GDPUK.com Opinions :: Brian Edlin : Walking the Line
Brian Edlin looks at DCP registration from a dento-legal perspective. The clock is ticking down with the 31st July GDC registration deadline coming ever closer.
Will laws be broken, and on which side of the team? Who will be blowing the whistle, and will the Professional Conduct Committee be even busier?
| Brian Edlin qualified from Glasgow in 1971. After a resident house job in Oral Surgery at the London Hospital he entered General Practice in Manchester where he worked for 29 years, running two practices, one NHS and the other fully private. Brian was an elected member of the Manchester LDC for 23 years and was Vice Chairman for many years until he left General Practice. He remains as a co-opted member. Brian joined Dental Protection ( DPL ) in 1995 as a Part time Dento Legal Adviser. He became a full time DentoLegal Adviser in 1998, and Senior Dento Legal Adviser in 2002. He is now Head of Dental Services at DPL’s Leeds office and has overall responsibility for DPL’s members in Scotland, Northern Ireland and Israel. He also has responsibility for members working in the Salaried Services ( Hospital, Armed Forces and Community). Brian has lectured extensively both in the UK and abroad on Risk Management topics. In his spare time Brian relaxes by cycling, running and reading.
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Walking the Line
Brian Edlin looks at DCP registration from a dento-legal perspective.
Anyone visiting the GDC’s Website will be reminded that the clock is ticking towards the end of July when all Dental Care Professionals (DCPs) working within dentistry will need to be registered with the GDC otherwise they will be breaking the law. The only exception to this is dental technicians and dental nurses who are still in training for a registerable qualification.
Some will see this as a positive step since most DCPs are likely to develop a feeling of belonging, as well as developing a far greater sense of responsibility, both to patients and to the dentists with whom they work. DCPs will be governed by the same ethical guidance, laid down by the GDC, as dentists. Any failure to comply with such guidance, such as a registrant who has been found not to have acted in a patient’s best interests or has been shown to be dishonest ( in any setting), could end up with the registrant losing their Registration if reported to the GDC.
The world is changing in many ways, and attitudes to healthcare have altered since the Shipman and Alder Hey investigations. It can be argued that the regulatory bodies in the UK seem to be adopting a more hawkish approach to their investigations and in dentistry we are seeing cases investigated at Conduct Hearings, which five years ago would probably have been dealt with through correspondence alone. It is important that as a profession we keep our house in order, and are seen to do so, and to maintain the confidence of the public through maintaining high ethical and clinical standards. It is imperative the Dental Schools, through their curriculum, and the various representative bodies, make sure those who are entering the dental profession are acutely aware of their responsibilities and the potential jeopardy they may face should they deviate from the GDC’s current guidance.
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Historically the GDC’s Professional Conduct Committee met twice a year. They met for two weeks in May and two weeks in November, and quite often they had difficulty in filling all the days. The world has now changed and currently Conduct cases are being heard on most if not all working days throughout the year. On a number of occasions two cases are heard concurrently in different parts of the GDC and it is likely this trend will continue, if not increase.
There are those who believe that registration will empower DCPs to follow a similar direction to General Nurses and Hospital Technicians and strive for more consistent working arrangements and conditions which can only enhance their status and morale. By now some Clinical Dental Technicians have set up their own clinics to make complete dentures for patients. Some will be investing quite a bit of time and money in their businesses while some may wish to work alongside their dentist colleagues and have the opportunity to carry out other types of prosthodontic treatment on prescription.
Over the years some dentists have developed a kind of love/hate relationship with their dental technician. They will show them unconditional love when the crown or veneer fits like a glove and the shade was so good that they and the nurse actually volunteered the mirror to the patient.
The other side of the coin is the nightmare scenario of the patient coming in, last thing in the evening for the fit of a remake crown because they are going on holiday the following day and the crown still doesn’t fit. This can evoke a “surgery rage” even with the most meek and mild, and it begs the question whether it should be a Health and Safety issue not having the technician working on the premises as the dentist. Of course in some cases the fault may not necessarily rest with the technician and as a result some technicians may decide to adopt a stronger line with dentists who send them impressions which leave more to guess work than to expertise. Registration should allow dental technicians to maintain their high standards and charge a realistic fee for their work. Some of their work can be classed as works of art. This may be the time to lobby the Department of Health to look at other ways of remunerating dentists and/or technicians for producing high quality precision laboratory work.
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Technicians are bound to seek their own advice on how to deal with the dentist who sends consistently poor quality impressions or who won’t settle their outstanding lab bill. The question would be whether this would constitute an allegation of being unfit to practise. I have recently dealt with a case where a dentist received a warning letter from the GDC for failing to settle an outstanding account with a supplier. The impression I got was that this was the yellow card and that it will be the red one if it happens again.
In other jurisdictions around the world DCP registration seems to work well and promotes good working relationships and mutual respect. Some dentists do worry that other dentists or DCPs may report them to the GDC about a certain skeleton in their cupboard, if something happened which caused a major fall out. Dentists and DCPs have an ethical responsibility not to turn a blind eye if they believe a colleague is being dishonest or unethical. We do see a number of cases aired at the GDC each year where dentist A has reported dentist B because dentist A felt they had an obligation to do so as they felt patients were being put at risk. If patients are being put at risk, then yes, reporting the concerns to the GDC is one way of dealing with it, but would normally be seen as a last resort unless dealing with it at a local level has failed. If the problem is very serious then reporting the concerns to the GDC would be considered acceptable. To ignore it would put dentist A at risk as well as the patients being treated. By going it alone, and not discussing the concerns with another colleague at the outset, can sometimes leave a dentist feeling vulnerable if the complaint progresses to a Hearing and they are subjected to tough cross examination by dentist’s barrister who may try and show that the complaint was made because of personal malice rather than for altruistic reasons.
Mutual respect and high clinical standards will go along way to allay any fears in this respect, which at the end of the day can only benefit the patient and the well being of the dental team. Post Shipman, the regulatory bodies are less likely to turn a blind eye to any form of concern or complaint irrespective of who makes it. Anyone who has had a complaint against them will be aware of the effect it has on their gastric mucosa and coronary arteries and to some; it’s a bit like walking the line!
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