GDC

Unrepresented dental nurses treated more harshly by GDC

Figures released by the General Dental Council (GDC) in response to a Freedom of Information (FOI) request show that 72% of Dental Care Professionals (DCPs) did not have legal representation when facing a GDC Fitness to Practise hearing[1].

The figures also show that 77% of DCPs without legal representation were suspended or erased from the Register and only 10% were concluded with no adverse findings.  However, only 32% of those with legal representation were suspended or erased and 39% were concluded with no adverse findings.

In response to a query on this subject by Dental Review (www.dentalreview.news), a  spokesperson for the GDC said  “While the vast majority of dental professionals will never be involved in a fitness to practise investigation we have spoken before about the importance of engaging in the process for those who have had a concern raised about them. The findings of our research on The concept of Seriousness in fitness to practise, published earlier this year, highlighted the potential for more adverse outcomes in cases where professionals either do not engage or where they represent themselves. It also found that dentists were reported as having higher levels of representation when compared to dental care professionals. The requirements for healthcare professionals’ indemnity are set by Government and we will provide support as needed for any work on this issue.”

The UK’s professional association for dental nurses, the British Association of Dental Nurses (BADN) is therefore  urging all dental nurses to obtain indemnity cover which includes legal fees for GDC investigations.  Current BADN members can obtain indemnity cover at reduced cost via a special members’ link when they join or renew their BADN membership.

“The BADN indemnity scheme, underwritten by CFC Ltd,  is dental nurse specific” said Siobhan O’Callaghan, Chief Operating Officer of Trafalgar Risk Management (TRM) who provide the BADN scheme.  “It was designed with dental nurses in mind – not as an add-on to a dentist’s cover; is individual, so goes with the dental nurse if she changes jobs; and includes legal fees for GDC investigations.  It is also an insurance scheme, rather than a mutual, so BADN members can be confident that they are suitably covered for their dental nursing activities under the GDC Scope of Practice.”

Membership of BADN is currently £35pa for Registered Dental Nurses, with special rates for part time workers and those on maternity leave.  Other benefits of BADN membership, in addition to the purchase of indemnity cover at special member rates, include a Legal Helpline, Health & Wellness Hub including a support/counselling Helpline, the digital quarterly “British Dental Nurses’ Journal” with verifiable CPD, and BADN Rewards – a wide range of special offers and discounts on travel/home/car/life insurance, travel, high street shopping, Apple products, motoring and much more!

Dental nurses can join their professional association at www.badn.org.uk/join

[1] Medical Protection Press Release,  23 August 2022

GDC launches public consultation on updated Interim Orders Committee guidance and associated information

As part of its work to improve fitness to practise processes wherever possible in the absence of regulatory reform, the General Dental Council (GDC) has launched a 12-week public consultation on proposed updates to its Interim Orders Committee Guidance and associated information.

The Interim Orders Committee is responsible for considering immediate and serious risks to patient safety and public confidence while investigations are ongoing. It does 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 dentistry in the UK, ahead of a substantive hearing.

GDC Executive Director, Fitness to Practise, John Cullinane, said: “In the absence of the wholesale reform of our legislation which is so sorely needed, we are getting on with improvements to our processes wherever possible. These proposed updates 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. This work has been informed by a broad range of evidence but capturing the opinions of our stakeholders in relation to the proposals is a vital step in ensuring we get this right. As such, I encourage all with an interest to share their views by responding to this consultation.”

The GDC has drawn on research, internal audit processes and case law when revising the guidance.

The consultation runs for 12 weeks, 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)

The GDC responds to FOI requests for stats on suicides during fitness to practise investigations

Earlier this year, after a reading a report published by the General Medical Council in March 2022 revealing that five doctors had died due to suicide between 1st January 2018 and 31st December 2020, consultant orthodontist Dr Farooq Ahmed put in a Freedom of Information request to the General Dental Council (GDC), inquiring as to the number of registrants that had taken their lives during a Fitness to Practise investigation. The GDC declined the request, stating that there is no requirement for the regulator to be informed when a registrant may take their own life, and that carrying out a manual search of records wouldn’t provide a ‘complete picture’, adding that the reasonable time limit for the GDC to carry out record searches is 18 hours.

Dr Ahmed pressed further after the regulator’s refusal to comply with the FOI request, and was told that when a search was carried out on the GDC’s internal database for the term ‘suicide’, it produced 6,753 results.

Fast-forward to 9th November 2022, and the GDC has responded in the form of a blogpost on its website, titled ‘Reporting the cause of death of registrants who have died while under fitness to practise investigation’. Stefan Czerniawski, Executive Director for Strategy at the GDC, explains within the post that the regulator has not routinely collected the cause of death after a registrant’s passing.

“A concern has been voiced that some registrants under investigation may take their own lives, and earlier this year we received a freedom of information (FOI) request seeking the number of dentists to have done so. We do not hold this information, because our primary concern is knowing if a registrant has died, so that we can take necessary practical actions, such as closing their entry in the register. If a fitness to practise case is open, it also enables us to close the case and record that we have done so.

“At that point, the cause of death has not always been established. Where the person has died unexpectedly or other than as a result of natural causes, the coroner (or in Scotland, the procurator fiscal) must be notified and an inquest may be held. That is always the case for a suspected suicide and only after the completion of the inquest can a final death certificate be issued which records the cause of death. That is likely to come some considerable time after the death has occurred and, crucially for our regulatory purposes, after we have removed the person from the register and closed any open fitness to practise cases. As a result, we do not collect and record causes of death where an inquest has been required.”

Czerniawski goes on to say that: “Because there has been concern about the matter, we think it is appropriate to develop an accurate picture of the prevalence of suicide while a fitness to practise case is active.”

He notes that a research project will be undertaken at the GDC, collecting data for the period 2019 – 2021, with a report to be published during the first half of 2023. “We will aggregate data over three years to minimise the risk of identifying individuals, and we will allow a twelve-month period for inquests to be completed and final death certificates to become available,” Czerniawski explains. “In developing our approach, we have drawn on the work the General Medical Council has undertaken to gather and publish similar data for medical registrants. We aim to publish data in a similar format to that used by the GMC and, like them, if the total number of cases is below three, we will indicate that, but not disclose the specific count – again that is to protect the anonymity of individuals.”

The GDC will not be providing any commentary on the results. Czerniawski cites guidance from the Samaritans, which states that “Speculation about the ‘trigger’ or cause of a suicide can oversimplify the issue and should be avoided. Suicide is extremely complex and most of the time there is no single event or factor that leads someone to take their own life.”

While the regulator is finalising the detailed methodology that it will use and is going to check that the retrospective collection of data can be effective in practice, Czerniawski adds: “If we encounter something which prevents us from proceeding as we have planned, we will explain what has happened and how we plan to address any obstacle. When the report has been published, we will go on to assess what the most useful longer-term approach might be, and we will share the outcome of this work once it is concluded.”

The post ends with a message to reach out if you are struggling:

“If any of the issues we have discussed above are affecting you, we encourage you to reach out to Samaritans. Their helpline is available day and night, 356 days a year. You can call them for free on 116 123, email them at jo@samaritans.org, or visit www.samaritans.org to find your nearest branch.”

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.”

GDC approves three-year strategy and confirms 2023 ARF

Following a public consultation earlier this year, the Council of the GDC has today approved the regulator’s strategy for the next three years. In so doing, the GDC also set the Annual Retention Fee (ARF) level for 2023 amidst considerable economic uncertainty. The ARF will be £690 for dentists (an increase of 1.5%) and £114 for dental care professionals (no increase).

The rise for dentists is far below the 10.1% rate of inflation (CPI, 12 months to September 2022) and the ARF level for both dentists and dental care professionals is lower than the GDC indicated when it consulted on plans in the summer. The lower-than-expected rates were achieved by the regulator tightly managing costs and absorbing, where possible, the impacts of inflation, as it committed to doing when it set out its expenditure plans.

In the context of such uncertainty, Council has set fees at a level that ensures the GDC can continue to fulfil its statutory role of maintaining patient safety and public confidence, while sensibly managing the financial risks caused by high and volatile inflationary pressures.

GDC Chair, Lord Toby Harris, said: “I’d like to thank everyone who shared their views with us on our plans for the next three years. We have listened to that feedback and look forward to publishing our final strategy in the coming months. Some of that feedback related to the fees we charge, and we’re really pleased to have been able to further challenge our own costs and deliver a lower ARF for dental professionals in 2023 than we initially forecast.

“We have statutory duties and so, to ensure these are fulfilled, we must be financially viable. But that is not the only reason we must continue to operate – I believe dental professionals gain great benefit from regulation as it is one of the things that underpins the reputation of the professions as a whole.”

In the consultation on its strategy, the GDC warned that due to high and sustained inflation it may need to increase the ARF in 2024 and 2025. While this does mean less certainty over the coming years in relation to the level of the fee, this approach enabled the GDC to make a prudent provision for inflation whilst keeping 2023 costs as low as possible for dental professionals. If further rises due to inflation are necessary, the regulator commits to limiting these to the rate of inflation at most, while continuing to challenge its own costs.

GDC Chief Executive and Registrar, Ian Brack, said: “In the current uncertain and volatile economic climate, it’s essential that we manage financial risks – particularly those relating to inflation. We’re confident that our expenditure plans will ensure we are able to fulfil our primary role of maintaining patient safety and public confidence.

“While we will continue to aggressively manage costs, as we have said we may need to increase the level of the fee in the future. Any such increase will, at most, be in line with the rate of inflation at the time, or as a result of other exceptional and unanticipated circumstances.”

The GDC looks forward to publishing the consultation outcome and final strategy in the coming months.

GDC launches consultation on updated learning outcomes and behaviour expectations in dental education

As part of the GDC’s statutory role in setting standards in dental education, the regulator has today launched a 12-week public consultation on proposed changes to learning outcomes and behaviour expectations for education and training programmes leading to registration.

The proposals are available to read in full in The Safe Practitioner: A framework of behaviours and outcomes for dental professional education.

In addition to introducing the new terminology of ‘safe practitioner’ to describe newly qualified dental professionals, the proposals will introduce new areas of required behaviour and make updates to both clinical and non-clinical requirements that programmes must achieve.

GDC Head of Upstream Regulation, Ross Scales, said: “Since the learning outcomes in Preparing for Practice were last reviewed back in 2015, there have been significant shifts in both dentistry and wider society, and the proposed changes in The Safe Practitioner Framework very much reflect this. I’d like to thank the many stakeholders who have shared their views to date, and particularly those who contributed their significant experience and expertise to our reference group which explored feedback and research. We are now seeking broader views on our proposals and welcome feedback from all of those with an interest in dental education and training.”

To read the full proposals and respond to the consultation before 10 January 2023, visit the GDC’s Consultations webpage.

Dental Protection welcomes PSA drive to wipe out inequality in regulation

Dental Protection has welcomed recommendations by the Professional Standards Authority (PSA) for regulators, including the GDC, to help tackle inequalities in professional regulation.

The PSA oversees the GDC and other professional regulators and produces reports to recommend improvements. In its latest report, Safer Care for All, the PSA states that tackling discrimination and inequality requires a collaborative, coordinated effort from all bodies involved in the provision and regulation of healthcare, including regulators.

The report calls on the GDC and other regulators to review and address “more directly and urgently” processes which may have a disproportionate impact on certain groups of registrants, and ensure investigators have the right tools to interrogate information included within a referral, to help avoid progressing complaints against certain groups of registrants that are not well-founded.

The PSA in its September 2022 response to the GDC’s consultation on its strategic plan for the next three years, also asks the GDC to consider how it is embedding equality, diversity and inclusion across all workstreams, and in relation to all strategic priorities.

Dr Raj Rattan, Dental Director at Dental Protection, said: “All dental professionals have the right to an inclusive environment, and regulatory processes that are fair and just.

“The GDC’s 2021-2023 vision is to be a champion of diversity, equality and inclusion and one objective is to ensure that regulatory activity is fair and transparent. This includes analysing over-representation in fitness to practise cases and what this means. 

“We are pleased to see this focus and recognise there are multiple and complex factors behind this issue. However, the PSA is right to call on the GDC, alongside other regulators, to address the issue more directly and with more urgency. We stand ready to work with and assist the GDC in this area wherever possible.”

A spokesperson for the General Dental Council said: “We too welcome the PSA’s report, Safer care for all, and look forward to further discussion with the PSA and other healthcare regulators about the important issues it raises.

“We are committed to ensuring our regulatory activity is fair, transparent, and accessible to all, and appreciate Dr Rattan’s recognition of the complexity of understanding what leads to overrepresentation in fitness to practise. We reflected on this in August when, for the first time, we were able to include a breakdown of cases by EDI characteristics in our Fitness to practise annual statistical report. While we are at the early stages of understanding what the data tells us, its inclusion provides a clear signal of our commitment to this important work, and we look forward to speaking more about this as it progresses.”

Dental Protection: GDC strategic goals must consider registrant mental wellbeing

Dental Protection has urged the GDC to ensure one of the key pillars of its three-year strategy includes reducing the impact of a fitness to practise investigation on registrants’ wellbeing.

In its response to the GDC’s consultation on its strategic plan for the next three years, Dental Protection welcomed the second strategic aim to ‘ensure concerns are addressed effectively and proportionately to protect the public’ but it said proportionality is also integral to the wellbeing of registrants.

Dental Protection has called on the GDC to ensure this strategic aim considers registrant wellbeing and helps to address the level of fear that exists among dental professionals regarding a GDC investigation.

Dr Raj Rattan, Dental Director at Dental Protection, said: “We agree that driving improvements to ensure the public’s concerns are addressed effectively and proportionately should be one of the GDC’s main strategic priorities. Dental Protection would like to work with the GDC on this aim, in particular on the desire to move towards a system which resolves complaints with only the most serious being dealt with as a fitness to practise investigation.

“Proportionate use of powers is integral not only in protecting the public but in protecting the mental wellbeing of registrants who may find themselves being the subject of a complaint to the regulator. We believe that reducing the stress of a fitness to practise process is a key tenet of the GDC being perceived as fair and proportionate and therefore should form a key part of this strategic aim.

“The level of fear that exists amongst dental professionals regarding the GDC is concerning. In a recent survey of early career dentists nearly a third told us they worry about a GDC investigation always, most of the time, or frequently. Fear does not support a culture of openness and learning; something all healthcare professionals should seek to foster. In respect of the GDC, this fear appears to stem principally from the fitness to practise process.

“We appreciate the GDC is making improvements in this area, but we hope more can be done. For example, we believe the GDC could explore how initial contact is made with a registrant to reduce the stress from what will always be an unpleasant letter to receive. A review of its style guide, perhaps considering best practice across regulators, could also be implemented as part of its strategic aim.

“While we understand certain legal information must be imparted to registrants, the tone and language of some written communications can cause unnecessary distress, overwhelm, and impact on mental wellbeing. Tone and language are also useful tools in creating a sense of proportionality.

“We would welcome the opportunity to work with the GDC to enable further progress in this area.”

GDC response 

A spokesperson for the General Dental Council said: “We thank Dental Protection for their response to the consultation on our strategic plans. We look forward to considering their views alongside the other responses we received and will share the consultation outcome after Council has decided on our plans for the next three years.

“We understand that a fitness to practise investigation can be a stressful experience and agree that proportionate use of powers plays a significant role in that. In the absence of government reform, we continue to explore and make improvements wherever possible, but we are often frustrated by the outdated and inflexible legislation which dictates much of our work. We look forward to working with our stakeholders to ensure that our role is understood and to make appropriate contributions to issues of shared concern across dentistry, including the experiences of those going through fitness to practise.”

GDC: Thousands of DCPs yet to make a compliant CPD statement

With just under two weeks to go to the deadline for dental care professionals (DCPs) to make a compliant CPD statement, almost 6,000 are yet do so. Within that number, around 4,600 are yet to make a statement at all, and 1,400 have made statements which do not comply with the rules.

CPD rules require dental professionals to make a compliant statement every year, as well as at the end of their five-year cycle, by the 28 August, and the GDC is calling on DCPs to make sure their statements are in order before it’s too late.

GDC Chief Operating Officer, Gurvinder Soomal, said: “The vast majority of dental care professionals renewed their registration last year with no complications, but more than 3,100 didn’t meet the CPD rules in 2021. That’s 3,100 DCPs who had paid their annual retention fee and made an indemnity declaration but failed to be compliant on CPD. We know that many of these were simple administrative oversights.

“This can have serious consequences for the individual, and for the team they work in, as non-compliance can end up with removal from the register. I’d encourage DCPs to check now to make sure everything is in order.”

For the last eight weeks the regulator has been urging DCPs to check to make sure they are compliant on CPD and encouraging employers and the wider dental team to think about how DCP colleagues could be supported to avoid problems. More recently, this has included a range of communication with DCPs who have not yet submitted a compliant statement — the latest instance being a text message on Friday 12 August — and affected DCPs are encouraged to read that information and get in touch with the GDC if they are unsure about what to do.

The quickest and easiest way to make a CPD statement is through eGDC, and it takes just five minutes to set up an account if one is not already in place. The GDC provides further guidance and information about Enhanced CPD on its website.