Institutional Arrogance

Many of you will be reading this from the sneaky preview of your ‘mobile device’ while on holiday so I will keep my mumblings brief. Don’t want the present Partners or Spouses to my dear readers getting a holiday stress on!

Holidays are of course the time when you re bond with the family, and past troubles diminish in their significance such that when you return, the sun still shines and the daises are growing. Holidays allow a new focus on the real issues such as the performance of the many Premier League teams.

If you are single of course holidays can be a “fun” time, strangely challenging in some respects. The STO or Short Term One-nighter relationship can lead to some interesting morning conversations.  Matters of Validity of Consent can raise their head.

And so it is, in your professional area of work.  

I do, I do I do …

You will return from holiday to a focus on your note taking and records like never before. For some time this has been defensive, and a recent case [1] now confirms that it is not enough to record what treatment you undertook. You must now have a discussion with your patient about the risks or proposed treatment, and you must know your patient sufficiently well to apply context to those risks, and the end result will be that the patient should be able to agree to a course of action of their own free will.

GDC Standards for the Dental Team was of course ahead of the consent game by stating in 2013

3.1.2 You should document the discussions you have with patients in the process of gaining consent. Although a signature on a form is important in verifying that a patient has given consent, it is the discussions that take place with the patient that determine whether the consent is valid.

3.2.2 You must tailor the way you obtain consent to each patient’s needs. You should help them to make informed decisions about their care by giving them information in a format they can easily understand.

This of course all takes time. As busy GDPs in mixed practice, that is the one thing that most of you will lack. The threat of an FtP case against you however focusses your mind.

Welcome back to the Autumn of un-squareable circles, as the GDC in their lofty arrogance see no reason why you should have a problem, that body being out of touch with reality.

OK …  Talking of that body the GDC  …

If you have not heard, the problems have officially been fixed. Hurrah!

The Professional Standards Authority issued a report [2] being most unfair & critical of the GDC. The GDC Press release [3] in response was beautifully dismissive – a masterpiece in Institutional Arrogance. Taking arrogance to a new level. Real Premier League stuff

We have already instigated a significant programme of change within the GDC which will help us to support dental professionals to deliver high standards of care and maintain public confidence in the profession.  

You would never guess that the PSA were critical in the extreme, the GDC being a long way below the standards of other regulators. Someone has to come bottom of the class but the GDC take that ‘achievement’ to a new level. You hear the PSA sighing in frustration.

Constantly we hear the mantra from the Executive Suite in Wimpole Street that a new Parliamentary Section 60 order is needed. And yet we read in Fitness to Practice rules [4] as follows:

Initial consideration by the registrar.

The registrar shall consider a complaint or other information in relation to a registered dentist or a registered dental care professional, including a dentist or dental care professional whose registration is suspended, and shall determine whether a complaint or information amounts to an allegation

So the reality of the GDC’s crisis is that it is entirely in the hands of the Registrar to create a system to sort out the wheat from be chaff in letters of allegation received.  Instead of picking true FtP cases, the Registrar operates a set of rules in which it seems that any allegation is considered seriously.  Good grief, the Caseworkers are in some cases a contracted company. 

The GDC has descended to the role of a commercial Complaints Handling body.

Standards is being used as stick to beat the profession and not as a level of practice to which to aspire.

Fitness to Practice is not a Regulatory function in hands of Ms Gilvarry, it has become a commercial operation of immense cost, be that financial to the wider profession through the ARF, the financial cost to a dentist under investigation, or of course  the emotional cost to dentists.

The way that Ms Gilvarry operates demonstrates that she has mastered the delivery of Institutional Arrogance. In the Chairman, Dr Moyes,  she has a willing partner who has revoked his role of oversight.

Who will rid us of this rotten leadership? The summer may be over but the need remains.

Coalescence

It is time for the six registrant members of the GDC to seriously consider their positions. I assume even they were shocked at the GDC’s Press Release.  The BDA and FGDP, perhaps with DPL, & DDU, and perhaps with Denplan, Practice Plan et al, have a massive role here through the BDJs editor’s concept of Coalescence[5]. Action is needed to grab the attention of both the Minister and the Council.

Unless of course they have all caught the Institutional Arrogance disease

 [1]The Montgomery case - Montomery -v-  Lanarkshire health Board Scotland 2015

[2] PSA link

[3] http://www.gdc-uk.org/Newsandpublications/Pressreleases/Pages/General-Dental-Council-response-to-the-PSA%E2%80%99s-report-%E2%80%9CRethinking-Regulation%E2%80%9D.aspx

[4]  http://www.gdc-uk.org/Aboutus/Thecouncil/Meetings%202006/Items%208%20and%209%20FtP%20Rules.pdf

[5]  BDJ leader Vol 219  No 2 July 24^th  “Coalescence”  Stephen Hancocks OBE

Oh cripes, oh crumbs! What have I gone and done?
I’ve only gone and broken GDC Principle Number One.
I tried so hard to put his interests well before mine,
But he works shifts and wanted me on Sunday at half-nine
Does an FtP await me?

Oh cripes oh crumbs! Now I’m in the poo!
I’ve only gone and broken GDC Principle Number Two.
I tried to communicate effectively, I really really did.
But he's a Glaswegian Kiwi and I couldn’t understand what he sid.
Does an FtP await me?

Oh cripes, oh crumbs! They’ll hang me from a tree!
I’ve only gone and broken GDC Principle Number Three.
I thought consent was valid, I really talked it through,
But his Uncle’s anti-fluoride and now they’re going to sue
Does an FtP await me?

Oh cripes, oh crumbs! They’ll strike me off for sure
I’ve only gone and broken GDC Principle Number Four.
His wife checked his appointment, the nurse said he wasn’t in
He was knocking off his secretary, committing carnal sin
Does an FtP await me?

Oh cripes, oh crumbs! They’ll boil me alive!
I’ve only gone and broken GDC Principle Number Five.
Anyone can complain to us, be it grumble, moan or wail
We thought me made it pretty clear, but we don’t have them in Braille!
Does an FtP await me?


Oh cripes, oh crumbs! They’ll torture me with sticks!
I’ve only gone and broken GDC Principle Number Six.
I referred her to a Specialist, one I’ve used a lot,
But she wanted to see another one, and now I’m in a spot
Does an FtP await me?

Oh cripes, oh crumbs! This is DLP’s heaven
I’ve only gone and broken GDC Principle Number Seven
I thought I could root fill a tooth, but I’m not able to you see
There are many many lawyers who know much much more than me!
Does an FtP await me?

Oh cripes, oh crumbs! Is another career too late?
I’ve only gone and broken GDC Principle Number Eight.
I thought her weight loss was down to a calorie controlled diet
I didn’t know she was under stress and I shouldn’t have kept quiet
Does an FtP await me?

Oh cripes, oh crumbs! Open the bottle of wine!
I’ve only gone and broken GDC Principle Number Nine.
I try to be upstanding, honest, good and true,
But I follow the GDC’s example – now that JUST WILL NOT DO!
Does an FtP await me?

Mike Ingram