The issue of revalidation has been brewing for some time in the minds of those that feel that dentists need to be monitored even more than they are already.
We have recently had to implement HTM 01-05 to monitor our use of cross-infection control processes and the Care Quality Commission guidelines to monitor the suitability our practice premises. In addition to these new requirements, the General Dental Council is actively considering revalidation as a means of ensuring that dentists are competent at doing (at the point of graduating from dental school) what they were trained for, and meet the minimum standards on an ongoing basis. Revalidation is seen as a method of ensuring that dentists are keeping to standards of current best practice by overcoming the failures of continuing professional development.
The GDC states: 'Patients need to have confidence that the professionals providing their dental care have not only shown that they meet our standards when they join our registers, but can show that they continue to meet the standards expected of them over the course of their working lives.'
In my opinion, however, revalidation is yet another regulatory hurdle for dentists to jump over. Complying with the demands of revalidation will, ironically, perhaps mean even less time to treat our patients. The British Dental Association agrees with the view expressed by the working group on non-medical revalidation that the intensity and frequency of revalidation must be proportionate to the risks inherent in the work that a practitioner is involved in. My hope is that the GDC will listen. I was pleased when, at the BDA/Eastman careers conference on February 4, Alison Lockyer, GDC chair said that the GDC would carry out a cost-benefit analysis of revalidation to ensure that it was not overly burdensome and costly to implement. I hope this analysis is indeed carried out and the results made public, as dentists are fed up with increased monitoring and regulation with no apparent equivalent benefit.
I attended various workshops on this issue when I was chair of both the BDA Young Dentists Committee and BDA Students Committees. Invariably, the discussions started off with the need for revalidation but then moved on to the even more pertinent question of when validation
should first take place. One option was for this to take place after dentists graduated from dental school but before they started vocational training/foundation training. However, I thought this would unnecessarily prolong the validation process and said that perhaps the GDC validation could take place concurrently with university final exams or even replace them. A further exam presented another conundrum. It would not look good for dental schools if graduates passed their exams but the GDC then found they were not fit to practise! Another option considered was that validation could start after a period of vocational training/foundation training, upon satisfactory completion of an exit exam.
One of the GDC's aims in bringing in validation is to ensure that all new registrants to the GDC would have to achieve the same result, no matter which route they took to get there. This means it would apply to graduates from any country wishing to work in the UK. However, it seems a little unfair to UK graduates who, having passed their (GDC approved) dental degree, would have to sit yet another exam to be allowed to work independently in practice. In previous years, the undergraduate degree was four-and-a-half years. It is now five years long, and the introduction of vocational training has added yet another year before dentists can work independently in NHS practice. It has been proposed that the validation period may be as long as two years, if that turns out to be the case then UK graduates could have to undergo seven years of supervised training before they can work independently in practice.
I question the need for the GDC validation period. Proponents argue that UK graduates are not competent enough to practise independently when they leave university. The argument I put forward as chair of both committees previously, was that if that was the case, then surely we need to look very carefully at university dental course syllabuses. If graduates are not leaving university as competent young dentists, something needs to be done about their time in training during their initial five years. A leading light in the GDC once said that there is always demand to add new subjects into the undergraduate dental curriculum but not the same clamour to take things out. Surely what's needed now is an in-depth review of university dental courses and teaching methods and if something needs to change, rather than add extra hurdles to those starting out in their careers, let's focus our energies designing a curriculum that is fit for purpose.