The Dentist Magazine.

Shift the balance, but fitness to practise must come first

Published: 27/04/2017

The British Dental Association (BDA) has told the General Dental Council (GDC) it must focus on the fundamentals and fix fitness to practise, as it responded to plans set out in the regulator’s Shifting the Balance document.

Of the nearly 2,300 dentists who took part in a wide-ranging BDA survey, 71 per cent said they wanted to see making fitness to practise fit for purpose the GDC’s number one priority, with ideas for expansion of the regulator’s remit and activities all scoring poorly. Nineteen per cent put the GDC’s signature concept of ‘upstreaming’ – focusing on reducing the likelihood of harm arising in the first place – as a top priority.

The survey also revealed the profession appears open-minded about ministerial plans to merge health regulators. Two-thirds of respondents said they would support a dedicated dental regulator, but a similar proportion would back amalgamation if greater efficiencies could be achieved.

Despite official claims that the Dental Complaints Service (DCS) is well regarded among the profession, the survey has also pointed to significant concerns from those with direct experience of the service, and support for moving complaint handling away from the regulator – with only 13 per cent of respondents supporting the GDC’s continuing role in this area.

The BDA has now called for a formal, independent review of the DCS before any consideration is given to extending its remit.

BDA Chair Mick Armstrong said: 

“We asked dentists what they would change about dental regulation. They painted a picture of an overbearing regulator that really needs to focus.

“Dentists want a watchdog that can get the basics right, and that has to start with fitness to practise. Talk of expanded remits and ‘state of the nation’ reports are the wrong priorities when the GDC cannot deliver on the fundamentals.

“Colleagues appear open-minded about upstreaming. There is a place for blue-sky thinking in regulation and we recognise that fixing things before they get to the regulator makes sense for patients and practitioners alike. But it is the view of this profession that the GDC’s core statutory responsibilities must come first.

“Our members would like to support a dental-only regulator, but not at any cost. Dentists are realists when it comes to plans for merger and, clearly, many doubt the GDC is capable of putting its own house in order. We will be equally pragmatic as we continue to push for a regulator capable of working with and understanding this profession.”

The BDA’s response isavailable to download

Headline points

  • Confidence – Confidence among dentists in the GDC’s ability to deliver on its reform agenda remains low, with 87 per cent of respondents to our survey neither ‘confident’ nor ‘very confident’ in the council.
  • Priorities –Fixing fitness to practise is the top priority of dentists, with 71 per cent of respondents putting it as the number one priority for reform. Other planned changes – such as expansion of the Dental Complaints Service, providing information about dentistry for the public and a regular state of the nation report on dentistry – were each viewed as top priority by less than 4 per cent of respondents.
  • Respondents were open minded about ‘upstreaming’ – refocusing GDC effort to try to reduce the likelihood of harm arising in the first place – this was a top priority for 19 per cent of respondents and the second most important priority after getting FTP right.
  • Merger –65 per cent of respondents expressed a preference for a dedicated dental regulator – but a similar proportion (62 per cent) said they would support an amalgamated health care regulator if greater efficiencies could be achieved.
  • Support for dental regulation comes with conditions, including overwhelming support among 94 per cent of respondents for the chair of any dental regulatory body being a dentist.
  • The Annual Retention Fee – the ARF was raised in 2014, specifically on the basis of anticipated complaint levels and FTP action in 2015 and 2016. This was contentious at the time, but now that complaint levels have not increased as predicted, 88 per cent of respondents support a reduction.
  • Eighty-two per cent of respondents would support the ability to have the option to pay the ARF by monthly or quarterly instalments – even if this could mean a slightly higher fee.
  • Dental Complaints Service (DCS) – 55 per cent of those who had experience of the DCS rated the experience as ‘poor’, with 18 per cent rating it as ‘fair’; only just under 12 per cent rated it as ‘good’ and 2.5 per cent as ‘excellent’. This clearly contrasts with the assurances given by the GDC and the DCS. 
  • There is significant support for moving any expanded complaint handling service away from the GDC. Thirty-nine per cent of respondents wanted LDCs to play a major role in the provision of such a service, which would also support the move of complaints handling to the local level. Only 13 per cent of respondents supported the GDC’s continuing role in this area.
  • Defensive dentistry – the pressure to practise ‘defensive dentistry’ emerged as a key theme in free text responses – without any external prompts. This cannot be in the interest of patients and is also not in the interest of a profession that, by definition, relies on scientific evidence to do the best for the patients it serves and is keen on developing new skills.