The British Association of Dental Therapists (BADT) and the British Society of Dental Hygiene and Therapy (BSDHT) have taken the unusual step of directly contacting each appointed Council member of the General Dental Council regarding overseas dentists registering as Dental Therapists and Dental Hygienists without any practical assessment of clinical skills.

Both BADT and BSDHT feel that continuing interactions with the executive function of the GDC regarding this matter have failed to produce any positive movement towards change in a situation that both organisations feel compromises patient safety. By directly raising awareness to the appointed Council members, BADT and BSDHT hope to move the discussion into the public forum to ensure change, in order to “protect patient safety and maintain public confidence in dental services”.

The letter reads as follows:

The British Association of Dental Therapists and the British Society of Dental Hygiene and Therapy are jointly lobbying all members of Council to initiate an urgent and public Council meeting agenda item regarding the registration of overseas trained dentists (outwith the EEA) as dental hygienists and dental therapists without any practical assessment of their ability to diagnose and treat dental disease.

There has been a 300% increase via this route to registration since 2017 and is being fuelled by several agencies actively recruiting individuals predominantly from India and Pakistan. These agencies advertise and demonstrate that this route to registration requires no Overseas Registration Exam (ORE). We have evidence of dentists who have failed the ORE more than once yet gone on to register as dental hygienists and dental therapists. When asked, the GDC refuses to share the legal advice they were given that led to this flood of registrations.

Are you, a member of Council, satisfied the “robust” process applied by the Registration Assessment Committee satisfies your remit of protecting patients? We, the BADT and BSDHT, advise all members of Council that this route to registration presents risk of serious harm to patients because of the lack of a practical skills assessment. We strongly feel that the mapping of learning outcomes carried out by the Registration Committee is woefully inadequate. We do not accept the representation by GDC executive arm that a lack of evidence of harm being caused by these individuals demonstrates the above is a safe route to registration as a dental hygienist and dental therapist.

13 of the 15 tests applied at an ORE are applicable to the scope of practice of dental hygienists and dental therapists. Various Freedom of Information Requests that have been shared publicly clearly demonstrate that around 50% of those taking the ORE fail at the practical assessment stage. We say that this is evidence enough that there is an obvious risk of patients coming to permanent harm should these individuals go on to register as dental hygienists and dental therapists. We ask:

Would you choose an individual who has failed the ORE, gone on to register as a dental therapist, to extract your children’s teeth; would you let them provide you with a filling? We ask you apply the daughter test to the above question.

Would you allow your daughter to undergo treatment by such an individual?

We contend that Section 36C (5)(a)(ii) of the Dentist Act gives the GDC the power to enforce a test on these individuals. We ask that the GDC suspend this route to registration in the interest of patient safety and treats this matter with the upmost urgency.

GDC publishes findings from ‘professionalism’ research

The findings from independent research, which was designed to inform a better shared understanding of professionalism, have been published today by the General Dental Council (GDC). This publication marks a major milestone in the regulator’s programme to develop new ‘principles of professionalism’, which will also see extensive engagement with stakeholders.

Some key findings include:

  • Professionalism is a multifaceted and context-dependent concept, and therefore, not easily defined for every circumstance or individual.
  • ‘Professionalism’ is viewed differently by members of the public and dental professionals in some instances. For example, views about professionalism in personal time, experience during the appointment, and whether the exchange of money for dental care plays a role. Dental professionals also typically framed professionalism in negative terms (i.e. what not to do).
  • These differences have important implications for the relationship between patients and professionals – and are likely to continue because professionals form their understanding of professionalism largely through observation.
  • Good communication and involving patients in decision-making is a key element of professionalism and an essential foundation of trust.

Executive Director, Strategy, at the GDC, Stefan Czerniawski, said: “Professionalism is important both to patients and to dental professionals themselves – but they don’t always mean the same thing by it. This new research makes an important contribution to the shared understanding of what it means to be a professional and to the development of principles of professionalism. It is also a crucial part of our increased focus on upstream regulation, which aims to prevent harm from taking place. I look forward to discussing the research findings with patients and professionals as the work continues.”

To read the full report visit gdc-uk.org.