Where's the CDO? - The week when we could have done with a bit of guidance
Well YOU Ticked The 'Unprofessional' fox, So What Po You Expect? - That New GDC Survey In Full - By Ex-DentistGoneBadd
(An Interview With A Former Member)
The General Dental Council’s work in disciplinary matters is sometimes not fully understood by dental practitioners. The revelations over the past few weeks that the GDC is registering overseas dentists as dental therapists without a thorough check of their practical abilities, that they withheld evidence which resulted in a fraudulent dentist being restored to the dental register, and that they have used private detectives to entrap registrants, has opened the GDC’s registration and disciplinary processes to close scrutiny. These recent stories on the GDC suggest those disciplinary processes to be more mysterious than ever.
GDPUK has been fortunate in being given the opportunity to speak frankly with a recent ex-member of the GDC’s Fitness To Practice panel, which helps determine the professional fate of over 112,000 registrants.
Peter is a clinician with over 28 years of experience in dentistry. He is currently working full-time in private and NHS practice. We have been asked not to reveal his identity.
It sounds like a lot of hard work. What made you want to serve with the GDC?
Serve? An interesting terminology there. The GDC has the statutory function of regulating the profession and whilst to many it seems odd, I wanted to be a part of this. Someone has to do it. I thought it might as well be me. You can stand on the outside and criticise, or you can be on the inside and see how the machine really works
Briefly, what were your duties on the committee on which you served? What is the makeup of the committee on which you served?
I sat on the Fitness To Practise panel and as a consequence, you sat on all the statutory committees. They are independent of the GDC – which is a challenging concept, given the GDC writes the committee guidance. On the FTP panel, you read, listen to and evaluate evidence presented. The civil legal standard is used so you find evidence on ‘the balance of probability.’ I personally believe it should revert back to the criminal standard. Beyond reasonable doubt stops charismatic barristers winning you over.
What training do committee members get?
It really isn't as intense as it should be. There is far too much concentration on ‘soft skills,’ such as communication and people skills, rather than legal understanding. I often felt it lacked any real depth. That said, the whole selection process is (allegedly) designed to select individuals that are able to carry out the workload. I personally doubt that, and feel the recruitment process is biased since the GDC seeks to ensure diversity. That aim is incredibly important since the profession is diverse, yet there is a part of me that is convinced that the recruitment process is flawed for this very reason
What sort of cases did you hear?
I heard cases involving all classes of registrant. They were, in broad terms, clinical or criminal. In addition to this there are health cases. Some were easy, some were extremely challenging due to the nature of the allegations.
Did you feel the cases brought before you were justified?
Ah, well, that’s a very difficult question to answer. In some cases yes, in others, no. When a dental professional is convicted of paedophilia then there's no discussion, but when a registrant is in front of a committee with a huge list of allegations that were clearly gained after the original index complaint, then it becomes difficult to clear the mind. The committee can only hear the evidence presented to it (alongside the allegations) yet I personally struggled with the concept. Indeed, in some cases (more than ever should have been) the original index complaint never even made it into the hearing. This conflicts with my personal sense of justice. The GDC managing to amass a long list of allegations based on its investigation was, and remains, of concern to me.
There are some criticisms that caseworkers can be over zealous when preparing ‘charges’ against registrants. Are these justified?
My personal issue with the caseworkers is that they lack any real knowledge of the profession. It can be reasonably argued that they don't need it to just list allegations, but this argument is fundamentally flawed as their inability to understand what is important and relevant is only dictated by guidelines they work to. The system is evolving with dental professionals now involved, but it is currently still lacking serious input
Do you think the makeup of committee’s is balanced and makes for a ‘just’ system?
Committees have to contain various elements in order to make them work. Prior to 2003 the ‘old school tie network’ led to many cases that were serious, failing the patients. There was a time when committees sat with five members. Nowadays, because of cost-cutting, it is invariably three. (The cost per day, per person plus expenses, is considerable). A three-person committee is unbalanced. It comprises one Lay, one dentist and one Dental Care Professional (DCP). One strong individual can influence the other two in my personal experience and a dominant influence means the case will fall their way. It's inadvertent "bullying" and this is why there is a focus on soft skills in the training process. Reverting to the criminal standard would eliminate this bias and mean that an individual’s influence would be more difficult to exert. It's either that or revert to ensuring committees sit with five members. One strong personality has to try much harder to convince four other members of his view.
Do you feel that decision making is hampered by Lay people?
No. The Lay perspective is very important BUT this must be balanced. I have already suggested that a strong personality can influence a committee. The Lay person is potentially the most at risk yet, again, a five-person committee would reduce this bias.
Quite often, registrants complain that they can also face ‘dishonesty’ charges in addition to the main charge – why are these added?
The dishonesty allegation actually tends to be a "collection" of allegations. It seems to arise from (again) expert evidence where the report writer may suggest that a "thing" couldn't have happened. It tends to be termed ‘inappropriate,’ ‘misleading’ or ‘dishonest.’
This to me seems to be a ‘get you one way or another’ allegation. They are usually listed as individual allegations that seem almost a snare. The GDC has to work to the remit the Professional Standards Authority decides and that overarching organisation seems to take great store in allegations that demonstrate dishonesty. Apparently, it is extremely difficult to remediate someone one who is dishonest. I'll let people make their own minds up on that aspect, but will say, to err is human.
Do you feel registrants are treated fairly in the FTP process?
Yes. Whilst to many from the outside it seems a draconian process, as a tribunal it has to follow English law. It is a quasi-judicial committee and it relies on expert input. As a committee member, you are not party to the build-up of a case but as a process, it is probably far too protracted for the comfort of a registrant.
Is it justified or necessary to go outside the index complaint and delve into all aspects of a dentist’s practice?
In my opinion, no. Now, if there was a very obvious risk to patients then certainly. But one complaint of a seemingly simple problem seems to lead to an escalation of the issues by ‘investigating’ the individual. I personally believe that if the index complaint falls away then the investigation should be stopped. This is not a criminal court. It has no powers other than to stop someone practising dentistry. But, and this is where I struggle, many employers may ask if you have ever been subject to an investigation. It won't appear on any criminal record but you would have to declare it - potentially ruining someone's future prospects because they failed to record someone's smoking habits.
Do you feel lay members fully understand the seriousness of their decisions on the registrant?
That's extremely difficult to answer. I have worked with some outstanding people and a few challenging individuals. One thing they have to learn is that, the consequence of a previous decision needs to be put aside by committee members. You can't let previous decisions regarding a registrant influence your decision. An example would be a registrant convicted of fraud in criminal court, but you are not convinced they were as guilty as the court found them. You must take it at face value. As a committee member you can't hide behind a previous verdict and you can only base decisions on the facts presented.
I think it is important to remember that some Lay members are, in essence, professional committee members and may sit on several tribunals and be extremely competent in what they do. That has a flip side, because a ‘professional’ Lay person then ceases to be truly ‘Lay.’
Did you ever feel that you your views were disregarded or overruled by the GDC or other members of the committee?
Yes. But that isn't always a negative. The whole point of having a minimum of three people sitting is so that a majority decision can be made. Your opinion will be heard but not necessarily agreed on. The GDC never influenced my decisions other than the published guidance (which is a separate question).
Do you think the GDC is currently fit for purpose with regard to disciplinary matters?
It is very easy to be critical and I think we are no different to our nursing/medical colleagues regarding professional regulation. By that I mean as long as there is a process whereby a professional’s conduct is questioned then no one will be happy. I have already raised some points regarding this. I do find it very bizarre that committees sit and hear evidence even though a registrant has said they are not going to attend/engage and indeed, are no longer working within dentistry. I once asked the GDC about the costs of a case, in 2009. A three-day hearing for a dental nurse who was never going to attend (she had actually written in saying they could ‘stick’ dental nursing), yet the committee sat and suspended her for 9 months. It cost in excess of £50k to hear this. I never followed up the individual after the period of suspension ended. When this happens (another area that is far too common) then no, it isn't fit for purpose. That was (at the time) the equivalent of the ARF of 50 dentists.
There is another area that makes me question the ability of the GDC to consider itself fit for purpose. This relates to the whole world of eggshells that is inclusivity and diversity.
The drive for diversity and inclusion is extremely noble and proper but shouldn't be a reason to put people in to the role that are essentially carried by more illuminated individuals on panels. The drive to hit inclusivity targets has skewed recruitment into the role rather than ensuring individuals have the ability and capacity to deal with the huge amount of information they are fed"
Do you think the source of complaints has changed over the years? Are there more fellow registrants reporting on their colleagues as ‘whistleblowers?’ If so, what do you feel their motivations are. Could you estimate the proportion of patient-generated complaints vs dental professional-generated complaints vs those brought by health authorities?
I despise the term "whistleblower" but I do genuinely think that motives vary. They go from genuine concerns, to vexatious ex-employees, to other motivations. There was a time when it wasn't the done thing to criticise another individual’s work. I don't necessarily think this is right but I do think there seems to have been a drop in professional discretion. Simply criticising some previous work for personal gain is shocking.
A committee isn't there to judge whether a complaint is based on that, but you get some that come through and you know that the motivation was all wrong. Vexatious ex-employees should be simply filtered out. Part of the problem is that if someone decides to raise concerns then invariably mud is slung from one side to the other. This leads to bizarre accusations that damage everyone involved.
I think genuine concerns regarding safety of patients is important but those involved in the very early stages of a complaint should be more robust in filtering. When a legal firm is the initiator of a complaint then surely alarm bells relating to a litigation process should be sounding in the GDC s ears.
Do you believe that radical changes are necessary in the GDC? If so, what?
I'm not sure there is a need for radical change. Perhaps what is really needed is consistency. If you look at the turnover of staff at all levels then you realise there is a distinct lack of consistency in the executive function of the regulator. That can only lead to confusion over time.
It's a bit like Chinese whispers I guess. Over time, interpretation of the way things SHOULD be done, is diluted. That said, I am still puzzled why any dental professional would contact the GDC for advice on any matter other than their ARF. The shake-up maybe needs the GDC to again tell dental professionals they do not give advice. Go on, give them a call and ask for advice on something and they give it... especially interpretation of guidance. The only folk you should contact are your indemnity company
Despite the GDC’s stated intentions to reform their disciplinary processes, do you feel they will effect change?
I think change will be forced upon them. I think this is a little similar to something I've already said, without consistency then change will just be a hand grenade that will just cause mayhem. It also depends on what reforms they actually can make. What us registrants want would be very different to what they are allowed to do. The Professional Standards Authority is not blameless in all this. They (the PSA) have instilled a sense of fear in the executive function of the GDC by essentially threatening judicial reviews when it disagrees with a committee’s decision. They are the watchmen watching the watchmen. If they don't like something then they choose to challenge it. Change must happen top down, not bottom up
The GDC has recently been criticised for:
What are your views on these recent controversies, if any?
The GDC should really hang its head in shame over certain aspects of these three areas.
I have read online discussions regarding all of these and have (unsurprisingly) formed an opinion on all three.
With regard to the registration story I read, it suggested that the GDC see no risk from registering overseas trained dentists as dentists despite the fact they may have failed aspects of the normal route of entry on to the register as a dentist. ‘Shocking’ is my only response. How long will it be before such an individual is in front of a committee? Will the committee have the kahunas to criticise the GDC for this? (Committees can criticise the GDC, I once sat on a case where we did and, as was stated in the determination, we would have awarded costs against the GDC if we had the power).
I sat on several cases where private investigators were used. I was always extremely uncomfortable with this process but was assured it was perfectly legitimate to attempt to get a professional to offer something they're not allowed to do. It feels wrong...very wrong and should be stopped and indeed, in cases where this evidence was used, I feel the cases should be re-sat without this evidence.
I'm no lawyer but withholding evidence is surely a miscarriage of justice? Remember it works both ways. In the case that has been highlighted, it has been demonstrated that all is not well at the GDC. Withholding evidence to prevent a hold (adjournment or postponement) is damaging to all parties involved. It's interesting how the GDC has been extremely quiet in not responding to enquiries in this and other areas. That is worrying because stonewalling only increases suspicion.
Do you believe the GDC uses the ARF money effectively?
I have never analysed the GDC accounts although there are many that do. I think there may have been some mismanagement many years ago which left the GDC in a predicament. That aside, the ARF is, for all registrants, far too high. A dental nurse whose skill set is not comparable to that of a general nurse, pays far more yet is probably paid less - shocking and the hike up for dentists was shocking. The GDC is not ostentatious (any more) when providing lunch or accommodation so those outside the organisation that criticise this should be careful. The attempt to reduce costs is noble, but perhaps not severe enough.
Do you believe that it is difficult for individuals to effect change from within? Does the government need to take a role in regulation?
The GDC is attempting to reform but as an outsider it is easy to criticise. That aside, they really only have themselves to blame given that they choose not to answer enquiries and using underhand methods to gather evidence instils no confidence. They perhaps need to be open about their dealings with ministers and health ministry officials and about how they have to engage in order to ensure that the guidance they give reflects the changing nature of dentistry.
Endless consultations seem to only attract a certain type of individual to respond and they will never get a balanced response because that nineteen year-old dental nurse who works from 8 to 8 for £9 per hour just couldn't give a toss. And when she is called in front of a regulator that she isn't aware of other than they want money off her annually, she will just go and do something else if called before a committee. Who wants that stress when you feel like you're the bottom of the pile and getting paid peanuts? You are understandably not going to care. That is possibly where the GDC could easily reform. Look at how it manages dental nurses and dental technicians.
Employees and ex-employees often describe the atmosphere within the GDC as ‘toxic.’ What is your view?
I wasn't an employee. No FTP member is, so my fleeting visits to the various GDC locations would not give me an opportunity to assess the working environment adequately. But I do take websites that people post these comments on, with a pinch of salt. A vexatious ex-employee may put toxic postings on just to be mischievous or air a grudge.
Why did you give up your role with the GDC?
I realised that I had "done my bit" it is very easy to stagnate in the role. I think I intimated earlier, that there are essentially professional committee members. They're not all Lay. Whilst it is important to have a broad church on committees it is somewhat bizarre that academics and non-clinical registrants are making decisions about care standards in an aggressive UDA system or on private practitioners just trying to earn a living.
Now you are no longer involved with the GDC, do you have any views on the current state of regulation and the ‘fear’ that is said to be gripping the UK’s dental professionals?
Neglect, fraud and certain things need addressing for sure but sanctioning an individual for a speeding offence really pushes the remit. The GDC says these committees as not punishing individuals but I beg to differ. Suspend an individual for a year and you have denied them their income. These sanctions are punitive in even the simplest form. It was becoming, and continues to be, farcical – leading to protracted hearings for trivial matters that should be dealt with locally.
Back to the subject of reform, the GDC perhaps should engage an ombudsman in more cases to decide what the complainant REALLY wants. If it is retribution or just a matter of "where there's blame there’s a claim" then that doesn't protect the public. Look at the length of determinations for even trivial matters, amazing. The Professional Standards Authority forced that. No, I don't want to be a part of that anymore.
With regard to the culture of fear that has developed in dentistry over recent years - the professional indemnity companies are not playing ball either. Their fees are extortionate yet they have the audacity to criticise the GDC. In 28 years, I have had to contact my indemnification company just once. I wasn't impressed.
I actually believe the indemnity companies are mostly to blame for the culture of fear. Their courses are toxic and full of fear. “If you don't do X or Y then the GDC will have a case.” Having watched many, many cases I can hand on heart say, I often shook my head at the really useless arguments they would instruct the barristers to present. They use ‘expert’ evidence to counter GDC evidence rather than peer to peer evidence. The experts are invariably academics or specialists that are way out of touch with the pressures of general dental practice. There is a massive disparity there.
Finally, I would sometimes find the hypocrisy at the GDC amazing. The biggest example that STILL irks me to this day is in the Maintaining Standards document pre-2006. It clearly stated that “a dentist must not work to a target driven standard.”
Because of the new UDA-based contract, the GDC had to make sure that particular passage wasn’t included in the guidance following the introduction of the new contract.
And the GDC is independent of Government interference you say?
They've Been At It Again! - Your Weekly Update To The Activities Of Those Wacky GDC Folk. By @DentistGoneBadd
Dentistry is tough, I have written that phrase as an opening to several pieces in the past. Things haven’t got any easier, in fact quite the opposite. There is a crisis of confidence in many young, and not so young, dentists.
>A High Court Judge has criticised the General Dental Council’s Professional Conduct procedures after highlighting a “serious procedural irregularity” which allowed a fraudulent dentist to be restored to the dental register.
(How The General Dental Council Fouled Up – BIG TIME)
Anyone who read my blog of a couple of weeks ago, which attempted to satirise the General Dental Council’s recent online opinion survey, will probably not be surprised by the alacrity with which I have jumped on the opportunity to outline the following episode, which beset an unfortunate general dental practitioner a few days ago.
The following events are true. The main action took place on Friday 12th October, 2018. The names of the “very professional” GDC employees have been withheld and the name of the protagonist has been changed. With a deferential nod of acknowledgement of the recent Royal Wedding, I will call the protagonist, who is very well known to me, Eugenie. I thank her profusely for granting me permission to relate her sorry tale to you.
Eugenie is a GDP currently working in general dental practice in a dental corporate. Her precise location she would like to also keep secret, but she describes it as ‘Moderately gentile, Middle Earth.’
Eugenie has been an NHS dental surgeon for 30 years and after a career as a full-time GDP, she decided earlier this year, to take early retirement and “escape the nightmare of NHS corporate dentistry.”
Eugenie being ‘exceptionally anally retentive’ (her words), she put in the appropriate pensions paperwork to the NHS Business Services Authority, informed her employer of her intentions and also the local NHS Area Team.
The latter irritated her somewhat, since she received communications twice from the Area Team, asking her if she was taking ‘24 hour retirement’ – her Area Team being unable to fully comprehend and understand the phrase “taking full retirement.” The Area Team also asked twice if she could confirm she had told her ‘employers’ of her intentions – the Area Team also failing to remember the concept of self-employed associates.
Being mindful that the GDC had taken over £900 quid off her earlier in the year for 12 months of exquisitely executed administrative services, Eugenie wanted to get her money’s worth and decided to retire on December 31st, 2018. Remember that date, it is important. That date was disseminated to all those that needed to know at the business end of dentistry, and she decided as a conscientious i-dotting and t-crossing individual, she would also inform the GDC of her desire to be removed from the General Dental Register on……come on, I told you to remember the date…yes, correct, the 31st December.
Ten days or so after submitting her letter, the GDC sent a form back to her via email, for ticking and signing and posting. Eugenie was surprised to find that she didn’t have the final say as to whether she could remove her name from the Dental Register. It was up to the GDC to decide if she had a valid reason to leave and the letter advised her that she would be informed of the GDC’s decision on whether to remove her name, in due course. Eugenie speculated that this was possibly to prevent someone in a spot of forthcoming bother, from removing his or her name before the GDC had the opportunity to strike them off themselves.
On the form, Eugenie was adamant that she made it clear she was removing her name due to retirement AND noted on the form, her desire for that procedure to be carried on after….come on…..anyone….31st December, 2018.
Skip forward to last Friday, 12th October. Eugenie was on an ‘early’ and by 9.45am had seen a bridge prep, a filling and two examination patients. It was the custom at the corporate practice Eugenie works at, for reception staff to hand letters to dentists at lunchtime, or earlier if the letter looked like it needed early attention. On Friday, the head receptionist handed Eugenie an unopened letter marked ‘General Dental Council.’ Eugenie nearly tossed it behind the computer monitor for later perusal, suspecting it was a letter confirming her removal at the end of the year. But something, fortunately, made her open it, because it was a letter from a ‘Registration Operations Officer, dated 10th October informing Eugenie that she had been removed from the Dental Register as from 9th October – TWO DAYS EARLIER. This mean that Eugenie had not only worked illegally as a dentist that day, but since the previous Tuesday. In other words, she had been, without her knowledge, breaking the law for four days, with, presumably, invalidated dental indemnity insurance.
She was chilled to the bone when she looked at the GDC register online and found she definitely wasn’t registered.
The practice manager was called. Eugenie and the manager agreed that she had to stop work immediately and her day was cancelled. The next patient, sitting patiently outside her surgery was fortunately very nice about the fact that she had wasted a forty mile round-trip, and happily rebooked.
An understandably irritated Eugenie then rang the GDC and spoke to a ‘very nice lady’ who eventually told her that on neither Eugenie’s letter or returned form, had she informed the GDC of her retirement date. After Eugenie’s protestations that she knew she had put the date on both pieces of correspondence and following the GDC representatives’ ‘consultations with colleagues,’ the GDC lady apologised for the ‘mix up’ – she had apparently been ‘looking at another person’s letter’ when she had given the previous statement that there was no date on Eugenie’s correspondence. The GDC lady said that a member of the Registrations Team would ring her back.
After one hour, at 10.45am, there was no call and Eugenie rang again, this time speaking to an equally pleasant GDC worker. She couldn’t apparently raise the Registrations Team and so Eugenie left her with the chilling message “I’ll be back.”
At 11.45am, still no joy, but this time the original person Eugenie had spoken to, answered the phone. She said the Registrations team were at that very moment looking into the matter and would definitely be in touch in the afternoon. By this time, Eugenie had decided not to leave the practice until the GDC had telephoned on her mobile, not wanting to be caught out having to take a call in the car. She said she spent the whole morning whining to colleagues and swearing a lot, as well as threatening the Registrations people by email with ‘action’ if she was not reinstated immediately.
Around midday, a sheepish, very polite gentleman from the Registrations team telephoned Eugenie and apologised profusely for the mix-up and reassured her that she would be reinstated immediately and that her name would reappear on the register online, after midnight.
What confused Eugenie was that this particular Registrations officer gave her a totally different explanation as to why the mix-up had happened. The first GDC worker said that the wrong registrant’s application had been accessed initially, while this Registrations man was saying that while Eugenie’s first letter to the GDC clearly stated the date of deregistration had been seen and noted, a second registrations officer had processed the GDC form without seeing the original letter and that form did not state the date. To Eugenie’s recall, she did date the form, the need for the date being critically important.
On having an early finish on Friday, Eugenie fired off an email and recorded delivery letter to the GDC, asking for a scanned or hard copy of her returned form – a form they still had in their possession and had apparently accessed on Friday. This letter was mainly to check and reassure herself that she wasn’t actually going insane, so sure was she that she had put the date carefully on the form, which the GDC were adamant she hadn’t.
Eugenie checked online on Saturday morning and found that her name was back on the Dental Register.
So all’s well….or is it?
One of the primary roles of the General Dental Council is to, (to quote the recent survey):
“Maintain(s) a register of dentists and dental care professionals, and check they meet requirements.”
I dunno, but I would have THOUGHT that if there was any ambiguity with regard to a dental professional’s intended removal, they would have double-checked with the practitioner. The GDC had responded to the original request for removal by sending the form to Eugenie, so surely that correspondence could have been looked at? After all, it is the most final act in a dental professional’s working life.
The other question regards the first GDC worker’s statement that she had been looking at another registrant’s letter! What???? Another letter on Eugenie’s file belonged to another registrant? I mean, GDPR and all that, surely???
I REALLY hope you all took the opportunity to fill in that survey, and if you did, you give them Hell when they start the telephone survey.
Happy retirement, Eugenie xxx
Dear Mr Brack,
I have previously been a harsh critic of the GDC, especially in the days of the previous registrar. Indeed, I wrote many blogs that were well received by the profession. With the departure of the previous registrar, there was an opportunity for the GDC to begin to repair the damage it had done to the profession by the draconian and inefficient manner in which it had been led.
There appeared to be a time when the new team seemed to be developing a far more appropriate attitude to regulation, and I therefore felt it appropriate to perhaps watch the situation without commenting further. It was disappointing when Jonathan Green left, although I did feel that with you at the head of the Organisation (for indeed it is NOT a business but a QUANGO I think you will find) then there would be a continuation of the bridge building that was sorely needed.
However, whilst there seem to have been some minor improvements, fundamentally there seems to be no real change in the way the GDC wishes to be perceived by the profession and how it executes its statutory duty. Under the aegis of protecting the public, it is actually doing more to negatively affect the public it serves to protect by continuing to prosecute its role in a draconian and often arrogant manner. There is still huge a lack of insight into the damage it is doing to the morale and the well being of its registrants; damage that can be squarely blamed on the actions of the GDC itself.
Because when a profession is so scared of its very shadow that it can no longer function as it is supposed to, then the ONLY thing that will happen is harm to the public. That these professionals are so scared of virtually every treatment they do, every comment they make (including ones like this), and every action they take is a sad indictment of the way that the GDC is systematically destroying the very profession it regulates.
By retaining the ARF at the same level again, with yet another different reason than before, is symptomatic of the disdain and the contempt with which the profession perceive the GDC have for them. The profession are happy to be regulated, but by a fair, just, and right touch regulator. The continued heavy touch that the GDC continues to use cannot continue if the profession is to survive to be allowed to serve its patients as there will come a tipping point where we will no longer be willing to accept the duress of just turning up to work. If we placed a colleague under this type of stress in our workplace then WE would rightly fear being reported to our regulator.
We are human beings who set ourselves out to care for other human beings. There is no higher privilege than to care for another. However, we make mistakes, we are fallible. You are the same as us, a fellow of the Human race.
We rarely do things wrong deliberately, but we shouldn’t live in fear that the next thing we do both privately or in our jobs could end our careers and destroy our lives.
Please think of the damage that is being done to our profession by this apparent continued lack of insight displayed by the GDC.
The GDC have recently being taking a stance over professional conduct and particularly in regard to social media. The Standards say that we must not publically criticise colleagues unless this is done as part of raising a concern. I should like to make it clear at the outset of this blog that what follows is part of me raising concerns. Concerns that I feel are not being taken seriously enough, and some not even acknowledged as being concerning at all. This blog is in 2-parts. Part 1 will look at ‘bringing the profession into disrepute’ in the context of social media. It is perhaps timely in view of Mr Hill’s recent effort of justification over the need to suspend retired dentist Mr Pate under the pretext of ‘protecting the public’. Part 2 will look at my concerns over conflicts of interests. Both will, as usual, look at this in terms of recent events and cases.
So my part 1 concern relates to a fellow dentist who is a Clinical Advisor providing early advice reports to the GDC and the material posted on the public stream of their Facebook page. Our regulator tells us that we must not post material on public media that may undermine public confidence or bring the profession into disrepute. On this public-facing social media page, there is a joke about a sexual act, several slang references to parts of male anatomy and masturbation, a profile picture that is potentially racially-offensive (depending on the generation of the particular panel that might be selected by the GDC), but the finest one has to be the picture which blames patients for their gum disease and tooth decay because they are “*insertslangformasturbators*’’. Yet this Clinical Advisor, wrote in an early advice report for the GDC that a dentist who communicated with a patient using Facebook Messenger, was unprofessional for doing so. This would be funny apart for the stress that the registrant was put under as a result of it being included in their initial allegations which contributed to the case being forwarded for a full hearing. There will be more of this to come in another blog.
I emailed the current Director of Fitness to Practise to ask him what he thought about the content on this Clinical Advisor’s Facebook profile page, and whether he felt it was appropriate for someone affiliated with the GDC. The GDC ought to know how their Clinical Advisor was behaving whilst giving potentially life-changing advice about other registrants’ professional conduct. Perhaps my tip-off might assist them in getting their own house in order after a run of bad hearing outcomes for them and at a time when the mood of the profession is resembling that at the time of the ARF debacle. At the time I had started to draft this blog I had not received any reply, and suspected that the GDC’s email filters might have kicked my email with its supporting attachments of profanities straight into their Spam Folder. I have now received my reply, so I will come back to that later.
On this particular issue of ‘unprofessional’ social media comments, 2 registrants recently received letters from the GDC reminding them of their need to uphold standards when using social media. They had both used an inappropriate word, albeit on a single occasion, on a Facebook thread and a helpful colleague had very kindly pointed this out to the GDC without raising their concerns with the group moderators or the registrants themselves. The digital evidence suggests that the anonymous informant was another registrant. In terms of the naughty word used, it was quoted ‘verbatim and in italics’ in the GDC letter. If the GDC think that word is inappropriate they ought not visit the Dr Rant page and see their ‘affectionate’ nicknames for Jeremy Hunt which are used on an almost daily basis. The GMC don’t seem to concerned however, but perhaps doctors do not refer each other to their regulator over spats and spite instigated on social media platforms.
Anyway, I felt pretty strongly that this particular display of conduct on social media referred to above really should not go unquestioned, all things being considered.
The Standards apply to all and this Clinical Advisor who is a fellow dentist, is held to the same standards as us all. No-one should believe that they sit above us mere-registrants, somehow ‘protected’ by a relationship with the GDC. A colleague has a four-month suspension for alleged religiously-offensive statements made visible only to other dental registrants, yet I found his comments less offensive that this advisor’s silly, misogynistic and sexist posts. Also, someone with the infantile mentality that is publically displayed arguably unfit to assess whether any other registrants’ behaviour is professional, surely.
Whilst waiting for my email to be replied, rather hilariously, another registrant got a letter from the GDC courtesy of another anonymous informant reminding them of their professional obligations, and advising them to take action so they too could be better behaved in the future. However, the letter gave no information on what was posted that caused offense or deserved some kind of GDC-referral retaliation. An SAR sent the GDC may well clear that one up in time.
Taking screenshots from Facebook and using them to make complaints to the GDC is a rather petty way to retaliate against another dental registrant in my opinion. Those doing it really need to take a long hard look at themselves, especially if they are in the subset of registrants whinging about our high ARF.
As it happens, the GDC Annual Accounts and Report show that by 2018, 9-10% of incoming GDC complaints (as per my little infographic below) currently arise from other registrants. This is a record year. Well done registrants!! Keep this rate of progress up and in a few years we might actually beat the patients.
So actually, never mind the GDC: we also need to get our own house in order here. Please can we all stop being so childish? If you don’t like what’s on Facebook, get off social media, leave the groups that aren’t to your taste or contain people you don’t like, block people who wind you up, or if what’s being said is about you is that bad, spend your own money on legal proceedings rather than wasting all our money artificially inflating the ARF telling tales by the use of screenshots. Still, it’s nice to see that the GDC has healthy reserves of £20 million against a back drop of a decreasing number of incoming complaints. Maybe this is in preparation for the day we achieve a level of 100% of complaints arising from all the back-stabbing and bickering going on between ourselves.
This is the problem with the ‘duty to report concerns’:
LEGITIMATE CONCERNS REPORTED TO THE GDC OFTEN END UP IN ONE OR MORE REFERRALS IN THE OPPOSITE DIRECTION.
This is the sheer reality of the dire situation that faces us. The minute you act on a professional duty to raise concerns with the regulator, you are at risk that ‘concerns’ will be raised about you, and there will be GDC referrals all round.
But back to my email: I did get a reply regarding my Clinical Advisor issue. I was advised that I should use the online form to report the matter to the Initial Assessment Team.
It looks as though we are not the only group happy to throw dentists under the bus, which is always nice to know.
It has been a little while since I last wrote this blog. Various things have taken over as they tend to do in life, and the blog unfortunately was something that seemed to never quite get done. However, I’ve now found myself back in the writing frame of mind, and I still seem to have opinions that some will agree with and no doubt others will disagree with, so here we go with some more ramblings of a Yorkshireman.
I have still been keenly observing what has been going on with regards to the profession over the last few months, and there still seem to be the same old problems surfaces that always have. I shall be writing about all of these issues in the near future.
The GDC seems to still be a problem to many, and personally whilst it seems to be to have become more aware of its previous problems, I don’t think it can truly move on whilst the current chair is still at the helm. It is time for a registrant to be in charge again, and for Dr Moyes to be moved to some other Quango where he can’t oversee damage to the morale of an entire profession.
Social media is also still a hot topic, and the GDC have now issued a case study on this. Some of the profession are obviously of the opinion that social media is the real world, and seemingly lack the ability to see it in its true context. There is a lack of humility in the profession where social media is concerned, and huge damage can occur to people when they believe that all they see on their iPhone is the unadulterated truth. It isn’t.
The lack of a new NHS contract, or anything really concrete is also concerning. However, I have a fairly simple view on this. We must be deluded as a profession if we think for one moment that there is suddenly going to be a fantastic new contract that will give the patients and us everything we ask for. I will guarantee that any new contract will primarily be worded to the benefit of the DoH so that the dentists can be held responsible for whatever goes wrong with it.
I’ll write more on these subjects in the coming weeks. But for this blog I though I would concentrate on something that has seemed to be brewing for quite a time, and might actually be reaching a tipping point.
Now, I can remember when my indemnity was about £1200 a year, and didn’t particularly change by much annually. But now, as a principal dentist working full time, it is £5800. This increase is over the period of about 10 years. We have seen an increase in both the activity of the GDC and especially negligence solicitors in this time, which it is claimed to account for the increase in our costs.
Indemnity is a little bit like car insurance in that you hope you will never need it, but it is a necessary evil to have. With the costs of legal representation being what they are, and the increase in the amount of cases being brought, it is not really surprising that costs rise year on year.
But how do we know how these costs are calculated individually? If you are a young driver with a fast car (which you will no doubt be flaunting on Facebook!) then you are likely to be a higher risk than an older person in a more sedate family saloon. This doesn’t necessarily translate to your dental indemnity though. It seems that the longer you are in the profession, the more likelihood you are to be sued and thus have higher premiums. Perhaps the reason for this is that when these practitioners retire, often the patients are found to have large amounts of remedial dentistry to be done. This may be the case, and I am aware of some dentists who have built up a good practice on rectifying this type of problem, especially when they perhaps encourage the patient to take some form of action against the previous dentist.
I’m not saying a wrong shouldn’t be corrected in that situation, but there do seem to be some dentists who are quite happy to throw colleagues under the bus in order to ensure they get the benefit of the patient charges to rectify the problems. Perhaps ‘There but for the grace of god go I’ would be an apt phrase to remind those considering this course of action. In addition, they will also find that their indemnity is going to increase also when this happens.
Because that’s how this kind of indemnity really works; the current members are paying for the claims that are currently being made and are going to be made in the future. In much the same way as the state pension works. We can’t have an indemnity company suddenly have empty coffers, so they have a duty to ensure they assess the needs of the society to actively have the funds to cover their expenses. All of this is paid for by the membership.
However, this is where I spot a problem. There are some dentists who for what ever reason have higher indemnity costs. Whilst it always seems unclear why this is (as there is no apparent transparency in the fee structure when applied to an individual member), it is not unreasonable to consider that there might be an increased risk identified by the indemnifier. So they are basically saying there may be claims likely to be made against this person in the future. I have no problem with that in principle, but the issue comes when this person then leaves the society because the costs of indemnity have risen so high it is fundamentally unaffordable for them to keep paying.
What happens then? The costs of these future claims will be potentially met by the rest of the members who are maybe NOT doing the same sort of high risk dentistry as the member who has left. One can argue that this is a socially responsible and indeed professional manner in which a wronged patient can claim recompense. The problem occurs when there are more of the lower risk members paying for the expenses of the higher risk. Add into this situation that the societies offer ‘discretionary cover’, meaning that your claim only has the right to be considered by the society (and not actually guaranteed to be supported), then some people feel that they are paying an increasing amount of money for less than guaranteed and continued support in their time of need.
It seems to me that many of the members of the traditional membership societies are becoming increasingly worried about the inexorable rise in costs, and the discretionary nature of the support offered. I am aware of much conversation about the pros and cons of moving between the societies, and I’m also aware of the increase in membership of the Insurance based companies as a result of the concerns about this. One of the advantages of insurance based cover is the presence of a written contract, and the ability to make a complaint to the Insurance Ombudsman, which doesn’t exist with the discretionary membership. In addition, the insurance companies are also heavily regulated by the likes of the Financial Services Authority; the traditional indemnifiers however seem to have no regulator at all. The counter to this argument is that with discretionary cover the traditional indemnifiers can cover those who are not indeed members at the time of a claim, and for the benefit of the profession. I can recall this publically happening at some point in the past, and if I am not mistaken it was a human rights issue that became clarified as a result. However, just how many times has the discretionary cover been used in that manner, and not just to refuse cover?
The way I see it, we will reach a tipping point if something is not done soon to clarify more robustly the stance of the traditional indemnifiers, especially where their discretionary powers are concerned. I want to know that I have the support of the indemnifier in assisting me in my time of need, and not that at some point they decide to pull the plug due to a disagreement or just because it is easier and cheaper to settle (despite it being morally, ethically, and clinically wrong to do so). Does writing a blog of this nature give them grounds to refuse cover? Your guess is as good as mine since there is no real published criteria to know where you actually stand.
I can see there becoming a tipping point at some time in the future where all the good clients of the protection societies are no longer willing to put up with the uncertainty and the lack of transparency about the decisions made about any individuals’ costs and especially the discretionary element of support. These clients will leave, and since it is a requirement to have appropriate indemnity, there will be no shortage of new style companies happy to disrupt the market place and offer an alternative.
For example, what if the indemnifier needed a million pounds to cover its expenses and it had 10,000 clients? The cost per client is obviously £100 per client. But what if this indemnifier then starts to haemorrhage clients until it only has 1000? The cost per client is then £1000. These remaining clients are not necessarily going to be the high risk ones either, as it’s probably the case that those higher risk clients will have changed society much sooner in order to keep their costs down.
This is probably a gross oversimplification, and I’d actually welcome someone putting me right over this, especially from any of the defence societies. However, fundamentally what I see is an ever increasing demand on the resources of these societies, with a potentially decreasing number of members footing the bill, and those members not actually knowing if they will be fully supported by the society due to the discretionary nature of the membership. This is a prime situation for a tipping point to occur that changes significantly the whole model this operates under. This might be practitioners leaving, or it might be a re-evaluation of the business model to take things into account. However it is not something that can remain the unchanged as it appears to me unsustainable in the long term.
Before anyone says this couldn’t happen as the societies are so big and have so many customers, all I have to remind you of is Kodak not identifying the digital camera revolution, Encyclopaedia Britannica not recognising the threat of the internet, and finally the inexorable rise of Uber in its disruption of how we utilise taxis.
All indemnifiers are also reliant on the need for legal cases to continue. By this I mean there is a symbiotic relationship between the defence and prosecution of dental cases, as without one side the other cant really exist the in the same way. Once a case is begun, then costs accumulate on both sides, and the legal profession feeds from this accordingly. These adversarial sides become dependent on one another, and in particular the defence side of negligence does not necessarily work under a no-win, no-fee basis in my experience and gets paid regardless of winning or losing (by our indemnifiers). Cynically, one would say it is therefore in the financial interests of those in the legal profession to have the current highly litigious situation in dentistry to continue, because there appears to be no shortage of work for them. The practice of dentistry becomes the raison d’etre for the existence of both the societies and those legal firms feeding it until we do something to stop it.
There may be protests from the indemnifiers of the tome of this blog; certainly I have taken no account of some of the truly awful issues that result in harm befalling patients by some practitioners. I am definitely of the opinion that we as a profession most certainly still need to put our house in order, and there is probably no room within it for some of the practices that some of our colleagues routinely feel are acceptable. However, unless you are part of the solution, then you are actually part of the problem, and I feel that there should be much more clarity evident in the world of indemnity, so that the profession can practice with the confidence that our patients need us to have when caring from them.
Otherwise, what’s the point in us continuing to serve our patients? That may well create a further tipping point…..of no one in the profession left to care.
Last Monday 14th August 2017, I had another meeting with Jonathan Green (Head of FtP) and Matthew Hill (Head of GDC Strategy).
It was a no holds barred meeting and I was free to ask any questions. I wasn't locked in dungeons under 37 Wimpole Street at any point!
Here is the agenda of the 90-minute meeting, along with the GDC answers in blue.
It raises some important considerations about what we need to do as a Profession. I think we need to think about the answers and discuss a strategy for the Profession.
There is a feeling amongst dentists on forums such as this that the GDC has become too heavy handed when dealing with alleged misconduct cases.
In March 2017 alone, of the 29 misconduct Fitness to Practice cases heard by the GDC, 9 dental professionals were suspended, 4 had conditions placed on them, 4 were erased and 2 were reprimanded. There were also 4 cases with the outcome still pending. That means of the 25 cases concluded 76% of dental professionals were found to have committed misconduct.
Compare this with the GMC figures for the same month, there were only 6 misconduct Fitness to Practice cases of which only 2 had findings of impairment made against the doctor. Considering there are more doctors than dental professionals registered to practice in the UK, the difference is significant.
In November 2016 the GDC introduced Case Examiners in an attempt to help streamline the Fitness to Practice process. Their role is to consider whether a referral should be made to the Practice Committee. Given this new stage is still in its infancy, we are yet to see what impact this will have on misconduct cases within the dental profession. However, it is hoped that as cases will be considered by a lay member and a dental professional, a more proactive approach will be taken at an early stage. This is the approach taken by the GMC and the low numbers of misconduct cases being referred for hearings could be a positive sign of things to come.
Unfortunately there are rarely any consequences for patients who make spurious complaints which are not upheld; however, the same cannot be said for the professional. The time, stress and expense of misconduct hearings can have a devastating effect. Many feel that their stress is exacerbated by an unsympathetic and heavy handed regulator.
If you are facing a misconduct investigation, it will no doubt be a worrying period for you. It is important to understand from the outset what legal test the GDC will be applying. This way you can properly prepare your defence and gather evidence from an early stage. Proper presentation at the start may well ensure that the Case Examiner determines that a case should be closed at an early stage. If the case should proceed to a hearing you will be armed with the necessary knowledge to put forward the best possible defence, which in turn could help with any later appeals to the High Court.
What test does the Professional Conduct Committee (PCC) apply when assessing Fitness to Practice?
The test the PCC applies is twofold;
1. Has misconduct taken place?
2. Is the dentist’s fitness to practice impaired?
Whether or not misconduct has occurred will depend on the allegations raised and the evidence produced and as such this element of the test will be fact sensitive. The PCC must decide whether ‘it is more likely than not’ that the allegations took place, which unfortunately is a relatively low threshold. However, even if any of the allegations are found to be proved, case law has established that the conduct must be ‘serious’ before moving to the next stage of the test.
Tip. Is this a potential area that can be challenged? Are you able to obtain evidence or refer to previous cases that show the misconduct is not serious and therefore no further action should be taken?
When considering if a dentist’s fitness to practice is impaired, the PCC should look at the dentist’s current fitness to practice? It will not be sufficient to show historic impairment, unless the misconduct is so grave as to warrant it.
It should be noted that impairment is not assessed against any established standards of proof; it is a matter of judgment for the PCC committee. However, a failure to comply with the fundamental standards laid out in the ‘Standards for Dental Professionals’ is likely to lead to a finding of impairment.
Tip. Even if you do not accept the allegations against you, you should consider what actions you can undertake to show your fitness to practice is not impaired. For example, attending training courses, amending your policies and procedures, or being mentored/shadowing another dental professional. This should not be seen as an admission of guilt but a recognition that professionals can always seek to improve.
If impairment is found, the PCC will go on to decide which of the following sanctions to impose:
In deciding what sanctions to impose, the PCC must apply the principle of proportionality by weighing the interests of the public against those of the dentist.
Tip. This is where you need to put forward your mitigating circumstances so as to reduce the sanction imposed. Also you are allowed to suggest out what sanctions should be imposed and if you are able to give the PCC well thought-out sanctions bearing in mind the allegations, this could prevent erasure or suspension.
Stage 1 – Case Assessment
When the GDC receives a complaint, it first considers if it is the correct body to deal with it. If so, it will obtain more information from the complainant to assess whether one of the ‘Standards for Dental Professionals’ may have been breached. It is important to note that the Case Assessors do not make any findings of fact.
You will be asked to provide:
1. Evidence of your indemnity insurance cover;
2. Details of your current employers/anyone you are contracted to provide services to;
3. If the complaint is about dental treatment, the patient’s medical records.
Tip. At this stage do not provide any further information than the above. Whilst it will be tempting to explain what has happened, at this stage the GDC has not set out what the allegations are against you, so you do not know what you are responding to. Any statement given could later be used against you.
Stage 2 – Case Examiner
If the Case Assessors consider a dentist’s fitness to practice may be impaired the case is referred to the Case Examiners; the case will be considered by one lay person and one professional. At this stage you will be sent details of the specific allegations against you and it is at this stage you will be asked to respond. The Case Examiners are not making findings of fact. Their role is to consider whether there is sufficient information to make a referral to the Practice Committee.
Tip 1. If the allegations are not clear, seek clarification. If evidence is referred to, ask for copies of that evidence.
Tip 2. Whilst the Case Examiners are not determining the case, if you can show there was no misconduct, we would recommend responding fully to the allegations and providing evidence to support your assertions. However, if you think there may be a case against you on the evidence received think very carefully before making any admissions at this early stage. It may well be worth seeing the extent of the case against you before admitting any wrong doing.
Stage 3 – Hearing
Should the case progress to a hearing then you will need to fully prepare for the same bearing in mind the test set out above. Consider:
· What evidence do you need to rebut the allegations?
· Are you able to show the misconduct is not serious?
· What have you done to show your fitness is not impaired?
· Will other dentists/patients provide statements as to your character?
· What mitigating circumstances are there?
· What sanctions should be imposed?
Tip. If you are not happy with the GDC’s decision you have the right to appeal to the High Court within 28 days. We set out the circumstances when you can appeal in Issue 2 of our dental bulletin.
If you need advice on a current Fitness to Practice investigation or appealing a decision of the GDC, please contact Laura Pearce on 0207 388 1658 or by email at
Recently, I have been mulling over issues of personal conduct. This has led me to the specific topic of this blog which is sexual misconduct or otherwise inappropriate sexual behaviour. It looks at historic and current cases and I hope is just as interesting and thought-provoking for you readers. Before anyone accuses me of misandry, I will state that I did not come across any examples of ‘females behaving badly’.
From discussions with colleagues and on other platforms it appears that the reason why the GDC have a mandate over personal conduct is not well understood. The Standards relevant to personal conduct and behaviour are:
There are some difficulties here that need consideration:
From a legal point of view case law dictates that surgeons, dentists, journalists, headmasters and even professional footballers are role models whereby ‘higher standards of conduct can rightly be expected by the public’. This statement came about as a result of an unfaithful footballer involved in a threesome wanting to keep it out of the media believe it or not. I’m not sure that Lord Woolf, when he made his judgement anticipated that today’s role models would also include reality TV stars who happily have sex on live TV but there we go.
The Indicative Outcomes Guidance (IOG) is always worth a read to understand how sanctions are arrived at and the reasoning behind it. The purpose of a sanction is to both protect the public and the wider public interest. What may on the face of it seem draconian and intrusive to a registrant’s right to a private life actually stems from GDC working extremely hard to maintain the reputation of and public confidence in the profession and they actually deserve credit for this. Poor behaviour, even if it does not involve any patients has the potential to seriously undermine public confidence in the profession and bring the profession into disrepute. With regard to sexual misconduct the IOG says:
So essentially, sexual misconduct allegations are likely to progress to a full hearing.
Sexual misconduct is essentially an abuse of power:
With all that in mind, here are some relevant case examples:
Dr AB kissed a dental nurse on the back of the neck without consent, and this was determined to be sexually motivated. Dr AB denied the charges, gave inconsistent evidence, maintained that his actions had simply been misunderstood, accused the nurse of being racist and of wanting money from him as well as thinking he would just turn up and have his side of the story accepted as the truth. This didn’t impress the panel and he was suspended with immediate effect for 12 months to hopefully give him enough time to have a really good think about all of this. The Committee felt that the registrant lacked any insight, and pretty much knocked out all the defence submissions. A couple of interesting lines from the determination are:
“The Committee was also aware that you are older than Dental Nurse A and in a position of professional power over her………
It [the committee] considered that dental nurses and colleagues do form part of the public and are included in the considerations of protecting the public.”
Therefore, professional boundaries do not just apply to Principals and patients. Associates must also maintain professional boundaries with their supporting colleagues.
Mr CD was sentenced to three years imprisonment for sexual assault on a female; a conviction that was upheld on appeal. The events surrounding the assault were the heads of charge and the FtP hearing considered both this misconduct and subsequent criminal conviction. Misconduct was easily established, and the committee rejected the sanction of a suspension on the basis of no apology or demonstrable remorse from Mr CD and he was erased. Placing your penis toward a patient’s mouth without their consent is possibly the most serious breach of professional boundaries, however it is interesting in this case that the sanction of erasure is automatically 5 years, which obviously exceeds the duration of his criminal sentence. Whether he ought to be allowed the chance to even reapply to the register is debatable.
Dr EF accepted a caution for kerb crawling but failed to report this to the GDC. The panel disregarded the difficult personal circumstances reportedly faced by this registrant at the time of the incident as they did not mitigate against the seriousness of the conduct. They also said:
“The Committee noted that the matters before it were not clinical in nature. It noted that there had been no harm to patients. However, it bore in mind that its primary function is not only to protect patients but also to take account of the wider public interest, which includes maintaining confidence in the dental profession and the GDC as a regulator, and upholding proper standards of behaviour.”
Dr EF was given a reprimand which will be on the public register for 12 months and as it will form part of the fitness to practise history it will be always be disclosable to any future employer and authorities in other jurisdictions.
A consensual sexual relationship with a patient can cost you a 3-month suspension as Dr GH found out not to mention on-going negative PR with the story still being available on Google many years later. Dr IJ also knows only too well the damage that can be done after being reported to the GDC by a disgruntled ex-husband of a patient who lied in his witness statement about having seen ‘explicit’ text messages such that the case progressed to a full hearing before it was concluded with no case to answer. Press stories with a ‘guilty as charged’ tone to them relating to his case pre-hearing are also still available online.
Are we beginning to see the problem with reputational damage to the profession yet? The press can quite easily defame registrants with their reporting of potentially salacious cases before and during a hearing, and those pages will remain online even when a registrant is vindicated. For this reason, relationships with patients are just somewhere no dental professional should ever go, aside from the fact that it is seen as being totally unprofessional and a serious abuse of position. If you find you are heading down the route of a genuine relationship with a patient for goodness sake find them another dentist PDQ.
Moving on from relationships with patients, another potential danger zone is with employees and students. When they rely on you to pay their wages or pass their finals there is a clear imbalance of power. If you have a fling with an employee be prepared for the risk of sexual harassment claims and grievances forever more. University lecturers may be accused of offering grades for sexual favours or bias (either positive or negative). Having a relationship with a student is often considered a gross misconduct offence these days. If you are a partner and you start fooling round with the staff on the quiet prepare for a total breakdown in trust. It is just best not to go there and if you don’t believe me or feel I am being overly alarmist, ask any employment lawyer about historic compensations awards for harassment claims spanning back over years and years and partnership disputes.
At the time of writing a university lecturer is awaiting a hearing facing allegations of engaging in sexual activity in his office, and then being dishonest about it during the University investigation. We will have to wait to see if this would have made it to the GDC save for the dishonesty aspect.
For those who think that a fumble on the dental chair with one of the nurses is acceptable I am sorry to disappoint you but it is not, and it never was.
In the Mr EF case part of the charges included:
7. Whilst working with Miss LM, you had a consensual sexual relationship during the course of which on one or more occasions on Practice premises during surgery hours or shortly thereafter you:
|(a) exposed yourself wearing a thong;||Admitted and proved|
|(b) exposed your genitals;||Admitted and proved|
|(c) engaged in oral sex;||Admitted and proved|
|d) had sexual intercourse.||Admitted and proved|
8. Your conduct as above at 7 was:
|(a) unprofessional;||Admitted and proved|
|(b) inappropriate;||Admitted and proved|
The Committee found Head 8(c) proved because, by your admissions, other people were present in the practice and therefore you put yourself at risk of being discovered."
The determination also says:
The Committee has found that you behaved inappropriately and unprofessionally towards four dental nurses who worked with you, and that your behaviour towards three of them was indecent. As a partner in the practice, working directly with these dental nurses, you were in a position of authority over them – which you abused. Furthermore you conducted sexual relations with Miss B in the practice, at times when you could have been discovered.
Mr EF was erased for this and whole host of other sexual misconduct misdemeanours including touching and making inappropriate comments to other nurses.
So even though many feel that consenting adults are entitled to some degree of privacy, the simple fact that they might be discovered in the act by a member of the public is enough to take things to the level of indecency. Oh dear. This also makes it clear that consent has absolutely no relevance in excusing occurrences of sexual misconduct or otherwise inappropriate sexual behaviour.
Wherever there is a hierarchical relationship or an imbalance of power there is potential for actual abuse or allegation of abuse of power. An allegation is all it takes, and I know of 2 instances where registrants have faced criminal charges based on false allegations.
Personal conduct involving sexual behaviour has an astonishing potential to bring out the widest range of opinion on what is acceptable or not if the recent debates on Facebook are anything to go by! I am sure we all know of successful relationships between dentists and employees, lecturers and students, even dentists and former patients. But this is really an area in which to tread extremely carefully as if you get it wrong the consequences are huge.
Tis the season to be jolly
Fah la la la lah, la lah la lah
Well after an autumn break to see how the land takes up the fertiliser of restful thought, we approach the Christmas break with a need for reflection.
What has 2016 thrown at us?
A reason to be cheerful? A season of Goodwill? A sense of hope?
There are three major areas that seem to be affecting the profession at this time.
There is the issue of the GDC and its new Case Examiners.
It is too early to say if this will genuinely make a difference. What we want is for the GDC to stop trying to be a Complaints House, taking everything on no matter how trivial.
Dr Colin Campbell, a widely-respected colleague in the Midlands, with a personal history of the dealings of the bludgeon that is FtP, clearly thinks not – again with personal experience.
But then again, why would CEs make a difference? They have been tasked and trained by the very organisation that had the problem in the first place. And the problem is that the GDC do not reject anything.
Some of the recent cases suggest that the GDC still do not know what a proper complaint is. The whole list of FTP is awash with material that is either better managed locally and or indeed a simple internal disciplinary matter.
So, if you have not done so, get your £900 out for another year of outrageous wasteful use of your money. But do so with a good grace. It could be worse.
Is it me or have we become so numb and subservient that we just accept it as a nuisance nowadays?
NHS Pilots – self funded by dentists!!
Meanwhile, perhaps all is well with new NHS Pilots. We all know there is new money, and we all know that the DH wants to get bodies through the doors, never mind whether anyone does any dentistry. But the idea of a Care Pathway appears to be well received on its own merits.
But there appears to be strange anomaly that the pilot practice may face up to 10% - YES TEN PERCENT – clawback – which if your profit is running at 20% reflects HALF THE PRACTICE PROFIT - which for most Pilot Principals suggests a cold winter looms.
Good on the BDA for highlighting this matter, on stage at the Local Dental Committees Officials Day , with the DH Head of Finance and the “fabulous” Dr Sara Hurley [You did see the Good Morning interview spat between our CDO for NHS England and Dr Tony Kilcoyne didn’t you?] sitting along side as Dr Henry laid into them in no undertain terms.
Indemnity in Crisis?
Maybe all is well with our support network, the Medical Indemnity Organisations. You know – Dental Protection, DDU, MDDUS and the newer companies such as Taylor Defence Services.
Well, who knows? There are stories of some colleagues finding their cover withdrawn in a discretionary manner halfway through a case. There are many stories of colleagues finding their annual cover suddenly approaching 5 figures and beyond. There is still no clear method for subscription calculation although one hears mutterings about the legendary ‘grid’. A sort of Spot the Ball for Indemnity subscriptions!
Whatever the truth, there is a financial crisis in Indemnity, driven by a combination of commercially proactive lawyers and an overzealous GDC. So much so that there is a one day crisis conference being held in January
After many discussions about rising Indemnity and concerns some colleagues have been left with no cover or representation etc., A 1-day Seminar is being organised by Dental Practice at the Hilton Metropole, Birmingham NEC, on Friday 27th January 2017 from 08.30 to 17.30pm.
Concerns are being expressed across the dental sector about the delivery of Professional Indemnity cover and what is and is not included in the various offerings from the MDO’s. As a result, and in conjunction with many key decision makers, it has been decided to hold this 1-day seminar to look at the current situation, with much time for Q&As.
Well that all makes for an energetic start to 2017.
It must be time for another letter to educate the public again, if the recernt rubbish written by Hunter Davies in the Times is anything to go by!
I suggest we all turn to our loved ones and count our blessings. In the year that we have lost Leonard Cohen, AA Gill and Greg Lake, we will not be short of words and music.
Put your practice to bed, and come back refreshed after a nod to the year, raring to go – unless of course you rely on Southern Railway in which case, the very best of luck!
If Christmas is your celebration, may yours be peaceful and joyful. That much we can be assured of
Dr Colin Campbell – the GDC have failed at their first hurdle
Henrik Overgaard-Nielsen, Chair, BDA General Dental Practice Committee, has posted an update about the prototype contracts on the BDA website
Also here for BDA members
http://www.content.digital.nhs.uk/catalogue/PUB22526 for NHS report of Motivation
Dental Working Hours, 2014/15 and 2015/16 Motivation Analysis, Experimental Statistics
Having been somewhat distracted by the school holidays, my latest blog considers some of the cases that managed to pique my interest, and gathers my collective thoughts during the months of both July and August. So that you are looking through the same lens, I’ll start off with the ‘legal definitions’ of misconduct:
Lord Clyde described misconduct in Roylance v the GMC (2002):
‘misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a medical practitioner in the particular circumstances’.
This definition was expanded in Nandi v GMC (2004), in that misconduct means a serious departure from the acceptable standard that is not just below the acceptable standard but:
‘conduct which would be regarded as deplorable by fellow practitioners.’
It has been further clarified in Meadow v GMC (2006) that misconduct sits at the same threshold for disciplinary intervention as the historic phrase ‘serious professional misconduct’:
‘As to what constitutes "serious professional misconduct…..it is inconceivable
that "misconduct" – now one of the categories of impairment of fitness to practise…..
should signify a lower threshold for disciplinary intervention’
On reading some of the recent charge sheets it appears that we have perhaps lost sight of misconduct, and moved on from the days where urinating in the spittoon, assaulting nurses or openly breaking wind in front of staff in the surgery sat at the threshold of deplorable conduct. If you have ever accidentally squirted water from the 3 in 1 towards a patient, you ought to be extremely concerned. We now have examples of unprofessional behaviour individually and collectively leading to a charge of misconduct such as:
And let’s not forget the beauty from a couple of months ago about bouncing balls of impression material down a corridor. How the panels keep a straight face through these types of charge is beyond me, but well done to them. Truthfully, I feel it is a bit embarrassing for the GDC to have it in the public domain. I may be wrong, but I believe that the barristers instructed by the GDC are involved in setting the final charges. With that thought in mind, I took a look at the Bar Standards Association and barristers’ fitness to practice hearings to see what allegations of professional misconduct are levied against them. Here is an example of a concluded Bar fitness to practice tribunal:
Observe how it is kept to one side of A4, extremely succinct, and there is nothing in it that may give any third party reading it anything to chuckle about? I also noted the lack of any published charges before the hearing for the sum total of 3 barristers presently listed as awaiting a hearing. This, along with the MPTS hearings begs the question of why does our regulator operate on a different set of rules that on the face of it appear more punitive to their registrants than those applied to equivalent professionals? Although it may give me nothing to write about, I would really urge the GDC to look at paring down their charge sheets and not making them public until after the facts have been determined in both their interests and those of the registrants facing a hearing.
One hearing saw a registrant face a charge of failing to:
adequately treat an on-going adverse oral hygiene condition.
It may just be me, but I can’t work out what this charge is supposed to mean and there is no explanation in the determination. In 17 years of practise I have not been aware I was obliged to ‘treat’ an adverse oral hygiene condition; I was taught that my duty was to offer appropriate preventative advice and oral hygiene instruction. It is, I believe, the patient’s duty to ‘treat their oral hygiene condition’ and I can think of at least one periodontist who would take issue with this allegation. I am not sure how anyone can ‘treat an adverse oral hygiene condition’ save for pitching up at the patients house a couple of times a day and doing the cleaning for them, or bringing them to the surgery daily to see the hygienist. Nevertheless, as is often the case with these hearings, we are made to feel that we have been doing it wrong all along, and nobody bothered to tell us until a hearing.
On that note, charges relating to alleged radiographic record-keeping failings have also been appearing more and more of late including not adequately or properly recording in the clinical record:
I looked at IRMER(2000), and the NRPB Guidelines which are the legally authoritative documents on radiation last month having been asked to consider the validity of this type of charge. In my opinion, the charges indicate a misunderstanding of what justification is; because it is not the same as the clinical indication for taking a radiograph. In the words of an RPA (with a PhD in clinical physics) I consulted over the matter of justification:
‘ "Justification" as required by IRMER is the process of weighing the probable benefit of a radiation exposure against the probable detriment. It is quite separate from "indication" - the clinical history, provisional diagnosis and intended treatment - and "authorisation" - the decision by the Practitioner that the proposed exposure is of sufficient merit. Both indication and authorisation must be recorded, because these are data, but not justification, which is an intellectual process.’
And his reply with regard to the question of where does IRMER(2000) state that we have to record QA score in the clinical record?:
'Nowhere. However Clinical Audit 8. The employer’s procedures shall include provision for the carrying out of clinical audit as appropriate. and The written procedures for medical exposures shall include— (e)procedures to ensure that quality assurance programmes are followed; Thus it is incumbent to occasionally review image quality, patient dose and clinical relevance, and since there is no other means of assuring the quality of the next image, it is important to check the quality of each image and resolve any anomalies before taking the next one. It can be argued that in order for audit to be properly objective, there should be no contemporaneous written assessment of quality: you audit by picking past images at random and assessing them "cold"'.
You should therefore record any faults or failures that demand corrective action, to provide an audit trail for that action, but images deemed acceptable should be filed without comment in order not to prejudice the audit.
Interesting stuff. I am baffled as to why anyone should be criticised for not recording an intellectual process. It is also clear that we do not have to record a grade in the clinical record, in fact we do not even have to grade every radiograph it seems, just check that the quality is acceptable in preparation for the next exposure and do an audit from time to time. So not only do we face issues with the bar of misconduct being stealthily raised, we are now also being tried and tested on doing things that are not actually required of us. This is why every registrant should be represented at a hearing in my opinion, and should only agree to charges that are indefensible. To admit to a frivolous or spurious charge purely to be seen to be ‘showing insight’ is not a position registrant should ever be put in, but I sadly suspect that is where we presently are.
There was, however, some positive evidence of a panel flagging up a GDC-appointed expert using non-mandatory guidelines as non-negotiable standards:
‘The Committee considered that Ms K’s approach was, at times, rather academically orientated and inflexible. In particular, she relied on a number of guidance sources, including the Faculty of General Dental Practice (FGDP) 2006 guidelines and the British Society of Periodontology guidelines relating to Basic Periodontal Examination (BPE), which, the Committee noted, are not mandatory. Furthermore, when alternative approaches regarding clinical matters were put to Ms K, she did not seem to acknowledge that it might be acceptable to deviate from these guidelines.’
It was last October I recall that the issue of guidelines and misappropriate use was raised by Dental Protection. This, along with the ‘gold standard bar’ really means that too many registrants are having their careers put on the line when there is a lack of clarity over where the threshold for misconduct really sits, and no universally agreed clinical guidelines. I remain in hope that the GDC FtP department is looking at this closely in the pursuit of proportionate regulation.
Moving on to some other cases, in the High Court, a registrant erased earlier in the year was successful in having his case remitted back to the PCC for reconsideration of an erasure. The registrant had got himself in to bother that might have been avoided by having to reapply to the register after his direct debit had failed, and was found to have been dishonest by fudging responses over two convictions for driving whilst under the influence of alcohol. It was held that the PCC had failed to consider relevant mitigating circumstances, namely that the employer had been informed of the convictions but the appeal failed on the challenge of the findings of dishonesty. You can find the judgement here.
Another noteworthy case involved a newly qualified dentist who wound up at an FtP hearing based on performance issues that arose within months of qualification. The question that I am sure on everyone’s minds is ‘how could this happen when the GDC-accredited dental school have allowed him to pass finals?’. Nevertheless, it is nice to see that whilst the GDC-instructed barrister recommended he should be given a reprimand for being let out of dental school too early, there was good evidence of remediation so no current impairment was found. The chap has now completed his VT year and is understandably ‘elated’.
The final case I am going to look at involved another registrant who was erased. This was the second GDC hearing Mr Idris has faced in his career. Having been told by his indemnifiers team during the first hearing that he was facing erasure and this having come rather as a shock they parted company. He instructed his own legal team and the case concluded with conditions. However, self-funding representation for the next hearing was not viable so after several years of reported wrangling with the GDC Mr Idris declined to attend this particular hearing, advising the GDC by email that he would be cleaning up his dogs’ mess instead. As a dog owner I can empathise with this and agree it is a taxing and time consuming task. Mr Idris’s absence was very diplomatically written up into the determination, but should anyone would like to read the unedited version of the email, it can be found here:
I’ll leave it here for now. My dog is barking to go out. Duty calls….
Insight is a wonderful thing
It carries so many meanings.
The GDPs view
Many of you demonstrate it in your daily work, by understanding what makes patients tick. They say one thing to you and you apply years of experience, so that after a few moments of reflection, you translate what the patient just said into a proposal for treatment with a couple of options. Our younger colleagues of course find this the hard bit of clinical practice, but with experience time and dedication all Dentists and DCPs in patient contact can become masters of this art.
At the other extreme, when it all goes wrong and some of our colleagues face GDC proceedings, the ability to reflect upon your circumstances is critical. The ability to show insight at the events that led to the GDC may be critical to a Panel taking a benevolent view.
Insight is an essential attribute for any dentist. For sure, lack of an ability to apply insight will often lead to trouble. It may compromise your relationship with your patient. You may finish up treating a patient despite the warning signs being there perhaps in the body language, or in the tone of voice used during a conversation.
Time? Not a lot of it about!
We recognise the application of insight as a skill and an attribute amongst our colleagues, and we admire those who have mastered the art of its use.
Of course the need to reflect and to gain insight require something that your NHS masters are reluctant to give you too much of: time
Even the GDC require time to reflect and gain insight.
So why is it that I think the top of the GDC may lack leadership, and the insight that is required to be effective?
There are at the GDC six Registrant members of the Council and numerous panel members who all, in their work and their practice have to find time to reflect and develop appropriate insight into their cases of regulatory work.
The Times - 6th August 2016
So it was with some surprise that the Chairman of the GDC, a certain Dr William Moyes PhD Esq, found himself demonstrating what seems to be a surprising ignoranceof the workings of NHS funded dentistry at the weekend, if The Times quote is to be believed.
Many of you will of course regard the summer as the season of slow news and will know that dentists are an easy target. If I were you I should take it as a compliment.
What never fails to amaze me though is how the media absolutely fail to gain any true understanding, insight dare I say, of the problems associated with the Government offering for the nations dental care
And so it was in last Saturday’s edition of The Times. Front page news no less. It was probably pure coincidence that the de Mello case was about to be started at the GDC. In fact, it was – a leading colleague single-handedly was trying to have the issue properly addressed. It is now behind a pay wall, but I have copied it below.
The Thunderer bellowed …
The article so nearly nails the issues, and in many respects it almost goes so far as to highlight “The Big Lie” and identify the lack of “Clarity of the Deal”. A big up to our colleague, Dr Kotari, for getting “High Street Dentistry” on the broadsheet agenda. Patently he did not write the copy.
The message was clear though. Even someone without deep insight into the NHS Dental Service can see it is trying to do too little for too many. There is only a certain amount of money, and the way it is spent simply does not allow for the provision of a broad range of highly complex procedures for everyone. There is a very good blog on the BDA site reflecting after this article by a young colleague Dr Robert Chaffe at https://bdaconnect.bda.org/bad-dental-press/ . The BDA through Dr Mick Armstrong were pretty robust in their reponse at https://www.bda.org/news-centre/press-releases/bda-response-to-the-times .
And as FtP numbers prove, the dentist’s lack of time to reflect and develop insight into the problems of a patient cause that patient to feel abused and make that first GDC contact.
It’s not a difficult loop to get your head around, is it Dr Moyes?
Clearly, it’s about clarity
Anyone with half a brain can see that the future must involve a clear demarcation of what is and what is not available as NHS treatment. The post-code lottery that is exemplified by the extraction -versus- endodontic treatment fiasco reveals the problem that everyone is shouting about. The only people who will not engage on this matter for no other reason than political fear are the dunderheads at the Department of Health. Even the BDA recognise that it will have to come - but everytime it is mentioned at DH or NHSE level senior officials shake their heads. "Can't be done dear chap".
UDA Targets are set by …
The message is equally clear about high levels of UDA targets – the dentists do not set these. The Local Area Teams do. In cases such as that of Dr de Mello, these colleagues may genuinely think they are doing the Governments dirty work for them in an efficient manner, bringing access to the masses at minimal cost. That is what the Government want, isn’t it? Dentistry is a broad church and while I would not poersonally be able to cope with a high UDA contract requirement, I know some can. Does that make them wrong in themnselves?
When I wonder will NHS management be called to account instead of the dentist who is the low hanging fruit of accountability?
What’s that you say? Never?
So when Dr Moyes, as GDC Chairman is reported in The Times as stating on behalf of the GDC, and I quote from the article:
The General Dental Council says that it cannot act because a lack of professional guidance allows dentists to claim that extraction is a legitimate option. “I’m sure that if patients had a full understanding they’d be quite appalled,” Bill Moyes, the council chairman, said.
What exactly can he mean? Is he saying there is a massive problem? Or is he demonstrating considerable ignorance similar to that which his infamous Pendlebury Lecture highlighted? Shall we assume Mr Chris Smyth, Times Health Editor, is including a quote relevant to the thrust of the article for now.
Can Dr Moyes really have so little insight into the working of dental practice? It certainly looks like it.
Did Dr Moyes not reflect upon the magnitude of the meaning of his comments? It certainly appears not. With that one comment Dr Moyes has revealed all that is wrong with his Chairmanship of the Council.
We now have a decent working team in the GDC Executive Leadership. But the Chairman has revealed that he is not neutral, and strategy driven. Instead, he appears to be a simple supporter of that broad-brush vox-pop opinion that “all dentists are trying it on”.
Last call for Dr Moyes…
The time has come for the Chairman of Council to shape up, learn about the long standing problems of NHS funding of dentistry and take on the causative Department of Health as part of the GDCs Strategic role.
Or he must step aside and let a more capable person take the role on.
It IS clear that it is time for Dr Moyes to reflect upon his position, for the sake of the profession he seeks to regulate and yet for which he patently has scant regard.
Slow news day my foot – have a great break if you are away.
The great dental rip-off
Thousands of teeth needlessly extracted as surgeries accused of putting profit before patients
Chris Smyth, Health Editor | Katie Gibbons
August 6 2016, 12:01am,
Regulators said that dentists were extracting teeth to avoid offering complex treatment, for which they are paid the same by the health service
Thousands of people are losing teeth needlessly because it is more lucrative for NHS dentists to take them out than try to save them, an investigation by The Times has found.
Regulators said that dentists were extracting teeth to avoid offering complex treatment, for which they are paid the same by the health service. The investigation has also found that some dentists earn almost £500,000 a year in a system that rewards them for cramming in as many patients as they can.
Dozens are claiming for the equivalent of more than 60 check-ups a day, in what has been condemned as an unethical conveyor-belt approach to patients. The upper limit is considered to be 30 a day for one dentist.
Under reforms introduced a decade ago, dentists are paid about £25 for every “unit of dental activity” (UDA) that they carry out. Each check-up, or simple examination, is classed as one UDA; tooth extractions count as three, along with fillings and root canal work, irrespective of how long the treatment takes. Root canal treatment usually lasts more than twice as long as an extraction.
NHS figures seen by The Times show that 30 dentists were paid for more than 15,000 UDAs last year — the equivalent of about 60 simple appointments a day over a standard working week. Ten dentists were paid for more than 18,000 UDAs, equivalent to about £450,000.
Alex Wild, of the TaxPayers’ Alliance, a public spending watchdog, said: “The amount of work dentists do will obviously vary significantly, but the figures at the top end appear totally implausible . . . an urgent review is essential.”
Dentists routinely weigh up how much time and treatment a patient needs against a desire to maximise earnings, say professional leaders who concede that the payment system is causing an “ethical compromise”.
The warning comes before the disciplinary hearing next week of the dentist responsible for the biggest patient alert in NHS history. More than 20,000 people treated by Desmond D’Mello, 62, were called for HIV and hepatitis testing after he allegedly failed to change gloves or clean equipment between appointments in an attempt to see as many patients as possible.
Mike Waplington, president of the British Endodontic Society of root canal specialists, said that extractions had jumped by a fifth and root canal treatment had fallen by almost half after the contract that paid the same for both was introduced in 2006. Root canal treatment could take three times as long as an extraction. “There is an incentive from the system and some dentists may say to patients ‘I can take this tooth out simply’.”
More than two million teeth were taken out on the NHS last year, but Mr Waplington said that many could have been saved, estimating “over the lifetime of the contract it would have affected tens of thousands of teeth”.
Many dentists also feel more comfortable taking teeth out, as only 277 out of more than 40,000 are registered as specialists in root canal work.
Trevor Lamb, co-founder of the Saving Teeth Awareness Campaign, said: “The public are too quick to accept that teeth should be removed. They are unaware of the alternatives and some dentists exploit this. You wouldn’t go into A&E with a broken arm and expect it to be amputated.”
At least 2,000 dentists claimed for more than 8,000 UDAs, equivalent to the upper limit of about 30 check-ups a day. Neel Kothari, a Cambridgeshire dentist seeking reforms, said that it was difficult to do more “in any ethical sense”, with 60 patients a day impossible without cutting corners.
He warned that dentists intent on maximising income might skimp on treatment as well as hygiene. “It’s as if you went to a top restaurant and they served you a Big Mac disguised as a gourmet burger,” he said.
Nigel Carter, chief executive of the Oral Health Foundation, said: “To do a proper assessment of the patient would probably take 20 minutes. But that hasn’t been what the health service has been paying for. There is a bit of an ethical compromise.”
The General Dental Council says that it cannot act because a lack of professional guidance allows dentists to claim that extraction is a legitimate option. “I’m sure that if patients had a full understanding they’d be quite appalled,” Bill Moyes, the council chairman, said.
A spokesman for the Department of Health said that a new contract was being tested, adding: “If a dentist was found to be needlessly removing teeth this would be a matter for the General Dental Council.”
Letter to The Times, Tuesday 9th August
Sir, Your report and editorial suggest that dentists can claim as many UDAs as they like. On the old system, dentists could earn more by carrying out more treatment, and the annual dental budget could only be estimated. The current contract was designed to allow a budget to be set in advance. Each dentist is contracted to carry out a certain number of UDAs a year. If a dentist exceeds the number of UDAs contracted to them they get no additional pay. If they fail to complete the contracted number, their fees are clawed back. The dentists have to tender for contracts each year. Whose fault is it if dentists are paid for a large number of UDAs? However, to claim that the upper limit of patients is 30 per day is unrealistic. In the 1990s I used to work with three staffed surgeries and treated 70 to 80 patients a day. That would equate to more than 30,000 UDAs a year. On a four-day week, I hardly ever ran late.
Retired general dental practitioner
Haxey, S Yorks
Just recently things have been relatively quiet in the area that I usually write about. The GDC seems to have realized the mistakes of the past, and the new executive appears to be making overtures about re-engaging with the profession. Slowly but surely many think there might be a break in the thunderclouds and a glint of sunlight over the profession where our continued regulation is concerned.
One would like to think that there are significant inroads being made by the BDA on our behalf as a result of the regime change at Wimpole Street. However, I think many will doubt this, especially when the GDC themselves have actually questioned who leads our profession.
Surely this is an indictment of the profile of our Trade Union and representative body if those at the regulator have to question whom is actually in charge of dentists? It isn’t the Chief Dental Officer, who is more of an advisor to Government than a figure the profession can rally round. Its definitely not the Head of the GDC. There are many ‘celebrity’ figures in Uk dentistry who give themselves the title of ‘KOL’ (key opinion leaders) but again they are really not the leaders of our profession, often just opinionated souls who have some form of medium through which to express their thoughts (and pictures of their cars!). It’s certainly not organisations like Dental Fusion (or should that be Dental Futile?) and other professional organisations who have very limited memberships.
It really is quite obvious then that it should be the BDA. Whilst there are some strong figures within the organisation, and the work that is done by the employees is excellent, it still seems to suffer from an apparent inertia and lack of awareness as to what it could actually achieve. Whilst it no doubt provides some excellent member services, (such as employment and general advice and the library) it seems to frequently live up to the expectation of the profession as a body that drives really changes.
Take for instance the removal of registrant addresses from the GDC website. I’m pretty sure this has been on the ‘Work in Progress’ list at the BDA for some time. Yet it takes one petition by an individual and the GDC not only look at it, but actually manage somehow to change the entrenched view of Chairman Moyes himself. Now the BDA can say that they have done lots behind the scene, but there’s no use doing this and seemingly not achieving anything, especially if it has been going on for years. To then jump on the bandwagon and claim that the issue being raised by the GDC earlier this year was solely as a result of the BDA exerting pressure (when I happen to know that people at the GDC acknowledge the pressure came from the petition) is a little bit naughty.
The BDA is also the only dental body invited to the table with the DoH when negotiating a new contract. To give an analogy from mother nature; This is a little bit like a seal sitting down with a Great White shark and agreeing on the least painful way of being eaten alive. Evolution has taught many creatures to not get involved too closely with the apex predators, yet the BDA continues its same path in the forlorn hope that one day the shark might have indigestion and the seals won’t get eaten. It will always argue that it is there because of those of its members who haven’t any option other than to be seals and swim in the same sea as the shark. Evolution by supporting other options for these practices has always seemed to be low down on the agenda. Shouldn’t leaders of the seals be telling its members to try to keep away from sharks? Won’t the sharks have to evolve themselves or eventually starve to death?
Another example is the pressure that the BDA should still be putting on the CQC. The CQC has not been the subject of my blog at all in the past, and given the fact that I have been a huge critic of them has surprised even me that they haven’t suffered from my ire yet. Since the appointment of John Milne as their National Advisor there has been a distinct increase in the quality of the inspections generally. There has also been the publication of the ‘Mythbuster’ series of articles on the CQC Website . However, it is apparent that even these can suffer from misinformation. In particular the one regarding radiation protection is riddled with errors that make the further entrenching of incorrect information more likely to be referred to as absolutes when they are not. The fact that these errors might then be referred to by the GDC as the CQC is seen as an authority when charges are brought against a practitioner mean that there can be potential for miscarriages of natural justice.
Whilst there is no intention to mislead, when there is an incorrect interpretation of the legislation, rules, regulations etc. by such as the CQC (who we can argue should be an authority themselves anyhow and shouldn’t make errors like this at all) then the BDA should be swift to bring these errors to the attention of the CQC and more importantly the profession in general. This shouldn’t be in a ‘behind the scenes’ manner, but much more publically. We would then know what they are doing. This is not to embarrass the CQC in any way, but merely to demonstrate the obvious authority the BDA should be seen to have, and command the appropriate respect. Once again these errors were brought to the CQCs attention by an individual.
There is a quite frankly ridiculous amount of legislation that governs the practice of dentistry these days, so much so that it is virtually impossible for individuals to keep on top of all the different aspects of compliance. It is vital therefore that whoever leads our profession has an organizational structure that should know all the things governing and legislating dentistry so intimately that at the first sign of a new urban myth appearing somewhere (and they should be aware of where all these myths originate – looking on GDPUK r Facebook is usually a good place to start) there should be a very public and robust re-affirmation of the real legislative and regulatory situation, and with absolute authority and clarity such that the myth is immediately disproved.
I’m sure we can already hear the cries from the BDA that they already work in this way at the moment for their members, and this is true to a degree, but this is usually in a completely reactive and individual manner, and you usually have to actively seek out this information yourselves. Given the sheer volume of stuff that is out there to comply with it is very simple to get caught up in some of the less controversial urban myths such that they become the new fact, and thus perpetuated more. So you actually have to know something is wrong before you question it, otherwise you will automatically accept it is true and thus it becomes the ‘done thing’ as everyone ends up believing the myth. Just like the obligation to record batch numbers of LA in the notes is a myth.
What about jumping on the incorrect use of standards by Expert Witnesses when these are used in GDC hearings and further entrenched by the rulings? Why hasn’t the BDA produced a definitive standards document regarding an acceptable (not minimum or aspirational) standard that items like a simple dental examination should include, and be recorded in the notes? After all, there is enough expertise within the BDA that a consensus document could be produced simply enough. If it has (and I may have missed it admittedly), why aren’t the Expert Witnesses then referring to a document like this as authority? Why haven’t the Indemnifiers mentioned the existence of a document like this in the defence of colleagues? (and why haven’t the indemnifiers produced one either, perhaps by working with the BDA on it?).
Why haven’t the BDA come down like a ton of bricks very vocally on those LAT’s that transgress or selectively (incorrectly) interpret the regulations? If they have, why haven’t they shamed them so publically so that other LAT’s know they are a force to be reckoned with and won’t try it on with other practitioners?
Finally, what about the headlines in The Times this weekend about (surprise surprise) dentists ripping off the public? There doesn’t seem to have been any attempt by the journalists to even contact the BDA for a comment. Surely one of the first organisations to be approached for comment on a story like this would be the association that is supposed to lead dentists. Or is it that even the press think that a comment from the BDA would be about as strong as a wet tissue? At such a time there should be an automatic and robust defense of the professionals, whilst simultaneously showing the failure of the SYSTEM that they work within, and laying the blame squarely at the door of the DoH and Government.
The BDA really should sometimes show its teeth much more readily (no pun intended). But the only time they have done anything approaching this was the Judicial Review into the ARF in 2014. Even then there didn’t seem to be an ability to press home the victory and hitting the GDC whilst they were still reeling. Rather it seemed to all be ‘behind the scenes’ as usual and waiting for the Health Select Committee to grill Gilvarry and Moyes. Where was the tactical approach of ‘putting the boot’ in when it was most needed?
I will admit that political activism often needs to be done behind closed doors, but we need to know that when this is what we are told is happening, something IS actually being done, rather than just being talked about. The reputation of the BDA is such that many feel it never seems to be achieving anything, and therefore people think that it never does. There are so many issues in dentistry that appear at any time, and the BDA suffers from having to be everything to everyone. But surely there is a common theme amongst all in dentistry that our professional association should be there to lead the way vocally and proactively. Instead it often appears to be more a reactionary organisation with the attitude of ‘mother knows best’.
Well I’m sorry, but given the achievements that individuals have made recently in engaging more successfully than the BDA have, would lead me to suggest far from ‘mother knowing best’, mother is now someone who needs to realize they might actually be past it and new ideas and a new approach are needed.
There are a few vocal people in the BDA, but there are also others who seem to be anonymous and conspicuous by their seeming lack of inspirational leadership. Leadership means setting a visible and vocal example that others can then assist them in taking things forward and more importantly want to take forwards despite the obstacles in the way. It’s certainly not getting behind other people’s crusades and then saying look at what we did to get this done. I know of a good many people within dentistry, many of them household names (and for all the right reasons) who are disillusioned that there is no flag we can rally round as a profession; so much so that groups of like minded individuals are now beginning to draw together in order to do what the BDA should be out there doing.
Which is to Lead the profession.
At the same time, there has to be an acknowledgement of the postion that dentistry is in within the bigger sphere of healthcare. We will never have the public support that the doctors can call on, and we only have to look at the way the Government have played hard-ball with them over the recent contract ‘negotiations’. Lets face reality here. We will not get any concessions, there will be no more money and the conditions will not improve. We have to accept this and move on. The definition of stupid is often said to be doing the same thing over and over again and expecting different results. I think we can quite easily argue the BDA continue to do the same thing over and over again…..
No doubt many of the BDA hierarchy will be offended at this piece; but quite frankly they perhaps need to be. I’m sure there will be suggestions that I should put my money where my mouth is and stand for the PEC. Perhaps they are right. But since I don’t have all the answers I shouldn’t put myself forward as a leader of the profession. But even if I did, the problem with this is that one person will always come up against the establishment, which believes ‘this is the way we’ve always done it’ and ‘we must think of the members’. Paralysis by fear of the unknown results. It would need a radical change to the entire structure and I’m not convinced the more traditionalist members within the BDA would go for that. Open up votes to those disillusioned and no longer members of the BDA then it might be a completely different situation, but then that obviously couldn’t happen.
I’m sure those most annoyed with this blog will be those who have the least reason to be because they probably feel I am not acknowledging the things that the BDA have actually achieved. I’m not having a go at any individuals; but it’s those who wear the BDA badge and don’t do anything vocally, visibly, or productively to manifest change. Being hamstrung by the often archaic position of the trade union often means it is easier to maintain the status quo or just score pyrrhic victories than really trying to elicit the change that is needed.
The recent membership questionnaire is a start to finding out just what members think; the problem is it’s not the members they need to be asking how the BDA can engage more. The very people who are disillusioned with the BDA are not going to be members by definition. Bleating on about joining so your voice can be heard is beginning to wear a bit thin to many of us I’m fairly sure; why join something so you can submit a survey once in a blue moon especially when they refuse to listen to why you might not be a member? It’s a Catch 22 situation that needs to be broken.
The BDA needs to ask the ENTIRE profession what it thinks about it. The GDC seems like it is going to try to engage with us as a result of unprecedented problems and the change in executive manpower bringing a fresh look at the issues. If they can do it when constrained by legislation then there is no reason the BDA can’t either.
Its time for the BDA to show just what sort of leaders they really have.
The GDC Specialist Lists were introduced in the UK in 1998 as a result of developments in European Legislation. As of October 2015 of the 40,953 registered dentists there were 4342 registered specialists; an increase of 31 on the previous year. A significant number of patients require specialist dental treatment each year; in 2012/13 approximately 3.5% of all NHS outpatient appointments were in a dental speciality clinic. There is no precise data as to the number of private treatments being carried out by specialists each year, but it is likely to be in the millions.
Whilst the state of the nation’s teeth used to be a cause for international mirth, over the last decade our love affair with cosmetic dentistry has blossomed. Implants are so popular that there are now calls for implant dentistry to be added to the already voluminous list of dental specialities; the UK has more recognised specialities than any other European country. On the face of it specialist dentistry is big business, but for who? Is it the practitioners themselves, or those who provide and regulate the training?
One thing is clear, it is hard work. To be entitled to enter onto one of the specialist lists the dentist has to complete a recognised training programme, ranging from three to five years, have a National Training Number (NTN) and to hold the agreed qualification awarded by one of the Royal Colleges. In total there are in the region of 500 specialist trainees each academic year; many of whom do sadly not complete or meet the programme requirements.
It is the GDC who set the standards required for specialist training, approving the curricula and quality assurance. The Joint Committee for Postgraduate Training in Dentistry (JCPTD), through the Royal Colleges and the Specialist Advisory Committees (SACs), is responsible for the development of curricula, devising assessments and examinations and making recommendations to the GDC on specialty training. The GDC embarked upon a review of the regulation of specialists in 2015; our dental bulletin considering this review can be found here. The second stage of the review began in 2016, and the first results are expected in the autumn. They propose creating a generic template that will serve the basis for all the speciality curricula, bringing a uniformity of language and structure.
The alternative “assessed route” is also under consideration by the GDC. This is where an applicant is required to illustrate to the GDC Specialist List Assessment Team that they have the knowledge and experience derived through academic or research work which they might reasonably be expected to acquire had they completed the specialist training. However, there is limited guidance from the GDC as to what this actually means, the approach to assessments lacks continuity, and applications are routinely returned having been deemed incomplete. Many applicants feel that the only way to ensure success is to seek legal assistance. What is clear is that clinical experience is not evidence of equivalence.
The decision of the GDC not to include clinical experience as admissible evidence is a frustrating one for many, particularly bearing in mind that many dentists were effectively passported onto the lists under the “grandfathering” scheme. This allowed experienced practitioners entrance to their chosen list where they could illustrate that they have the requisite knowledge and experience, wherever acquired. The scheme remained open for two years after the formation of each list. As such it is possible for dentists with no postgraduate qualifications and having passed no exit examination, such as the MRD or equivalent mono specialist exam, to hold the title of specialist.
Patient safety must be paramount in this argument. The assessment of specialist trainees is so rigorous that members of the public can generally be satisfied that they are receiving treatment from an appropriately qualified dentist. For those “assessed” or “grandfathered”, there is less clarity as the assessment criteria appears to be reasonably subjective, and dependent upon the assessors view of a paper application rather than any face to face assessment over time.
There are also a limited number of training posts available; and recent attempts by universities outside of the “Big Three”, KCL, The Eastman and Queen Mary’s, to increase supply has been met with some resistance. The lack of available NTN’s has also frustrated many applicants hoping to enter onto a training post. The Dentists Gold Guide (June 2016) states that the purpose of NTNs is for “Education planning and management” enabling Postgraduate Deans to keep track of trainees and “Workforce information”, to document within each country and speciality how many trainees are in each programme and to provide information as to when training is likely to be completed. There is anecdotal evidence that some dentists working in hospitals and universities can wait years for a training number to become available. Whilst there is a clear advantage to requiring a minimum number of placements to ensure there are sufficient specialists available, it is hard to justify a cap on the maximum. A large number of specialists do not practice in the NHS, and commercial interests will inevitably dominate private practice. An increase in the number of specialists would allow greater freedom of choice and drive down costs for patients. Why not simply maintain competitive entry onto programmes and keep a register of all specialist trainees, doing away with the NTN system in its entirety. Thus removing the lottery of when a number may come up.
The inequality of the playing field for those entering training is another problem. A three to five year, expensive training programme and a limited number of NTNs inevitably means that established practitioners, particularly practice owners, can rarely afford to take the time or money out of running their businesses to undertake the programme. Many of these individuals have been honing particular specialist skills in practice for a decade and simply don’t require extensive clinical training; indeed it is not unheard of for dentists who have limited their practice to a particular area teaching on Masters programmes in their chosen field. They missed the grandfathering window, and can’t afford to have a three year career break, but they can’t rely on their considerable clinical experience to show that they are already practicing at the level of a specialist.
A further disparity arises in relation to European dentists registered in the UK. At present a broader test is applied to European Citizens than is applied to UK dentists, who are assessed on the basis of all their experience, including clinical. So whilst an extremely experienced Spanish endodontist may rely on the number of treatments she has completed in practice, her English equivalent cannot. Although the rules were designed to give individuals coming from European countries, that follow different training pathways and recognise different specialities, an equal playing field, they have arguably ended up allowing European applicants an easier ride. Of course, post Brexit, this may all change.
1. They could scrap the assessed route in its entirety. This would ensure uniformity across the specialisms and create a clear quality control of all specialists.
2. Alternatively they could include clinical experience as a factor in the current assessment process, applying the same equivalence rules to all practitioners, regardless of their origin. This would open up the lists to a vast number of practitioners and has the potential to drive up competition in the fields. However this process would be open to criticism as the assessment process is hugely subjective, and there is no hands-on assessment required.
3. I would propose a third option. The GDC could create a more structured assessed process; mapping an individual’s experience, both academic, research and clinical, against the specialist training programme, require a minimum number of years PQE and the successful completion of the relevant exit exam for each speciality. There would remain an element of subjectivity of course, but considerably reduced, and a candidate’s ability would be appropriately tested through the examination.
The GDCs 2015 review talked about “tightening up” the assessed access, but gave no guidance as to how this would be done. They also considered doing away with it in its entirety. That in my view would be a mistake. The assessed route allows diversity and experience that would be lost should all specialists follow the prescribed training programme. It would also unfairly discriminate against older applicants who would not have the years of practice ahead of them to recuperate the considerable costs involved. We wait in anticipation of the results of the next stage of the review, and can only hope that good sense prevails and a fit for purpose assessment route is unveiled.
My understanding is that the GDC do not agree with the criticism that too high a standard is being applied in FtP hearings. As it happens, last month I was asked by a colleague for some concrete examples of use of the ‘gold standard’ by expert witnesses, so I went specifically looking for it in my review of June’s FtP hearings.
June kicked off with a performance review hearing of a plethora of clinical issues involving a non-engaging registrant who had neither attended nor provided any representation at either hearing, which is always a bad move in my opinion. The case was initially heard in May 2015. Professor Morganstein was instructed by the GDC in this case, and is still according to Google the Dean of Dentistry of the University of Buckingham Dental School that I’m not sure has any dental students. There was a fair amount of criticism in the charges levied at instances of alleged failed treatment and inadequate discussions which the panel did not find proved, and when an allegation that the registrant had provided inadequate care by not giving a patient with an orthodontic retainer specific advice on using a fluoride mouthwash, tooth brushing and reducing sugar consumption the determination states that the Committee considered the expert had applied the gold standard rather than that of the reasonable dentist. This registrant was initially suspended for 12 months and then a further 12 months at the review hearing. The panel had no other choice due to the lack of engagement and attendance in the process and had there been any evidence of insight and remediation the registrant may well have been able to continue practising under conditions. It has been demonstrated in a paper written by Professor Kevin Dalton that registrants who do not attend their hearing and are unrepresented face a significantly higher risk of a high sanction being imposed than those who attend or are represented.
In another review case heard this month the GDC-appointed expert was found by the Committee to appear to be ‘applying a ‘gold standard’ with respect to the diagnostic quality of the radiographs’ at the initial hearing in January 2015. The lesson here is that coned off radiographs are not necessarily poorly-positioned if it is possible to get adequate diagnostic information from them. There is also reference to not recording LA batch numbers and expiry dates in this case which another ‘gold standard’ recording is keeping requirement at best.
Next up a Committee was of the opinion that: ‘in some cases, Mr Expert was advocating a ‘gold standard’.
Some examples of the not proved allegations in this case that probably fit into the ‘gold standard’ bracket included:
So there are three cases here providing some evidence that the gold standard is/was being used (and being identified by Committees) in a sample of new and review hearings held only during June 2016.
The statistics for June were:
Interim Orders held 20 new hearings and 13 review hearings resulting in:
Practice committees held 29 new hearings and 4 review hearings resulting in:
Per registrant type there were 46 dentists, 7 dental nurses, 11 technicians and 2 clinical dental technicians involved in hearings this month.
June was a bit bare on any interesting charges such as bouncing balls of impression material in corridors, bringing children to work or having untidy hair. However there were a high number of erasures that month, and dental technicians brought in front of a PC or IOC for acting out of scope in June also featured quite heavily.
Briefly, the main reasons for erasure were:
With regard to the technicians, pretty much all of these cases related to acting beyond scope; taking impressions when not trained to do so and working without a prescription. This is clearly an area that the GDC are tackling very proactively.
One no misconduct case was particularly interesting in terms of how it ever managed to get so far. It involved a registrant who had sent a letter to some patients of the practice asking for their consent to release their records to the GDC who were investigating a previous partner of the practice over financial irregularities on the basis of concern being reported by the registrant. The letter must have raised a few eyebrows as the GDC alleged that it was:
It is worth noting that Dental Protection had provided guidance and advice on this letter before it was sent, and the registrant had not discussed it with the staff in order to protect the integrity of the investigation, yet the case still progressed. The patients ought to have been told why their consent was being sought to hand over copies of their records in my view. So all in all, it appears to me that someone who fulfilled their professional duty to raise a concern and assist in an investigation found themselves on the wrong end of the FtP process by way of thanks. It is not clear to me what the GDC hoped to achieve by bringing this case, and how this will encourage or protect those who may need to raise concerns in the future.
As you all disappear on your long errant holidays – take note.
Finally the GDC have issued a small puff of white smoke from their chimney in Wimpole Street.
After much personal hard work by our colleague Dr Vicky Holden, and an uncertain amount of work by our representative body at the other end of Wimpole Street, the Council of the GDC voted to remove all address details from their on line register. 60,000 mainly female DCPs will I suspect be mightily relieved. 20,000 odd female dentists will rest a little easier.
If you have not been on the end of unwanted attention, it can be many things. Embarrassing … alarming … irritating … flattering … laughable … but worst of all of course is when it becomes frightening … perhaps even sinister.
Many of us will have had nurse as employees who find themselves on the receiving end of unwanted attention from some admirer- in-waiting. Some of us may have even had to step in on occasion
How the previous CEO of the GDC even thought there was any justification in the first place remains a mystery. But then the workings of the previous CEO were a mystery of course.
Our patients are entitled to know we are registered. In fact 99% of them assume we are.
Perhaps we should put our GDC Number on all correspondence … estimates, invoices, letters etc. I know many do. It’s not a secret.
But it is right that patients with ulterior motives should not be able to pursue an alternative and unwanted agenda.
So hats off to our GDC. Of course you might ask why the Council did not do this 2 years ago when it still scorchingly obvious to anyone with half a brain that the matter needed addressing, so to speak.
This episode suggests that the new senior executive management at the GDC are quite different. There is a sense that their agenda may well be one we could subscribe to.
But perhaps this whole ‘address’ saga says more about the Council. It was those 12 Members, 6 of whom are Registrants, who ducked the issue 2 years ago.
It rather confirms in my mind that we have a better Executive in place at the GDC but we still lack a strong Council who will do the right thing at the right time.
Ah yes ... that brings me to ‘ole Billy boy. The Old Guard still sitting in that position at the middle of the table I see. Still writing twaddle-blogs!
Good job he has been able to keep his address secret all these last few years what with all the FtP debacle!! Perhaps we can look forward to a new method addressing Dr Moyes in the near future: The Former Chairman … Then we might see some real changes.
Have a great holiday. May your sun shine on your upturned cheeks!
During May I spent some time reading the Medical Practitioners Tribunal Service hearings list. MPTS deliberated issues including inappropriate relationships with patients, physical altercations with patient family members and performing inappropriate intimate examinations of patients without chaperones. Comparably, the FtP panels of the GDC were reconvened to consider the issues that NHS England probably ought to be dealing with. Charge sheets were littered with allegation minutiae of the usual failures in record-keeping, and whether bouncing balls made of impression material in corridors might contribute to a finding of misconduct. It’s not specified if the balls were alginate, addition or condensation-cured silicone, or Impregum, and they may or may not have been bounced in front of colleagues or patients and the date of the alleged bouncing was unknown. But those facts aside, I am sure it was fairly clear-cut!
If anyone is interested like I am in comparing the differences between the MPTS and GDC FtP charge sheets to see how MPTS put theirs into the public domain, let me give you an example:
‘The tribunal will inquire (note the inquisitory tone) into the allegation that in April 2014, whilst working as a Specialty Trainee in Obstetrics and Gynaecology, Dr X’s actions towards a patient were not clinically indicated and were sexually motivated’ (and then some further housekeeping information and notes for interested journalists).
‘Charge (note the accusatory tone) that……..(insert pages and pages of specific individual allegations painting a poor picture of the registrants practice and behaviour)......
And that, in relation to the facts alleged, your fitness to practise as a dentist IS IMPAIRED (note the suggestion that the outcome is already proven) by reason of your misconduct +/- deficient clinical performance’ (and if only deficient clinical performance then perhaps add some dishonesty for good measure).
I know which presentation of the forthcoming hearing sits better with Article 11 (presumption of innocence). Furthermore, if the charges are not meant to be taken literally (as I am advised they should not be without knowing the relevant context of the case), then it begs the question whether they ought to be made public? Dishonesty I will touch on later but I feel the GDC ought to be looking at how they present their charges of these public hearings and I believe that a new approach to how the charge is put into the public domain is needed.
But back to last month’s cases of interest of which there were a few:
Interim Orders acted extremely swiftly to curtail two attention-grabbing business ideas with potential to breach GDC standards, or encourage UK registrants to. One related to provision of orthodontic aligners direct to the public without a prior examination and the other was referral incentives for implant treatments referred to a clinic abroad. Both registrants had conditions imposed clipping their entrepreneurial wings. I later received an email from another company looking to ‘partner-up’ and offering me payment for helping with certain aspects of their ‘ortho-direct-to-patient’ business. Possibly the best of both ‘GDC standard-breaching’ worlds in that email, but seemingly no UK-registrant behind it to take through an FtP.
The PSA failed in their appeal of a health-related case. The PSA alleged that the case was under-prosecuted by the GDC, and that an unduly lenient sanction was given with insufficient reasons. The registrant, who was placed on conditions by the Health Committee for what appears on reading the determination to be extremely cogent and reasonable reasons, had complied with all the conditions and made huge efforts at remediation. He was extremely anxious about the prospect of the matter being remitted back for reconsideration and is obviously now very relieved. He told me that the GDC have been a life-saver to him, and that his case shows how some good can come out of FtP procedures, although the time left in limbo has been tortuous. Additionally, it is worth giving credit to the GDC for their handling of the appeal, as they described the conduct in broad terms and kept the health condition out of the public view. The PSA did not however, and some very private material relating to this registrant has now been read out publically in court, which was awfully nice of them.
In the conduct arena, Mr Radeke ‘won’ an appeal in March 2015 against an incorrect PCC decision to erase him over dishonesty and the case was remitted for a new PCC to reconsider the appropriate sanction. He remained suspended only until the end of May 2016 when the case was finally reheard. When I say ‘won’ an appeal, this is really in a loose sense of the word. The wins on appeal are often pyrrhic victories. Registrants who have gone through FtP and appeals suffer enormously through stress, anguish, accusations (perhaps false), public humiliation, financial turmoil and can still find themselves unemployable after a ‘victory’ not to mention their families breaking down or having to go bankrupt in the meantime. I do not wish for second that anyone who reads my blog on FtP thinks that any sarcasm or satire is an attempt to trivialise something that I take tremendously seriously and have had, at times, invading my own sleep. Nonetheless, Mr Radeke’s case involves an unarguably disastrous patient death following treatment, but the original panel had attached incorrect significance to the ASA of the patient prior to treatment and ostensibly decided that the registrant had committed perjury to the coroner; which is a criminal offence. This case, along with the Kirschner case, suggests to me that dishonesty is something that we need absolute confirmation from the GDC that their selected panel members are capable of handling appropriately, given that the GDC like to levy it at registrants at such a high rate (45% of conduct cases include a dishonesty charge if my memory serves me correctly on that FOI data). If you are going to accuse, and then find someone guilty of dishonesty, you had better be sure you are getting it right, and that you properly understand the legal test. Panel member names are redacted from final determinations, but in the interests of transparency ought not those who are the judge have their names kept in the public domain? We do not see judiciary member names redacted in their judgments. Perhaps someone in the know can comment on why this is the case? For those interested in the Radeke appeal judgment to see what the problem was in the PCC decision-making, and it is worth reading just to compare the tone, it can be found here:
In the ‘no misconduct’ case a registrant was reported to the GDC by the ‘GoodThinkingSociety’ (who profess to ‘encourage curious minds and promote rational enquiry’) for allegedly promoting the dangers of amalgam, misleading patients over the benefits of homeopathy and serving alcohol in the practice, and they are unrepentant about the outcome from the emails I have exchanged with them. Why this case warranted a full hearing when we have false advertising attracting an unpublished warning in others is not obvious to me. However, for reasons that evade us registrants who politely entertain patients with ‘alternative’ beliefs, a full hearing was considered justified. The GDC scored the own goal this month by their appointed expert being shown evidence that changed his opinion at the last minute, and presenting a witness who maybe did not realise they were being engaged as a prosecution witness and seemingly blew the GDC case apart by being extremely supportive of the dentist at the centre of the hearing. Aside from his obvious incredulity of being called as a witness (I think he may have written to the GDC to complain about the withdrawal of the 15cc of champagne on offer before an examination and then ended up being called) he told the panel that he could make his own mind up on what was good for him…….and if that was a small bottle of champagne before a check up, who are the GDC to say differently? I am glad to hear that the residual champagne has now been consumed. Cheers!
Finally, the statistics for May are:
Interim Orders held 17 new hearings and 8 review hearings resulting in:
1 outcome TBC at the time of publication.
Practice committees held 28 new hearings and 6 review hearings resulting in:
By registrant type, there were 46 dentists, 11 dental nurses and 2 dental technicians involved in hearings this month. As far as I could see, only 5 registrants were not present and not represented this month.
I have been keeping an eye on the cases emerging from the Fitness to Practice and other committees of the General Dental Council [GDC] for some time, I am sure other GDPUK readers will be interested to know what goes on each month. So, the aim will be to write summary monthly, in what we hope is a short lived blog.
Monthly breakdown of case types and outcomes
The month of March saw 59 hearings scheduled after one was moved back to start in April. There was 1 registration appeal which was granted. Of the remaining cases, 18 were new Practice Committee hearings, 6 were Practice Committee review hearings and 2 were health cases. Interim Orders held 14 new hearings and 18 review hearings. Broken down by registrant type, there were 48 dentists, 4 dental nurses, 4 dental technicians, 2 hygienists and 1 clinical dental technician involved in hearings.
Interim Orders handed out 8 new suspensions and 8 continuation of suspensions, placed 1 registrant on conditions and kept 7 on conditions. One suspension was revoked, 1 suspension was downgraded to conditions and 5 cases had no order. Of the new suspensions 6 of the 8 registrants were not represented and not present.
The Health Committee suspended 1 registrant and placed another on conditions. The Practice Committee erased 1 registrant, issued 2 suspensions, 2 extensions of suspension, and placed 2 registrants on conditions whilst 2 had their conditions extended. Four suspension orders were revoked, 3 reprimands were given, 3 cases were adjourned, 3 registrants were found not impaired, 1 case was referred back to the Investigating Committee, and in 1 case no misconduct was found.
March’s cases of interest
The erased registrant was neither present nor represented, but the case mainly related to failing to take appropriate radiographs, failures in treatment planning and record-keeping, lacking indemnity cover whilst treating patients on 4 days, and a failure to cooperate with the GDC.
In the ‘No Misconduct’ case the registrant essentially faced charges which related to not providing an estimate of costs for root canal treatment (although he did not actually invoice the patient for any of the treatment provided), not informing the patient of the risks of the proposed treatment and therefore failing to obtain informed consent. In fact, the registrant had only provided emergency treatment to try to relieve pain and infection. This was ultimately not successful and the tooth was removed by another dentist. The patient/witness actually complained to the GDC about something else, but this was not worthy of any charges so how this case actually came about is not clear from the determination. Despite having a confused recollection at times, the patient was still described to be a credible witness. Another matter which is not clear in the determination is why there were 3 experts involved - 1 for each party and a joint expert statement. The registrant admitted all the charges, but the panel found some aspects not proved and despite both the GDC and defence counsel accepting misconduct and impairment, the panel found neither on the basis that the treatment was emergency in nature rather than a definitive RCT procedure, and the failings not so serious as to be considered deplorable. A happy outcome here with the lesson of not assuming that because you have not charged a patient they won’t complain about you.
The case referred back to the Investigating Committee involved fissure sealants on a single patient, which the GDC-appointed expert Professor Deery (who is a paediatric dentistry consultant and Dean of Sheffield School of Clinical Dentistry) had concluded were appropriate after he had examined the patient, and that wear on the patient’s teeth was due to erosion rather than damage caused by the registrant. It was submitted that this evidence would change the view of the IC and that no realistic prospect of a finding of misconduct existed, begging the question did one exist in the first place? How the case came about, and on what the basis of the patient complained is not explicit in the determination but it is implied that the registrant may have perhaps been accused of creating damage in which to place fissure sealants or otherwise creating unneeded work for themselves. This case highlights the inherent issues with the lack of a clinical examination until a late stage, (if at all) in the FtP process and how assessors and experts creating charges purely on clinical records is a flawed concept. This case will have involved a significant waste of registrants’ money in reaching a Practice Committee that could have perhaps have been avoided with an earlier examination of the patient. Hopefully with the recruitment of dentally-qualified caseworkers cases like this can be avoided in future.
Mr N, who was neither present nor represented, was suspended following his hearing which included 73 individual heads of charge, many of which had several sub-headings. The GDC-instructed barrister may have missed Jonathan Green’s presentation at the Dental Protection Study Day last October where he stated that no over-drafting of allegations would take place following the embarrassment of the Kirschner case. In the determination the GDC-appointed expert, Professor Morganstein seems to advise that linings ought to be placed under amalgam restorations. With no representation there is no means of contesting such a view even though many GDPs would now not line amalgams, nor is there any conclusive evidence that they need to be. Professor Morganstein is apparently the Dean of the dental school at the University of Buckingham (I know what you are thinking…. and I’ve not heard of it either). I feel this case nicely highlights the problem with the GDC using experts who are focused on academia or in specialist practice opining on GDPs, and is directly contributing to the stealthy moving of standards in an upwards direction.
Finally, the long-running Carew case which I have been watching with interest due to the charge of:
· you failed to adequately record the clinical reason why a try-in was required……
has left me somewhat disappointed as this charge was withdrawn on day 1 of the hearing. It looks like we will never get to find out why this element of record-keeping was considered to have been essential.
Welcome back. I think Easter if officially over, just watch the traffic next week!
Your regulator, the GDC, is trying make the news again. Perhaps in that ironic respect, it is very successful. I suggest the smell is not good.
However, perhaps not in in the way it might be hoped. The GDC is spinning the facts to serve its own interest. Again.
You remember the GDC?
It’s that organisation for whom you pay the best part of £900 per year as a work tax. If your business also funds your staff registration, you will be paying well over £1000 per year.
It’s that organisation, paid for by you, that squanders money on frippery and self-serving PR, accountancy consultation and £9M building expenditure. Prudent management of other people’s money is not part of its remit, it would seem. Your money is used in part for its role as a World Class Complaints Agency [remember all those outrageous FtP cases? … they are still coming through!].
Seconds away … Round 4 - Dentistry versus the GDC
It is the latest bleating of the Chairman that should catch your eye and stir your loins with a sense of disbelief and injustice. It certainly has for the BDA [ are you a member - £30 a month for the fighting fund, get on with it!] who have returned to the ring for another fight. We can but hope that Big Mick is aiming to knock over Chairman Bill and obtain the final ‘fall’.
If you have not taken great interest so far, I am sorry to lean on you again, but please – without YOU taking a simple action, nothing will happen.
As a wet fingered GDP, you CAN make a difference.
The BDA alone cannot clean the stable on your behalf. The smell and the excrement remain, and it “All hands to the brooms”
Why all the fuss?
You will, I hope, have noted the PSA Report before Christmas.
Finally some three months later Dr Moyes, Chairman of the GDC sticks his head over the parapet. Writing in his Blog, you could take a rosy view of the world in Wimpole Street. This Blog is seemingly the first of many. Boy, I look forward to those … the excitement is too great.
I suggest to you that these are the words of a professionally dying man. If you read the minutes of the 3 March 2016 GDC Meeting, to which Dr Moyes makes reference, it is clear that the Executive Management Team [EMT] of the GDC have been explicitly humiliated so that the Council can remain in post.
What's the problem? This is the problem:
The BDA are to be congratulated for shovelling more coal on the fire, but I think more is needed yet.
If you know a Council Member, ask them why they have not resigned? If you know of them, write to them and ask them the question.
What "Point of Principle" causes them to stay?
Dr Moyes may think he has got away with it but I think we must all prove him wrong. So very, very wrong.
Until this Council are forced to resign en-masse, nothing will change because it was Dr Moyes and his merry band of Members that oversaw the woeful actions of Ms Gilvarrie, and it is the GDC Council which will design the Job Spec for the new CEO.
If you mix your cake with a poisoned spoon, the cake will always be poisoned.
The GDC have fallen - The political referees should end it now
The Council of the GDC should resign. The Chairman should already have gone. It is an amazing arrogance of unholy magnitude that he and they have not.
Whom should be first?
It is clear the Chairman has the skin of a rhino and so it is down to the Council to consider their positions based upon the principle of what is right.
Your profession needs your help. Support the BDA. Write to your MP. Write to the Registrant members of the Council. Phone people.
JUST DO SOMETHING
DO NOT BE SILENT.
There is a sense that the BDA have started the final round. You need to shout and holler’ your support.
May all of you have Spring in your steps.
BDA: ‘new era’ at GDC comes with £½ million cleaning bill
Mick-Armstrong to Bill Moyes letter 01 Apr 16
Bill Moyes' Blog; Learning the lessons of the past
GDC Council Meeting 3rd March 2016 Discussion about the PSA
A report on the investigation into the General Dental Council’s handling of a whistleblower’s disclosure about the Investigating Committee
21 December 2015
Welcome back to the start of what promises to be an interesting year
There appears to be a consistent theme however running through the early events, which seem to me to be somehow all related. Perhaps not in a complimentary way.
Firstly we have the Daily Telegraph Letter, discussed widely on here, as well as a supporting article in the newspaper itself.
This is of course the third year that such a letter has been published by, this time, some 400 signatories including this writer. Critically, a small nugget of self-opinionated idealism say some. By contrast its supporters suggest it is merely a further reasoned cry for a sensible strategy to use the limited Government money for the groups in need. For example, those such as children who finish up in theatre under a GA, or other high needs groups, often postcode affected.
Just where is the Clarity of the Deal for the rest of us for example?
However, is there a Conspiracy of Silence? Perhaps a mood of disdain? For as we speak some 3 weeks later, the BDA have not mentioned its publication. At all. Anywhere. You may search their News Releases at https://www.bda.org/news-centre/.
Would you care to wonder WHY the BDA feel so reluctant to even acknowledge the letter let along jump on the brief media bandwagon? Complacency or Conspiracy? You choose.
The PSA-GDC relationship
It is certainly a case of no love lost. Before Christmas, you will recall, the GDC were aligned in the crosshairs of the PSA and their hyper critical report.
Comment made again on GDP UK and elsewhere has been withering. It is clear that there is a mood that the Chair of the GDC must go, not just because of these events, but also BEFORE any process to identify a new Chief Executive takes place.
It is therefore very interesting that the GDC have seen it unnecessary to mention in their public media releases anything about this report, let alone any sort of “It’s all good here” spun response.
Complacency or Conspiracy? You choose.
Peter Ward, CEO at the BDA has placed a damning Leader “Whistling in the Dark” in a recent BDJ about the GDC at http://www.nature.com/bdj/journal/v220/n1/full/sj.bdj.2016.1.html
I have stated it before. Others have stated it. And so we all say, again:
The Chairman must go, and the Council, in particular the Dental Registrant Members of the GDC, should seriously consider their position.
Shortly before Christmas , before the letter in the D Tel, the BDA seniors figures and the LDCs met with the new CDO of NHS England, Dr Sarah Hurley and you may read the reports here courtesy of Yorkshire’s East Riding LDC
Is it me? It is similarly interesting to think that since then the BDA have kept a very tightly sealed pair of public lips on matters pertaining to the disgraced UDA system of Contracting and its Prototype successor
Not a mention, not a dicky bird.
Complacency or Conspiracy? You choose.
There is it might be argued a fine line between complacency and conspiracy as to why each of these bodies [The BDA and the GDC] have chosen to ignore these two unrelated and yet significant events.
In the case of the GDC, I think we can speculate that the present Council are in their final days, especially after the unprecedented mauling by the House of Lords in the debate this week. I will put that down to complacency therefore. Please view the debate here http://parliamentlive.tv/Event/Index/2a3f3b86-7d34-448d-ab91-52e134879e49
The GDPC - CDO[NHSE] Relationship
Which leaves me to ponder the conspiratorial nature of the relationship between the GDPC of the BDA [representing all you dentists at the negotiating table for the New 2020 Contracts] and NHS England’s Chief Dental Officer.
It seems like the old days, for those of you old enough to recall that great old wise owl, Labour leader and Prime Minister Harold Wilson. Beer and sandwiches at No 10. In this case, filter coffee and homemade biscuits with a fine group of colleagues.
Transparency is dead.
Complacency is the food of conspiracy
The outcome is the same. It appears any chance of truly driving change with the wider interests of the public and profession at heart, in a transparent manner, at the highest level of our Profession, is to be denied.
Instead agreements will be cobbled together in secrecy and behind closed doors by the privileged few. You will told when you need to know
As was stated recently: we are a Profession that suffers Group Mural Dyslexia ! Failure to see the writing on the wall.
A little more energy is required if we are to see the Profession make progress against the political headwinds this year.
Perhaps a little less complacency and a little more Conspiring to rebel? We can but hope!
Details of the forthcoming GDC hearing are available at:
Further details of the BDIA’s CSIDI activity can be found at:
The British Dental Industry Association (BDIA) is a non-profit making organisation which means that any surplus funds generated from its activities are ploughed back into dentistry either directly or by supporting and working with other professional dental bodies.
Can we make the Regulators serve the Public and the Profession in foro conscientiae (the court of the conscience), rather than just a notion of what the regulations might say?
I have attended and been asked to make some input into a variety of cases recently involving several different Regulators.
It has become clear that there is a real danger that rules and regulations which may have been drafted for the protection of the Public and the guidance of the Profession are sometimes widely misinterpreted at best and occasionally deliberately corrupted and applied at worst.
How does this occur?
Whilst it might be considered that most regulation has been drafted to improve standards and reduce the risk of poor practice continuing; it is quite obvious that it can be applied in a manner to exert control or ‘manage’ the Profession. Sometimes this may occur deliberately and because it broadly serves the purpose of a government administration, it is allowed to continue at least as long as it serves a purpose. Sometimes it occurs at a much lower level and whilst not serving any particular purpose, it is allowed to continue because there is nobody at that level who is prepared to question it.
I’ve got nothing against shop assistants, however I wouldn’t be wanting them to draft the GDC Charge Sheet which might end a Professional career. There is a high turnover of staff at the GDC which I suggest leads to a poor understanding and there appears to be a low level of dental knowledge.
One of the cases to which I refer involved a young colleague, and for whom funds were raised at very short notice thanks to the excellent GDPUK membership.
If you read the Charge Sheet, you would be forgiven in believing this dentist was a real danger to the Public. However I’m sure that you will all remember me reminding you to read between the lines whenever you are dealing with a Regulator. That is certainly necessary in this case.
(i) The use of a double cantilever (the bridge was fixed-fixed)
(ii) Not adequately assess that a RCT was required (the tooth was root treated and had been a symptom free bridge abutment for 20 years)
(iii) Fitted an inadequate post which was a) short of the apex, b) not extending to the apical third and c) was inadequate in width. (The post was temporary and deemed too wide).
If the Charge sheet is a nonsense, the solution is simple. The Panel changes it, strikes it out or substitutes different wording. In other words, it moves the goalposts. The Panel, which is independent by hearing both parties then asks its own questions of the witnesses. It is advised by experts and can choose which expert it ‘prefers’. The expert appearing on behalf of a registrant might then be warned by the Prosecution barrister that the GDC may take action against them. The prosecuting barrister is instructed by the GDC and regularly prompted by their expert witness.
In one of the cases to which I refer, four patient witnesses who had made a complaint were called. One of the witnesses was travelling to London and it was found that she intended to speak in favour of the Defendant and it was agreed therefore that this patient would not be heard.
The Panel seemed to have some ability to read between the lines, but in the end ‘prefers’ the testimony of two patients. One of these patients produces a hand annotated diary of the treatment dates containing some dates that the defendant was actually not in the practice (a screen shot of practice diary was produced as evidence). The patient was receiving treatment from more than one dentist at two different practices simultaneously, but on the ‘balance of probability’ is to be believed. This patient was heard to say that she was seeking ‘redress’ on at least four occasions.
Our young colleague describes how he always uses rubber dam for RCT and yet on his last day in the practice he finds there is no rubber dam available. He admits that on this single solitary occasion, rubber dam was not used. The patient has pleaded that a temporary post crown be placed (the same inadequate temporary post that was short of the apex) and he accedes to the request of RCT and temporary post, since the broken tooth was within the patients smile. He uses rotary RCT instrumentation, floss on hand instruments and high volume aspiration. The patient is the same one who was not given the opportunity to give further evidence in support or denial of the registrant. Our young colleague is guilty therefore of serious clinical failures and therefore misconduct.
Another patient gives evidence about never having received treatment he has paid for, but the Panel agrees that this evidence is just not credible, which it isn’t.
A fourth patient was having a long and complex treatment plan part of which had been incomplete and following a tooth fracture needed to be modified. The patient didn’t clearly understand the new treatment plan and for that our colleague was criticised.
It’s worth mentioning that there were NO PATIENT RECORDS available because there had been a burglary declared immediately following the practice change of ownership. This was highlighted to the Panel.
Communication was a big word in this Hearing. Other significant words are ‘insight’ and whether or not the Panel consider that this is ‘embedded’ sufficiently. Our young colleague was supported by Sir Peter Bottomley in person who made a statement and also by the testimonials of 47 patients.
The GDC however do not need to give weight to the above in making their determination, although I noted that the prosecution barrister frequently returned to the GDC to ask for further instructions. I think it worthy of note that the Panel describe our young colleague within the Determination as follows ‘It is clear from all of this evidence that you are viewed as a competent and caring dentist, who will go out of his way to assist his patients.’
Do the GDC therefore need to apply Conditions, because that’s what they did?
Please read the GDC Determination when it is published.
If you recognise any of the issues above, you are guilty of misconduct and your standards will be deemed serious failings. Approximately 1 in 7 dentists in the UK currently face some form of investigation which could result in imposition of sanctions either through the GDC, CQC or NHS and this number is growing constantly. This might mean that we have the worst performing Dental Profession in the World bar none or that we have the most disproportionate Regulators.
You may consider yourself lucky and are happy to cross the bridge with your indemnity organisation when your time comes; or you may be sufficiently confident to wade across the raging torrent alone when your indemnity organisation makes an unexpected discretionary decision against you.
What type of indemnity organisation are you currently paying for?
You are required to have professional indemnity and it is considered a serious failure if you have ANY gaps in your cover period. Indemnity providers however do not guarantee to provide legal representation to you and if they exercise their discretion in favour of their balance sheet (or dressed up as other members interests) you will find yourself alone or facing a huge legal bill.
A recent Hearing which I attended over 7 days starts at £32,000 and it’s uphill from there.
Does anything need to be done about this?
You read the PSA report published 21st Dec, I hope. https://www.professionalstandards.org.uk/docs/default-source/psa-library/investigation-report---general-dental-council.pdf?sfvrsn=6
What exactly have we learned about whistleblowing from the Sir Robert Francis Report (Mid Staffs)?
And you can see how the whistleblower was treated, you can see what the PSA thinks about it and you have seen how the GDC are going to be dealing with your ‘serious failings.’
You tell me, do you need to do something about this?
From a variety of recent cases we can conclude:
· The GDC consider failure to use a rubber dam in endodontics to fall seriously below the required standards and therefore to represent IMPAIRMENT and worthy of sanctions.
· In my view neither the CQC nor the GDC have a currently correct understanding of CONSENT which conforms with the recent Supreme Court judgement of Montgomery – v Lanarkshire Health Board. This needs to be challenged in the High Court.
· The GDC will always use the ‘balance of probability’ in forming an opinion on which evidence it prefers.
The Profession must for once in its life join together. The issues regarding Consent and use of rubber dam will need to be challenged and this requires more than a well-intentioned individual or some crowd funding. It requires a strongly actioned move being taken by the BDA and the indemnity providers.
I could basically repeat this mantra for the whole of this blog and I don’t think many would disagree with it (except of course Bill himself). However, I think my readers are more used to having a bit more to get their teeth into, so I’ll pad this out a little more. It won’t run to the 306 pages of the Professional Standards Authority report (here) into the GDC, but the sentiment is the same…
As well as reading my ramblings, I would strongly urge you read two blogs by a couple of fellow colleagues whom I have the utmost respect for. This blog was not originally going to be about Ghosts of Christmases Past, Present, and Future, but it is quite an appropriate analogy.
These are our perspectives on what has gone before, what is still happening, and what we need to do. Three views for the price of one.
I am very aware of the warnings by Dental Protection not to be too critical of the GDC in public. However, I think the publication of the recent report allows me to point out some factual issues in that report, and exercise my right to free speech about a public body without too much fear.
The PSA’s whistleblower report makes fascinating, and at times unbelievable reading. What is clear from it is that the GDC at both Executive and Council level is not only a failed organisation, but a completely and utterly incompetent, insensitive, and dare I say it, corrupt (in the ethical and moral sense) edifice that now needs to be put out of OUR misery.
The report is probably the reason that Ms. Gilvarry has decided the time is right to move on. We can only hope that other regulators do not suffer in the same way as we have in the recent past; I would certainly hope any organisation thinking of engaging her in a similar position is made aware of this damning report and the role she quite obviously played. It’s really not something I’d want on my CV.
From the writing of policies by untrained and unknowledgeable staff who then went on to train more untrained and unknowledgeable staff in the process of discipline (via the Investigating Committee), the lack of scrutiny of the IC’s work, the failure to correct the problems outlined in the previous PSA report, having an ineffectual whistleblowing policy, rewriting it and it still being useless, to the utter lack of oversight by the very Council whose duty it is to ensure the Executive do not go off on a tangent, there can be no doubt the GDC has become a derided regulator both by the profession and the PSA.
So how on earth then can the Chair feel he can remain in post too? Not only that, are the other members of the Council so isolated from the real world situation everyone else can clearly see, that they somehow feel they have no responsibility for this disaster of an organisation that they are at the head of?
Having a regulator that uses untrained staff, described by their own director as just ‘bums on seats’ and ‘clones’, to be responsible for an entire section of a professional disciplinary process is nothing short of negligent. It is admitted in the PSA report that they were under pressure from the Executive to ‘Get the Job Done’, which implies the rulebook went out of the window. When people’s careers, livelihoods, wellbeing and indeed their personal lives are being held in the hands of people quite obviously out of their depth and unaware of their duty, then that attitude by the Executive is utterly reprehensible. Not only that, there still has to be the accountability that is sadly lacking. These members of staff are not specifically blamed by the PSA for the problems, as it was recognized the responsibility was entirely that of those in overall charge of the systems (and some of them are no longer in post thankfully), but one would hope that the moral compass of anybody involved would direct them to make the right decision and now leave.
Whilst the influence of these people was seemingly only on the members of the Investigating Committee, one would hope that the integrity of those on that committee was such as to not be influenced by them. However, by a simple process of extrapolation it makes one worry that other committees were under pressure of being influenced in the same way. The evidence for this isn’t in the PSA report because they didn’t specifically look for it, but we all know the GDC have acted unlawfully before in setting the ARF, which isn’t exactly a great track record. Not only that, but the findings suggest that the situation the PSA investigated with the Investigating Committee leaves the GDC open to further legal challenges via Judicial Review over the decisions it made. I would therefore suggest that EVERY SINGLE case that falls within the dates the report encompasses is reviewed and looked at independently, at the GDC’s own cost. If that bankrupts it, good. Perhaps the Government might take notice when it has to bail out the GDC.
It’s a bit like a parent dealing with a delinquent child; it tends to ignore it hoping things will get better, then gives it a stern talking too, but when it finally has to go down to the police station and bail it out for a serious offence the realisation that there is probably something perhaps seriously wrong with its offspring begins to dawn.
It’s one thing Ms. Gilvarry falling on her sword (or was she pushed?), but the supervisory role of the council during this period was non-existent. In addition, the judgment of the chair has also been called into question over decisions that he made. The sort of important decisions we take for granted will be made correctly by someone in his position. The sort of decisions that if we made incorrectly would see us in front of the regulators fearing for our careers….
There is NO way that Dr Moyes has the respect of the profession as a result. He has shown his lack of understanding of the profession on so many occasions, starting with the infamous Pendebury lecture where he likened us to the supermarket sector. That’s all well and good in this increasingly consumerist world, but you don’t get people losing their careers if they give you the wrong shape carrot or your tin of beans is past the sell by date.
So I address the final part of this blog to those people involved in the whole sorry affair.
To the Investigating Committee Secretariat, you must ensure nothing like this is ever allowed to happen again. The overwhelming majority of people in dentistry are good people, and they are not numbers that need processing despite your instructions to ‘get the job done’ by what appears to be a bunch of Dentist Haters. There is no defence to the excuse of ‘we were just following orders’; Nuremberg in 1947 saw to that. Whilst the GDC whistleblowing policy has been shown to be pretty useless, please bear in mind the need to do the right thing if there are things you are not comfortable with. Please remember, you are not the judge and jury.
To the members of the council; you might have thought that being part of the GDC would be altruistic and for the greater benefit of our profession. It should be. You might even have thought it looked good on the CV. At one time it would have conveyed respect and deference. But given the utter failings and lack of detailed, focussed, professional management that has occurred, you might be better admitting you were unwittingly coerced by the members of a ruling Politburo, which might go some way to rescuing both your CV and your own professional reputation. The Council’s oversight has been so lacking, not even Specsavers could help it.
Finally, wake up and smell the coffee Dr. Moyes. You seem to have absolutely no idea what being part of a profession is, and the members of the council have obviously not educated you properly (or been allowed to). The insight that you rightly demand of your registrants has been sadly lacking by your entire organisation, and given the tone of your emails to us particularly by yourself. I’m just waiting the email from you saying what a resounding endorsement of the GDC the PSA report is, since that’s the usual spin that is put on things at Wimpole Street. Your oversight of the Executive has been completely ineffectual. Your part in this whole debacle cannot be brushed under the table; it happened on your watch so you must bear responsibility at least in part. It’s quite ironic that some of your previous posts have been with the Office of Fair Trading and Monitor. Because there has been absolutely nothing fair about this organisation whilst you have been at the head, and your monitoring of what was going on around you appears to have been non-existent. Dentists might be in the minority of whom you regulate; but believe me without us the profession couldn’t exist. Ignore us at your peril.
For that reason your fitness to regulate has been found impaired and you must face the sanctions.
Dr. Moyes, you must resign.
You must all resign.
The GDC specialist lists were established in 1998; the most recent, Special Care Dentistry, being added in 2008. The UK has more recognised areas of specialism than any other European country. There are currently 4261 registered specialists across the 13 disciplines. The GDC are not obliged to have specialist lists, but are empowered to do so by various pieces of European and domestic legislation and regulation. If they wanted to dispose of the lists it would not require legislative change, but would need a compelling policy reason and would require a significant amount of regulatory change.
There is no comprehensive data about the total number of patients treated by Specialists each year; although there were 2.7 million outpatient appointments within dental speciality clinics and a further 320,000 consultant episodes in 2012/13 according to NHS data. This of course does not account for private patients.
The GDC recently undertook a review of the way in which the specialist lists are regulated. The aim was to determine what the benefit of regulation was when it comes to patient protection and whether the lists did in fact help patients make a more informed choice about their dental treatment.
The first phase of the review began in January 2014; whereby information was obtained from both the public (with a representative sample of 500 adults) and the profession regarding their experiences (there were 68 responses from the profession, including 25 from individual specialists and 5 from GDPs).
The most common way to obtain entry onto a specialist list is to undertake a recognised training programme. Approximately 500 students per year attempt this route. Alternatively, candidates can seek to illustrate equivalence in “knowledge and experience gained through academic or research work”; commonly known as mediated entry.
European registrants with qualifications in Oral Surgery or Orthodontics are automatically recognised.
In 2011 there were 175 additions to the list, in 2012 245 and in 2013 231.
Only a registered specialist can use the title. This is also true for the use of the “ist”; endodontist, periodontist etc. It is not permissible to use the phrase “specialising in” if you are not registered on a specialist list. The only permissible terms are “special interest in”, “experienced in” and “practice limited to”. Using an incorrect term can lead to professional disciplinary proceedings and/or a conviction and fine.
The cost of registering on a specialist list are relatively low; just £345 for initial registration and £72 per year thereafter.
The GDC have calculated that the cost of regulating the specialist lists in 2014 was £339,000, which income is forecast to exceed by 6%. There does not appear to be any comparison with earlier years, and as such it is not known whether this is a constant figure. However, this cost also includes the cost of the review so is likely to be much higher than previous years.
Conclusions of the Review
Does specialist regulation bring any benefits in terms of patient and public protection?
The reality is that public awareness of the specialisms is extremely low; shockingly more than half of those surveyed did not know ANY specialism existed. Only 1% was aware of periodontists and restorative specialist, only 2% of prosthodontics and only 3% of endodontists. The highest recognised term was “cosmetic dentist” at 22%, closely followed by orthodontist at 19%. Worryingly 10% believed implantologist to be a recognised speciality. However, most people felt that it was important that specialists were properly regulated. Unfortunately, only a third of those questioned had even heard of the GDC (and this was when prompted!).
It is useful for specialists and practice owners to bear in mind that when choosing a specialist most of those who did recognise specialisms relied on their dentist’s referral rather than their own research. What is abundantly clear is that dental specialists are not effectively marketing their existence, and by implication their value.
Of those in the profession who responded, the general view was that regulation should not be decreased and that deregulation risked those not properly qualified attempting procedures outside their capability. However others pointed out the lack of evidence that regulation does in fact improve patient care. Concern was raised re the lack of regulation of specialists post-entry. At present CPD requirements are the same for both GDPs and Specialists.
Is regulation proportionate to the risks posed by dentists providing complex treatments?
Perhaps understandably specialists were more supportive of the lists than GDPs. Some respondents felt that the fees charged were disproportionate. However this is surprising bearing in mind the amount of administration required in certain cases. £345 may seem a lot for someone who has been awarded the CCST, but is a small reflection of the cost of mediated entrance. It is curious that a more diverse fee structure has not been recommended and that practitioners are not being asked to fund appeal hearings, particularly if unsuccessful.
Many respondents questioned the need for the number of specialist lists. However the review concluded that they were necessary due to the number of complex procedures undertaken.
Are the specialist lists the appropriate mechanism for helping patients make more informed choices about care seen as falling outside the remit of a GDP?
74% of patients who had visited a Specialist had been referred by their GPD. Only 4% of those questioned said that they would check the details of their Specialist with a regulator. Although the majority responded that it was important that the information was there if they did want to check.
GDPs and Specialists generally agreed that the lists do assist in making appropriate referrals.
In reality although specialist lists are available on the GDC website, the public a) doesn’t know about the GDC website and b) doesn’t understand the terminology used and significance of qualifications recorded. It would appear that it is the GDC who are failing in the provision of information to patients.
Should the GDC be the body to regulate the specialities?
It was generally agreed that the GDC are the appropriate body to regulate, however it was pointed out the GDC was reliant on the Royal Colleges to provide guidance on the skills, knowledge and behaviour of specialists. Nor does it quality assure specialist training or have a separate revalidation process in place.
The review made for possible proposals for the future:
1. Strengthen the GDC’s approach to regulation. The GDC are developing a “work programme” to achieve this and intends to give a clearer definition as to the meaning of specialist, ensuring the lists are correct, “tightening up” mediated access or removing this route entirely, quality assuring specialist training and providing information to patients.
It appears that the only rational for proposing the removal of mediated entry is to reduce costs. Surely a fairer and more sensible approach would be to charge applicants appropriately.
2. Explore alternative models of regulation:
If the Council is of the view that the current regulation does not offer significant benefits to either the public or patients; is not proportionate; or that resources could be more properly focussed on key regulatory functions; then there would be no further policy changes and instead possible alternatives to statutory regulation would be explored. This could include investigating the possibility of removing all specialist lists save Oral Surgery and Orthodontics:
3. Continue to regulate the Specialties, but not make any significant policy changes. Although it is still suggested that the mediated entry route would be reduced.
4. Further analysis of the evidence of improved patient outcomes.
Overall the review has uncovered the alarming lack of understanding by the public regarding Dental Specialists and the Lists. However, on a more positive note, appears to suggest that those within the profession believe that the lists are both necessary and helpful. Of the proposals, only one thing is clear that dentists can expect an attack on the mediated entry route over the coming years; although there seems little justification for this save on costs grounds.
**Blog image from Creative Commons
***This blog has been written for Rumpole of the Surgery by Julia Furley of JFH Law
Welcome back to the Indian Summer of tropical rain…
There was a time when those of use of a certain age [OK Old if you will, but take that tone out of your voice!] decided to pursue dentistry for many reasons one of which was the life time career of care which happened to be comfortably paid. Professional life was stable, practice management was an ongoing process. Interestingly by and large we saw all the patients who wanted to be seen and managed their dental needs without any political calls for damage limitation of a crisis of “Access”. Those of us so inclined went home for a celebratory glass of cheap Chateau Rinse de Bouche over an FP17. [For those of our younger colleagues unfamiliar with such things, these were the old claim forms that allowed a course of treatment to be ‘claimed’]
Complaints were rare. The GDC were a body to whom one looked up in awe and respect, and yet who played little part in day to day practice. Indemnity was low cost as was the ARF. At some point in one’s career one would make the decision to up the standards of ones work and seek to change the way one practiced. It was a cycle of professional life.
Meetings [long before CPD became a fashion statement] were a cacophony of chit chat about practice matters.
Morale I would be so bold as to say was always, broadly, high
So what on earth has happened? How do we find ourselves at the edge of a perfect storm of change for the worse?
The GDC are a runaway train of high cost complaints handling and we are all paying through the nose and other orifices too, I should think. The persistent arrogance and lack of accountability of the GDC and its leadership remain a real cause for concern. A worry in part because they affect us but we do seem to be able to affect them, nor can the PSA, it seems.
Just look at Indemnity as an example. On the one hand it is a significant chunk of income on an annual basis, now being compulsory [so the lawyers can REALLY get their teeth into you]. On the other hand, despite reassurances, there is a pervasive sensation that they will dig you out of a shallow pit of excrement, but if you are truly up to your neck they may simply leave you to flounder. A worry in part because they affect us but we cannot affect them.
Now we have news of the falling away of dentist incomes. In a separate and apposite piece of Government news, even that respected statistical body HSCIC, thinks morale is a worry amongst dentists. Now incomes falling is hardly news because most of us have noticed this in the last 5 years. How? Well, we run these efficient Micro-Businesses, Minister and produce the annual accounts.
Practice Plan’s latest Confidence Monitor is hardly an advert for happy campers under the Governments clinical cosh that is the UDA. The vast majority of the NHS dependent sector must be feeling very uneasy.
What has caused this change of circumstance? Why are all the pointers suddenly running the wrong way? If morale is a precarious state of mind, all this news must surely cause the spiral of decline to turn more quickly unless something is done?
Can morale fall, like the rain, in stair-rods?
Now hold on Dr Prism … Dentists are a resilient bunch – we get by, we generally don’t moan, and we take the rough with the smooth because, let’s face it, there are many worse off than us and despite what the Daily Fail et al may say, we do have a social conscience.
In our day to day work, we [you me and all the other GDPs] take personal responsibility for our situation. It is up to us to be happy … or not as the case may be. It is up to us to run our businesses. All good so far.
But for the bigger external problems we rely upon an external body to do our work for us. We reply upon our Academic colleagues to lay out the ground for evidence based clinical practice. Not some random bunch of Red Braces in Wimpole Street who would not know a dental practice if it hit them on the head! We rely upon a representative body to keep the bad news at bay – to fight off the bad guys as it were.
Where are the BDA as our ‘Union’?
Perhaps they themselves experiencing a decline in morale as time and again they fail to make an impact against the onslaught of Government regulation and initiative? Not so long ago there was the change of subscription system and I seem to recall there was a ‘bit of a fuss’. Even on a professional matter such as obesity and the sugar debate, it was the medical fraternity that snatched the victory, and the BDA were left to issue a “told you so” PR statement which barely caused a public ripple.
Perhaps the lesson of influence here was that we need strategic alliances to amplify our voice and our influence.
Why is the BDA so effective on so many levels of “back office” matters and yet on the “Front Line” of headline influence and involvement, it is abjectly falling short. Why is it that as a body of 20000 dentists, they are neither first to be thought of in the media domain nor are they regarded with respect by our political masters?
Incomes … the UDA system … the Prototypes … the CQC … the GDC and its quisling Dental members … the GDC and it expansionist ambitions … FtP … more FtP … Professional Morale … a vision for UK dental care … Children’s Dental Health … Young dentists and early training... Planning for Tiers ... the list goes on where as members [and non-members] we cry out for some serious bloody Bolshiness – and time and again we feel they fall short. Too busy having ‘polite meetings’? You might say that, but I could not possibly comment.
By and large of course those who are in private practice are able to manage their lives and rise above the challenges of NHS practice. This indeed is reflected in the consistent theme of the HSCIC, Practice Plan and others: their findings relate to NHS practice
So if the NHS GDP is the poor bloody infantry, who are their Generals?
Well certainly not the new CDO, ironically Colonel [Retired], who is happy to discuss the present and future problems on the same stage as the very man who was their architect, now relishing his role as a non–exec director for a leading Corporate.
The sign of poor morale in an organisation can be its collective ineffectiveness of leadership.
Perhaps the problem of spiralling morale in GDPs is in part due to a perception of low morale at the BDA?
For sure as profession we need a dose of Feelgood Salts and a good kick where it hurts.
The season is underway.
The BDA need to start scoring some goals.
It’s not like the ball is not in the open, and for sure the net is wide open. The NHS GDP needs its leaders, its “Generals”, to start doing more than limply waving a PR flag. I suspect members would prefer one action over the hundred words of a glossy Press Release.
Can it really be a year since we and the BDA all went up in arms over the ARF change? A fine campaign of action but has 2015 seen it followed through?… It’s a sad reflection that, as no doubt predicted by Madame Gilvarry and Dr Moyes, the ARF is now seen as small beer – have you looked at your Indemnity bill?
Get a grip BDA.
Start earning your members fees. Before a large part of the profession withers under your watchful gaze.
The signs are out there. How many more hints do you need?
New report looks at motivation and morale of primary care dentists http://www.hscic.gov.uk/article/6675/New-report-looks-at-motivation-and-morale-of-primary-care-dentists
The first NHS Confidence Monitor https://www.practiceplan.co.uk/dental-plans/the-nhs-confidence-monitor
BDA Current Press Releases https://www.bda.org/news-centre/press-releases
New CDO to speak at therapists conference https://www.gdpuk.com/news/latest-news/2004-new-cdo-to-speak-at-therapists-conference
You join your ship with lots of other passengers and set sail. What is vitally important though is that you’ve been told before you sail you have to provide your own lifejacket. You notice that there are quite a few different sorts and colours. Some are ones that only inflate whilst you have them with you, and some are inflated all the time, even when you get off the ship at the end of your journey. Some passengers even have special coloured expensive ones that some of the lifejacket manufacturers don’t even supply. We’ll come back to those later. The industry is getting bigger and bigger, so more and more life belts have to be made for all those going cruising.
Initially it’s all really nice, the food’s ok, and the accommodation is too. However, there’s something not quite right. The crew seem to be openly hostile to you, and the officers never seem to speak. The captain of the ship and the 1st officer never come down to speak to the passengers. You’re actually suspicious that the direction the ship is headed isn’t the one you signed up for. Not all the islands you visit are as welcoming as others. After a couple of ports you also start to see the numbers of passengers dwindling a bit and you hear a lot of splashes at night.
You do a little research and you find out that the crew is in better quarters than you are, and your money has gone to pay for that. You have to tip the crew more and more even though the service is rubbish, and then you find out the way they worked out the tips was illegal. More worryingly you hear that the captain orders the crew to round up passengers who might be a danger to those who live on the islands the ship has visited or might visit yet. The captain orders the islanders to report anything they don’t like about the passengers to the bridge. The captain also allows spies to be put ashore to trap some passengers if the locals themselves don’t report the things that are done ashore. Passengers who have committed some sort of infraction are invited to visit the Bridge for a tour. Its not an option. You hear rumours that some of the officers don’t speak as the 1st officer has ordered their tongues cut out, possibly to prevent mutiny. You laugh at this, but you start to get a bit worried. You realize the crew doesn’t trust the passengers at all. Some of the passengers even report other passengers, or get the islanders to report them, or even join the crew.
Then you see why the passenger numbers are dwindling. Every night, the crew makes those passengers who’ve had the bridge visit walk the plank. They are allowed to take their lifejackets though. Sometimes the crew let the passengers off before they get to the plank, although there isn’t always consistency as to who will be let off or not. Some even get halfway down the plank before they are allowed to come back. Usually that’s because the lifejacket manufacturers send their best machinists and repairers to make sure of the buoyancy of the jacket whilst its owner is on the plank. This costs the manufacturers lots of money, so it’s better if the lifebelts never get used in the first place. But you’ve already paid for the service when you bought the lifejacket.
Most of those that do fall off the plank therefore obviously have their lifejackets to help them. These keep them afloat until the rescue boat picks them up and puts them back on the ship. Sometimes some are thrown overboard before the captain has heard the case and they might be allowed back on board, or they might be put ashore until the case has been heard, then they get to walk the plank all over again.
However, there’s a problem with some of the lifejackets. Not all of them are going to work. Most do, but not all. Any you might be wearing one that isn’t going to work when you need it.
Now some of this is because the passenger has done something so bad that Mercenaries employed by the crew are allowed to puncture the lifebelt. Some of these passengers drown or swim to shore, but either way they never get back on board. Occasionally the crew or even a mercenary punctures a lifebelt through their own incompetence and hope they don’t get found out. The lifejacket repairers sometimes throw a spare lifejacket to them. But sometimes the sharks get them first.
But sometimes its because the maker of the lifebelt has decided not to put the flotation device in a lifebelt because of something you’ve told them or you’ve walked the plank before. It looks the same, and you certainly paid the same for it, but its only when you try to use it that you realize its not working. Remember those with the special coloured expensive lifebelts? They’re really expensive because the normal lifejacket makers wont supply normal ones to these passengers because they keep being made to walk the plank, or just keep jumping overboard because they do stupid things and don’t seem to learn from it. In fact, some of the lifejacket makers wont supply them at all but don’t always say why. Strangely, some of these passengers seem to arrive at the ship in fast cars and occupy the biggest and best passenger suites.
Occasionally there are times when a passenger is walking the plank and the manufacturer of the lifebelt actually takes it off them, either just before they walk, when they’re in the water, or when they get back on board having survived the ordeal. The rules say passengers can’t stay on the ship without a lifejacket, but they now can’t get one to fit, the manufacturer wont sell them another, or they don’t have enough holiday cash left to buy another one. They either have to stowaway for which the penalty is immediate plank walking, or they have to get off at the next port.
The captain no longer answers to the ships owners, but they don’t seem bothered, and the captain and 1st officer decide they’re going to expand their little seafaring enterprise as a result. There’s a ship right behind with loads of passengers that go ashore and always paint the islands white and harm the natives, and occasionally the captain makes one of them walk a plank, but doesn’t seem that bothered by the harm they’re doing. They don’t have any lifebelts on that ship either.
The passengers frequently get together and talk to one another, but no-one ever has the bravery to arrange a passenger mutiny even though they keep having the cost of the planks added to their tips. Most of the passengers are too busy trying to protect themselves to look out for the others. The senior officers of the crew don’t talk to one another as they haven’t any tongues, and those passengers that become part of the crew and can still talk don’t want to resign as they say they’re the ones that keep the bridge visits and plank walking fair. The happiest are the mercenaries that get to puncture the lifebelts as they get a bonus especially if they can make it take longer. The manufacturers seem to want to really only give the lifebelts to those that will never use them as they don’t have to spend money readying them for plank walking or repairing the punctures. But their top repairers are happy because they get paid more when they have a puncture to repair.
What a silly story…. No one in their right mind would get on that ship if they read that, or stay on it a moment longer than they possibly could once they found out what was happening.
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.
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  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.
If you have not heard, the problems have officially been fixed. Hurrah!
The Professional Standards Authority issued a report  being most unfair & critical of the GDC. The GDC Press release  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  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.
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. 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
The Montgomery case - Montomery -v- Lanarkshire health Board Scotland 2015
 PSA link
 BDJ leader Vol 219 No 2 July 24th “Coalescence” Stephen Hancocks OBE
Is there anybody out there?
These words introduce the beginning of my favourite song, Pink Floyd’s ‘Comfortably Numb’, the title of which has always struck me as a particularly apt song for dentists.
Several times in my career different parts of the song have resonated with me for various reasons, but this is perhaps the first time the whole song in its entirety relates to dentistry at the moment. For those that don’t know the song, it’s about a reluctant performer who is made to keep going on stage by the various influences and promises of those who seek to benefit most from him, without any consideration as to how the performer is actually feeling inside. Sound familiar? Give a performer a new drug (the continued promise of a new contract??) and that’ll keep you going through the show….(despite the eventual catastrophic effects).
However, I’m not going to muse about the wider issues of dentistry that are analogous to the lyrical musings of Roger Waters otherwise this will be a very long blog.
So, in particular given the recent Professional Standards Authority paper looking into the rethinking of regulation, one has to ask if there is indeed anyone out there who is actually listening to what this paper suggests.
Here we have what is effectively a toothless organization in the PSA (show me precisely what it has actually done to rein in the GDC given its publicized failings over the last few years?) that is suggesting a completely new way of thinking with regard to the regulation of the professions. Its worth a read as there are many things that have been mentioned within the pages of GDPUK.
However, it’s one thing suggesting this radical rethink, but who with the power to actually instigate change is listening to what the PSA have to say? The Health Select Committee still seem to be getting their diaries in order after the election, and with no apparent repeat hearing for the GDC in the offing one has to wonder if other more pressing health matters will take priority over our issues. There appears to be no pending Government Bill in the offing to set up a super regulator (which is what I personally think will happen eventually) or rewrite the outdated legislation of the current regulators. It is obvious that the PSA sees radical failings in the current scheme of regulation, and we all know the opinion it has of the GDC in particular. However, we need to be careful about thinking the PSA is our knight in shining armour riding to the rescue; one of its remits is to review all the decisions of the GDC FtP process and if it feels they are insufficiently protective of the public (i.e. not a harsh enough punishment) then it can order further action against the registrant via a re-hearing. So they are no particular friend of the regulated, but I would counter that by suggesting they are at least an organization with the ability to actually understand what modern regulation requires. They, after all, they keep referring to the paper written by them for the Council for Healthcare Regulatory Excellence on what ‘Right Touch’ regulation means, and it doesn’t appear to always be the touch of the executioner’s sword.
There was a suitably robust call from the BDA for the government to take action as a result of the PSA paper, and whilst this is the sort of thing we need to see and hear from the BDA, once again I have to ask if there is anybody out there to listen? We are unlikely to ever get any press sympathy like the GP’s do; when the Daily Mail is happy to run a story asking if we are all Natural Born Killers as a result of the recent Lion hunting episode then we really are going to lose that battle before we begin. As a profession we already know the issues, so really the BDA is only going to be preaching to converted. How they get the message out to the wider public is the key to getting the regulatory change we so desperately need. That is going to require an awful lot of positive PR and I don’t see much evidence of that. Even the fact we have been harping on about the perils of refined sugar for years seems to have fallen on deaf ears until our medical colleagues woke up to it.
The PSA paper recognizes that over-regulation costing more offers no additional benefit to the patients, or the fact that healthcare has inherent risks that cannot be regulated out without a disproportionate amount of money and time, and that attempting to do so only serves to not only stifle the beneficial innovation that can help the patient, but also the general benefit to the patient overall. None of this will be news to any ethical practitioner reading this; but it’s not us that needs to take heed of this, we need to be listened to by the people who can instigate change and actually have a desire to do so.
The PSA also admit that one of the problems with the current outdated regulation mechanisms is that the action or words of a registrant last lasts only a mere moment or so but can result in serious damage to not only their careers and lives, but the lives of their families too; often having a serious and lasting effect. Again, not news to us particularly, but at least it is being recognized by the PSA. The disproportionate effect of a minor, spurious, or downright vexatious complaint should not be able to carry this threat, and indeed never used to; but more recently seems to be something that we must all be prepared to bear as an occupational risk no matter how diligent we are in our care and dealings with patients.
More interestingly for the GDC though is that the PSA warn against the expanding of the boundaries of regulators and the lack of clarity and tensions this then produces. It’s no secret that Mr. Moyes has said he would like to develop the role of the GDC and broaden its remit. It is already apparent that this seems to have begun, as the GDC is no longer just the upholder of Standards within the profession but has become the de-facto complaints service which will happily look into every single issue it is made aware of. A stop to this ‘mission creep’ as the PSA call it must come sooner rather than later, but again, the PSA has little power to prevent it at the moment.
Yet the GDC in its latest press release once again refuses to acknowledge that responsibility for regulatory failings are in any way its responsibility, choosing to blame once again the legislation that constrains it, and actually indicating it doesn’t go far enough currently. I think most registrants would be of the opinion that when a single complaint can have you in front of a committee that can end your career, then there isn’t actually an issue with the legislation not going far enough. The GDC is also apparently putting in place a series of ‘measures’ to help support the profession in delivering high standards of care and maintain public confidence in the profession. What these measures are we don’t know yet, but of course one way of doing this would be to make sure there are less people able to meet the standards they enforce, either my repositioning the interpretation of standards to make them virtually unattainable, and then ‘help’ by removing the registrants who fall short via the FtP process or by just driving them out of the profession by fear. Maybe this is too cynical a view but it’s hard not to have such thoughts in the current environment.
More and more I hear of dentists leaving the profession due to the immense pressure placed on them every day. Despite their best efforts to remain positive, it is increasingly difficult to not think that the next patient could be the one that ends their career, despite not having done something bad enough to justify such a draconian result. That makes the risk of practicing dentistry increasingly difficult to justify. It would be interesting to see if you are likely to have a longer career these days in the field of professional bungee jumping or crocodile wrestling than clinical dentistry. In what way does this help patients when good practitioners decide to leave our profession?
I remember a satirical comment a few years ago that eventually there would be 100% employment in the UK. Only one person would actually have a job doing something, but all the others would be employed to regulate them. I can see the dental profession going this way if someone in power doesn’t start to listen soon, as there will be less and less people electing to remain in or join our profession. We as individuals therefore need to unite and show the public that the pressures on our profession will directly affect them. Only when the voting public is affected will the situation come to the attention of those in power and change can be made. Although how this will pan out if the supposedly unelectable Jeremy Corbyn takes control of the Labour party and renders the opposition as toothless as the PSA remains to be seen.
Getting back to the title of the song then, the problem is that too many of us are (un)Comfortably Numb with inactivity. So we are reaping the rewards of our complacency and intransigence and will continue to do so unless we unite to do something positive. If we were as vociferous and active as dairy farmers have been recently when things finally got too much to tolerate we would have arranged some form of peaceful and professional group action. Perhaps we should round up a few hundred small cats (lions would be too difficult to risk assess and probably attract the wrong type of dentist) and release them into the General Dental Council chamber at the next meeting. Trying to herd said bunch of cats into Wimpole Street is likely to be simpler than getting dentists to do anything en masse. We could then say not all dentists have a desire to hunt cats (including small ones), and given that social media these days seems to be obsessed with the antics of cute kittens then surely this is guaranteed to get positive press interest. A flock of sheep might be easier to manage, but we don’t really want them in the Council Chamber do we? Tongue in cheek maybe, but food for thought nonetheless.
In all seriousness though, whilst it appears the public at large don’t appear to have a clue what damage over-regulation and the current litigious and complaining environment is doing to the ability for dental professionals to care for them appropriately, these are the same people who in their chosen fields are also likely to be suffering from similar threats. Speak to many of your working adult patients and you’ll find we are not alone in suffering the pressures we are currently under. Admittedly there might not be the same degree of threat to their career and livelihood, but certainly anyone in one of the professions and the emergency services have very similar issues as we do. ‘Guilty until proven Innocent’ is not unique to dentistry.
This is the message that needs to be conveyed in no uncertain terms to the public by both our professional leaders and us as individuals. Only when the public has empathy with us will we have their support. If nothing changes then the profession will dwindle more and more as a lack of morale grows.
For it is they the public as patients who will then suffer most when there are no longer any of us out there.
Well the summer looms, indeed some may argue we have had it !!
Radiant heat from our nearest star warming the cockles of our hearts is a rare treat in these temperate climes. Some things never change though, and the weather is one of those. I am sure by the time your read this, moaning about the heat will have rapidly become the usual philosophic whinge about the rain and wind! Maybe we should talk to our patients about the GDC instead …
And so, it seems, the GDC are to be placed in the same weather related category of criticism. Always something to moan about.
But there is an unavoidable truth:
The Executive simply do not get it.
The problem, they imply is us moaning dentists - we just do so always go on about them. Get a life and move on, you hear, mainly from an anonymous adviser in Wimpole Street somewhere.
Exactly where are we?
They are castigated by the Panel Chairman in the Singh case – and we are not talking a “could do better” comment as per my old school report. We are talking having a “Door Closed, Hat on” interview [Those of a miltary background will recognise that as being as bad as it can get] in which the conversation was very much one way. I think we can imagine the Chairman was using a raised voice when he dictated that little lot! This of course , suggests the GDC in its imaginative defence, was all down to a one-off with a rogue GDC lawyer who has ‘moved on’. Funny that.
Not satisfied with that there has been a Professional Standards Authority Report. To suggest it is hardly complimentary would be an understatement. Bottom of the Class. Absolutely useless. You decide! The tone of the recent GDC Newsletter for us all suggested they had passed with flying colours.
Do they really think we are that stupid?
Many members of the profession have written vociferous, well-argued letters of complaint to their MPs. Although duly acknowledged and in some cases passed on it seems to the Secretary of State for Health, Hon Jeremy Hunt MP, little action or redress seems to be being planned. That said, the MPs and Ministers would be unlikely to signal the intention of Parliament.
The Damp Sqib of the Health Committee
It's not about you. It's about not rocking the boats of politics.
The Health Select Committee of the House of Commons Accountability Hearing has turned into a damp squib simply because an Election intervened. The HSC committee has only just had a Chair voted in, and the committee has yet to be elected, at the time of writing, in a secret ballot of MPs. Replies from Dr MP suggest that the Health Committee might reserve a right to recall the GDC but it is hardly stirring stuff.
You would have to be very naïve to image the GDC and its woes are likely to be sliding off the top of the Minister’s full in-tray. Political agendas are notoriously hard to influence.
But what weapons do we have to drive change at the GDC?
We could ask that the Council registrant members use their Whistle-Blowing policy. Now ironically, they have to go the Chief Executive, or The Chairman [I think not ...] or the PSA … who have just issued their terrible report, and whom, of course, … have no authority to do anything!
The PIDA [The Public Interest Disclosure Act] list at the GDC Governance Document written for Council members states
The specified matters should be issues that are in the public interest, for example, under the PIDA these are:
Well it strikes me based on the cases reported on the GDPUK forum that the GDC are certainly open to accusation on at least three of that list - I will let you adjudge which!
GDC Standing Orders for the Council permit either an Emergency Motion [SO 3.7] [requires at least 4 Members to sponsor it] or a Routine Motion for discussion [ SO 4.3].
If anything such as a Council Vote of No Confidence were to occur it would need a pretty unanimous vote by the Council and would patently be resisted by the Chairman, Dr since these items are perversely at his discretion.
So where are we ?
You have to give the Chairman and his Chief Executive due credit – their hides must be sun baked to a hardness not previously seen.
For Accountability Hearing at Parliament, it looks more like an Accountability Holiday!
The Registrant members by their silence speak volumes and it would appear that they are happy to take the GDC Shilling.
The BDA are trying, as are the FGDP but are it would seem simply bouncing off the armour plated skins of the Executive.
That leaves us – you know, that’s you, me and the others - to make a public gesture of some sort.
A Conference it has to be Ladies and gentlemen to offer a vote of no confidence and to request the honour-bound resignation of dental members of the GDC
Who will rid us of this corrupt and disgraced body?
It has to be us, everyone else has sadly left town on the Accountability Holiday Omnibus
GDC Whistle Blowing Policy for Council Members Page 27/28 http://www.gdc-uk.org/Aboutus/Thecouncil/manual/Governance%20Manual%20for%20COUNCIL%20MEMBERS.pdf
UK Horizons 2015
Following the success of the last seven years, Dental Protection is pleased to present another series of the popular Horizons evening roadshows taking place in England and Wales in September 2015. Dental Protection’s senior advisers will present a lively and interactive session. This whole team event is designed to provide a wealth of information which can help you to practise more safely and manage your own risks more effectively. The presentations will cover:
•Where do the main problems come from?
•How can these problems be anticipated and managed?
•What do practitioners get wrong most often, and why?
•What are the key clinical records that need to be kept and why?
•What are the key consent issues and pitfalls?
The full programme can be downloaded here.
Dates and locations
The roadshows will take place in four cities across the UK:
Newcastle – Monday 7th September, Copthorne Hotel
Sheffield – Tuesday 8th September, Hilton Sheffield Hotel
Cardiff – Wednesday 9th September, Copthorne Hotel
London – Thursday 10th September, Cavendish Conference Centre
Be an early bird and book your place before the 31 July* to save £10 on your ticket (£30 for members and £50 for non-members). All DPL Xtra practice members will be eligible for the early bird rate, which means the whole team can attend for just £30 each.
*Booking forms must be received by the Dental protection team before 31 July 2015 to be eligible for the early bird rate
2.5 hours of verifiable CPD will be awarded for attending one of these sessions.
Full event information, including timings can be found on our website www.dentalprotection.org
The Hired Gun with a smoking gun….
We all know the GDC has spent the last few years on its own little self-righteous planet, and even given its recent pitiful showing in front of the Health Select Committee there appears to be no sign they are planning to return to normality in the near future.
Indeed, this week, what can only really be described as damning evidence of the GDC’s utter and complete contempt for the process of Justice in its most fundamental form has been revealed.
A case in front of the Professional Conduct Committee this week has revealed that it is not only the initial stages of the disciplinary process that are woefully inadequate which resulted in their huge backlog of cases; but that the basic legal requirement of full disclosure of the case against a registrant may be riddled with horrific inefficiency and contempt for the fundamental tenets of justice. Not only that, the GDC is not following the rules set out for its registrants and flagrantly flouting them in order to pursue its own agenda of what now appears to be a persecution of the profession via its individual registrants. The PCC themselves described it as an ‘Offence to Justice’.
In this particular case, amongst other things, the GDC had 9 different versions of its expert witness report, and failed to submit many of them in a timely manner for the defence case to be prepared. It was still submitting them to the defence on the day of the scheduled hearing. Not only that, but it would appear that evidence the GDC held was not submitted to the defence at all, which may have helped the defence case. Thankfully the outcome has been for justice and propriety to be upheld by the members of the PCC. (who have for some reason remained anonymous)
With the facts that have come out about the way this case has been handled, the GDC has now plumbed new depths it seems. I didn’t think we could be treated with any more contempt that we already were; but this is jaw-droppingly bad. By what definition do the GDC expect us to have fair trial if they don’t submit the evidence as per the rules? They fail by their own standards throughout this case. Where is their duty of candour? Where is their transparency in their dealings with the registrant? Have they actually read the Human Rights act? I refer them particularly to Article 6, the right to a fair hearing, which quite obviously would not have occurred in this case had it not been for the integrity and the strength of the members of the PCC.
For the PCC to accuse the GDC of being egregious (or outstandingly bad) is an extremely strong and unusual stance for them to take. Whilst this occasionally happens in the criminal and civil courts when a judge or jury might take exception to the conduct of one of the sides, for a committee funded by one of the sides to effectively take a swipe at its paymaster is highly unusual. I know the PCC is made up of independent members, but don’t forget, despite this independence, they are funded by the prosecuting side, the GDC. I am not for one minute casting any doubt on the integrity of any of the members of these panels, and in this particular case nothing could be further from the truth. But one has to wonder how much of a culture of fear is being instilled that pervades throughout any process the GDC is remotely associated with including these committees. How many other cases have been similarly dealt with by the GDC and the PCC not spoken up in the same way? We know now that this is an organization that doesn’t seem to apply the rules of law and justice properly to those it pursues, and even think these rules don’t apply to itself, and then show no insight whatsoever into its failings. Even the GDC solicitor involved in the case appeared to have had an inappropriate contact (not contemporaneously noted incidentally!) with the patient witness in order to ask leading questions and to coach them which also a big no-no.
Just as strident but more worryingly to my eye is the criticism the GDC’s expert witness comes in for at the hands of the committee. I have not seen this amount of criticism of the expert in any case before. It almost seems like he has gone out of his way to act as some sort of private investigator in order to help the GDC secure its desired conviction. There have been a couple of cases recently where the GDC’s expert witness has come in for criticism, but not to this degree.
Expert Witnesses are required to be independent and objective. It is an enormously privileged position to be in as they alone are allowed to give opinion-based evidence to a court and not just statements of fact. They are not and should never be seen as a Hired Gun to destroy the defendant. For whatever reason it would appear that in this case the expert has gone beyond his remit in such a way that one could seriously question that if this were a civil or criminal case whether serious charges against him would be the result of such a deviation from the accepted role. All the expert witness training I’ve done (and I’ve done a lot) has stressed the importance of never being a Hired Gun. I’ve had solicitors request I change parts of my reports to better serve their cases; and the answer has always been an immediate refusal. An expert witness has a duty to the court and to no-one else. We are not Magnum PI no matter how much we might want to be.
But by acting as a hired gun, this expert has now turned this case into a smoking gun.
Experts are no longer immune from prosecution, and given the evidence in this case, one has to wonder if the abuse of process by the GDC and its expert means that this should now be taken further by the defence team in order to recoup their costs. Ironically, the expert could well be professionally covered by the same indemnifier involved in the defence, but then I’d have thought that might be an appropriate time for any discretionary support for the expert to be withdrawn since it appears he acted in such an unusual manner. Its also rather hypocritical of an expert who appears to be acting far outside his remit to feel he can stand in judgment of a practitioner who may or may not be acting outside his sphere of expertise. Unfortunately Expert Witnesses are not regulated in any way other than by their profession; but this behavior has to be close to bringing the ‘profession’ of expert witnesses into disrepute. I know a good many experts who are aghast at the revelations in this case.
I’m sure the acquitted practitioner will probably now want the whole thing to go away, but I really hope that he doesn’t take this lying down; the GDC should be massively on the back foot with this revelation, and the profession’s moral (and legal) advantage should be well and truly rammed home now.
The BDA should also now get very vocally involved again, and if they don’t they are going to miss a huge opportunity. If they approach it through lobbying MP’s they should broadcast this loudly to the profession so we can hear their voice. Some have said they should call for a complete halt to the GDC investigating process; but this would leave the public open to the risk of any truly dangerous individual being left free to practice. However, in my opinion they should press for every case both this expert and this particular GDC team been involved in to now be independently reopened, re-examined and all at the cost of the GDC. The costs of this should then be made exceptional from the annual GDC budget so they cannot then charge the profession for this. I’m sure they’ve got some indemnity insurance kicking around somewhere they can use. In addition, every pending case that involves just a single patient complaint should be now be suspended until a full independent inquiry (and I don’t mean by some equally flawed organisation like KPMG) into the above cases has been completed. There should be full and complete disclosure, and compensation paid to any registrants if the GDC are found to be in the wrong. Any employees of the GDC found to be in breach should feel the full weight of any legal process, and not be allowed to hide behind the corporate protection of Wimpole Street.
The GDC are quite obviously in breach of the Human Rights Act. There was no way this registrant was going to get a fair trial, and the GDC were quite obviously unconcerned by that. How many times they have done this before now needs to be made public. If we persistently did the same to our patients we would lose our careers, our livelihood, and our professional integrity. They should pay the same price and their executive should now be held vicariously liable if the law has been found to be broken (again…)
Resignations of individuals at the GDC are no longer enough for confidence to be restored in our regulator. The profession should demand the highest powers possible now decide their fate. Whether this should be up to individuals crowd sourcing an opinion from a barrister as to whether the GDC are breaching our human rights; or our indemnifiers taking their own legal action to seek redress for the expenses incurred in cases like the above; and whether the Health Select Committee recall the GDC Executive to be given the coup de grace; or the BDA continue their lobbying of MPs whilst we keep filling those same MP’s mail sacks with letters. It needs to be all of the above and simultaneously. We need to unleash a veritable storm that cannot be ignored.
Enough is enough. We need to keep taking firm action. Is the entire profession listening? It’s time to hit back again.
Acronyms should be catchy in dentistry, shouldn't they? Surely that's a rule? GDC, BDA, DPL, CQC, NVQ, CPD . . . It also seems to be a rule that they have to be three letter acronyms but maybe the exception proves the point!
I have been puzzled by the newer demand to note non-verifiable education. GDC call it "General CPD".
In my mind non verified means it cannot be defined nor denoted as a specified event in time.
I feel if written down, this act of noting the time spent means it is verified. Expressing this the other way, the act of writing, noting the activity, makes it no longer non-verifiable, to my mind. I therefore offer you 2 minutes of recorded general CPD for reading this article on a dental website, and of course, closing your eyes and reflecting on it.. There you go. Only 174 hours 58 minutes to go and RECORD!
I propose, if the GDC insist we must continue to note this time spent, and they do, this part of recorded CPD has now become not-non-verified and must be renamed as "self verified personal study time".
I'm off to do some SVPST!
Now that's bound to catch on.
In forming the ideas for this blog, I have thought about the changes that have occurred in the leadership and role models for the dental profession in the UK in the last decade or so. Some bodies have not changed their style, nor the stature of their dental leadership. In some government controlled ones, they have.
I will consider two leaders, Chair of the General Dental Council [GDC] and the Chief Dental Officer [CDO] of the Department of Health [DH].
As you will know, an era is over with the retirement of Dr Barry Cockcroft as Chief Dental Officer, NHS England. I am sure the whole profession wishes Dr Cockcroft well, we hope he has a long and healthy retirement.
The dental profession knows the role of CDO was downgraded when this incumbent was moved sideways from the Department of Health, giving advice directly to Ministers. Of course this role has always been a civil service post, but included advisory duties as well as the expectation of leadership qualities.
During this recent tenure, the role of CDO seems to have changed to a more "director of dentistry" style, implementing imposed changes from the DH, in order to carry out the political will of the DH. Not necessarily changes which benefit patients, nor the public, nor the profession, sad to say, but changes which have benefited HM Treasury. No doubt this would be argued against by the outgoing CDO, the changes under his watch have been dictatorial, and controlling, often based not on evidence, but on political expedience. In fact that concept of lack of evidence base is a marker for his term, of course dentists must follow an evidence for all our decisions, but UDAs and HTM01-05 demonstrably lacked any proper evidence. Only one person would argue that they do.
The historical model was that a highly respected, highly qualified colleague fulfilled this role, and often with a public health aspect, and watched over dental developments emerging from the DH, supervising in a more nurturing, parental style. We do not know how internal battles were fought with the DH over dental policy historically, but the role of the CDO appeared to be protective of patients and the profession. Will these days return?
Now over to the GDC at Hallam Street and now Wimpole Street, and from 1956 to 2012 leadership was provided by a President, who served a fixed term, elected from the body of the elected GDC.
The Presidents of the GDC over the years have included some of the heavyweight names from the surgical and scientific fields of the profession. Those dentists may have been in positions of authority, but they were colleagues that other dentists could look up to, admire their achievements, and accept leadership in thoughts, philosophy and deed.
The same thoughts would also go for the holders of the post of Chief Dental Officer.
But, as we know, the present Chair of the GDC, imposed by the Government, and put into position by the Privy Council, has been a lay person, Dr William Moyes. Not a leader of the profession, and indeed, someone who has shown little insight into the way the UK dental profession ticks. For example, in a speech, he suggested that UK dentistry should be comparable to the supermarket industry, with shoppers able to choose between the Waitrose style practice, or the Aldi/Netto/Lidl style.
Colleagues in dentistry shudder to think who will be appointed to be the next CDO. I personally hope the appointee will be able to show the profession the way forward, to be able to speak to the profession, and not be one who is planning further degrading downgrades to professional status, or perish the thought another appointee who sets in train solutions which offer lesser results for the people of the country, or which transfers the blame for reduced outcomes back onto the profession. We need a CDO who stands up for the profession and professional ideals.
We have figureheads of the indemnity societies, the faculties of the Royal Colleges, the universities [who seem to be inward looking], trade unions, private care providers, corporate bodies, online groupings, in place, all carrying out their roles, but none of them have yet emerged as a true leader, widely recognised.
My hypothesis is there is a vacuum in strong, thoughtful, highly moral leadership of the profession, this vacuum has been created by barmy ministerial edicts over a decade or more, when politicians have either not had advice or ignored it, and have chosen to appoint different types of people, the wrong people. What do you think?
Who will provide the leadership? From where will this person or people of stature emerge, when the profession so badly needs the core values of moral, philosophical and intellectual guidance?
The Health Select Committee will be holding an accountability meeting with the GDC on the 3rd of March. It’s about time too, as they haven’t been asked to account at all to anyone but the judiciary recently (and they lost). It will be interesting to see if they try to spin that meeting in the same way as they did in the press release just after the decision in the high court in December.
It looks like the GDC have finally got to face the only people who they are answerable to. I wonder if they are going to try to wiggle out of the unavoidable truths?
I presume everyone reading this is going to submit his or her evidence to the HSC through this link before the deadline of 19th February.
Well actually, that is probably extremely close to the truth. I am personally quite worried these days that a GDC letter will arrive on my doorstep for some reason or another (and that is not because I know I have something to fear – my inherent belief structure tries to ensure I do the right thing by patients at all times, but I have also been openly critical of the GDC, which I’m sure they do not like – and they get to decide what is deemed as professional or not). All someone these days has to say (even in jest) is “I’ll report you to the GDC for…” or ‘I bet the GDC have their eyes on you” and it feels like a letter from Wimpole Street is already winging its way to you starting the process of investigation and a potential loss of livelihood.
The lack of proportionality that has been written about previously means that a situation like this could be an increasing possibility for all of us. It’s why the ARF had to go up according to the GDC for goodness sake. To put a few figures on this, if you reckon on 40,000 dental registrants having about a 40 year career, and the current data from the GDC is that there were 1700 complaints in the first 6 months of 2014, then the maths shows that each registrant will have 3.4 complaints in a career. (3400 complaints x40 /40,000). Some of these complaints are against DCP’s, ok, and not all of them will go to the full Fitness to Practice hearing, (but 40% of them currently do) but I’m sure you get the overall idea. Is it right that if this way of dealing with complaints continues, on average, every single dentist will have to face this career-wrenching possibility more than once? This alone tells the general reader that the regulator is going the wrong way about it.
Since the GDC are the initial arbiters of our standards and decide an investigation will run to see if there are any grounds to an allegation, and there is currently the interminable wait for a hearing, then I don’t honestly think I could mentally deal with that kind of pressure for that long with the fear of loosing all that I have put into patient care, this profession, and that of my livelihood and ability to provide for my family. Even if an investigation goes all the way to a hearing, is there any guarantee that there will be an understanding of the pressure we are now practicing daily under from the committee, especially when it is made up of so many lay persons? Tony Jacobs wrote an excellent blog on this subject.
Some of you will have no doubt read the very eloquent and erudite blog written by Colin Campbell, a very well thought of colleague in my locality and indeed nationally. Colin is one of the most ethical and conscientious practitioners I have ever met. If you haven’t read it then it is a ‘must read’, because Colin is a person who wears his heart on his sleeve and this series of blogs are likely to be a wholly authentic and personal view of how HE felt during the process he went through.
There are many (most of us?) out there that fear the GDC, and not for the correct reasons. We need to respect our regulator, and know that whilst it absolutely MUST act to protect the public, it is not effective ‘right touch’ regulation to do this by ruling the profession with that kind of fear. Using a methodology akin to continuing the beatings until the morale improves is not how it works these days.
Mistakes happen; I was once told right at the beginning of my dental career by an older practitioner the reason he was more experienced than me is because he had made more mistakes than me. Nobody is ever going to excuse the type of mistakes that are so dangerous they have to be dealt with swiftly and appropriately. But if we are to be perpetually living in the fear that one minor transgression will bring the full weight of our regulator down on our backs then that is wrong.
There are also bad people in our profession; nobody is denying that, and I will certainly make no excuses for them. But the climate of fear that pervades the profession at the moment is no way to prevent mistakes from happening, and it certainly wont do ANYTHING to stop that minority who are out to damage people because they probably don’t have the emotional or ethical values to allow them to feel the fear those of us that practice ethically and responsibly (and fearfully) do.
So at the moment I remain scared. But I will still be submitting evidence to the Select Committee because I cannot, and will not be made to feel this way for the rest of my practicing career. We care for patients every day, but we also have to care about our future health for the sake of our families. After all, we too are human, just like the public the GDC must protect.
We have to stand up to the GDC and now show them the true and high calibre of the vast majority of Dental Professionals.
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?
Pantomime season with a Grimm warning
I’ve had a busy couple of days and upset some applecarts; perhaps I should apologise if I have bruised any fruit?
On Friday the 21st, I spent an interesting day in Corpus Christi College, in Cambridge with my fellow NADA (National Association of Dental Advisers) colleagues as well as a selection of the great and the good and quite a few of our younger dental colleagues who had come along for the verifiable CPD and to find out what sort of profession they were entering into.
Sarah Rann (assistant medical director East Anglia Area Team NHS England) kicked off proceedings by asking us and then telling us what we should be doing as National Dental Advisers. The only aspect that she missed off her list was influencing the Regulators, (aka upsetting the established applecart by proffering an expert opinion).
We were then treated to a relatively complimentary double act between Barry Cockcroft and John Milne’s views on Contract Reform. There was a large amount of agreement even concluding with synchronised retirement from their respective roles early next year. Barry emphasised that ‘access’ was less of a political hot potato now than it had been and he saw this as one of his successes during his tenure. John talked about the impact of pilots and possible implications.
A little local difficulty about a dental practice not far from Nottingham was briefly mentioned.
A question regarding access to certain less privileged groups was aired and this is where I must apologise. I raised the question of ‘access to what quality of care?’ And I then asked ‘who was responsible for the World Class Commissioning of such ludicrously large and unmanageable contracts?’
Well there was a stunned silence and poor Barry looked like he had been stabbed in the chest. Fortunately John was on hand to ride to his rescue and acknowledge, although not answer the question and then draw stumps on this part of the meeting.
We were treated to some joined up thinking from David Geddes (National head of primary care commissioning) who discussed intelligently and without too much smoke and mirrors what the future 5 year plan may mean to dentistry, please read this if you haven’t: http://www.england.nhs.uk/ourwork/futurenhs/
Amanda Crosse (consultant in Dental Public Health) went a little off piste with her unguarded comment regarding perhaps planning to have dental NHS commissioning overseen by CCG’s. An interesting idea which seemed to irritate the level headed David and which he was forced into backtracking a little.
David Behan was cut short, the previous part of the agenda having overrun by 50 minutes meant that David only had 10 minutes to get his message across about the new CQC. He did it very well I thought and was only sorry that it was necessary to tell the gathered throng of dental advisers that he was disappointed in their union attitude to pay and perhaps we would like to put something back into the profession. He was having no more of discussing an inflationary fee. Actually I agree and am happy to spend my time for free advising the CQC.
This is where all of you come in…...’Efficacy and the CQC inspection, on the right path now? ‘It’s your opportunity to get the message across and its coming to GDPUK soon.
Poisoned apples for ‘afters’………..,
The afternoon was devoted to a Brother’s Grimm pantomime about a dodgy dentist with decontamination and NHS gaming tendencies, played brilliantly by Bryan Harvey (DDU), who was frighteningly good at getting into Character. We were assured that this was not based on any recent situation and I pointed out that it couldn’t have been, since they failed to notify the Press or recall 22,000 terrified patients…., Oops!
The GDC on this NADA inspired day was represented by Mike Ridler (Head of Hearings) who displayed distressing figures on FtP hearings. Mike expressed his inability to understand the reasons since in his experience there had not been an associated decline in professional standards. Somebody in the audience mentioned that it might have something to do with National advertising?!! Mike did not wish to be drawn further on this.
He obviously didn’t feel inclined to join in with the GDC pantomime either and suggested that if anyone wanted to talk about other ARF type issues they could do this individually later, although it wasn’t his ‘field.’ He then failed to answer the other questions, since they weren’t his field either.
The meeting closed with another unplanned shedding of apples just as stumps were drawn and flat hats were on; Jason Stokes leapt up on stage and shouted that if the younger members of the audience felt slightly dismayed by opinions voiced by the demobbing great and the good; NOW is the time to make their voices heard. Oyez, oyez!
Right Path Ltd
Disastrous events have and will still occur in dentistry, despite being, in the UK, the most over-regulated profession. But my question in this "open-letter" blog is not just about the right touch of the regulators, but about who runs and who controls the regulators.
In the good old days, the regulators of the professions were drawn from the professions themselves, people of good standing who were willing to put themselves forward, possibly by election or appointment, and it was the case that many good people did indeed come forward.
During the last twenty years, or less, political theories developed suggesting greater and greater roles for the lay members' control of regulators, and my strong contention is that the pendulum is proven to have gone too far away from professional input and control. In other words the regulators have visibly and clearly lost touch.
Regulators insist that professionals show insight into themselves. As professionals, do we educate ourselves correctly, probe our own weaknesses and failings, educate ourselves away from those weaknesses?
But have the regulators shown any form of insight? I also contend, in a very short time frame, the lay element just do not have insight of the profession. How it ticks, how practitioners think? Do they know? How new professional problems are viewed and solved? Intelligent people, as professionals, are put into the rapidly shifting sands of a hightly regulated and inspected system, how do the professionals respond to all those influences, and how do they cope? Do the lay regulators pick this up? How? GDC regulators, the people making the policies have now become so detached from this they have no idea at all. That detachment has been so vividly apparent this summer and autumn, with the GDC remaining with its' collective head deeper and deeper in the sands of 37 Wimpole Street.
Dentistry is also regulated by the Care Quality Commission [CQC]. The CQC early engagement with dental profession was disastrous. In many ways the initial relationship between the CQC and the English dental profession could have served as a case study in how not to engage, a manual on how to alienate. Even in 2014, when CQC have pronounced that dentistry in England carries a low risk for patients and inspections will be made each 5 years, the early alienation created by CQC remains at the forefront for the profession.
The style of CQC speakers, tasked with communicating to dentists in around 2010, was bullying, harrassing and when they saw the dental audience was visibly angry, they invoked the Health and Social Care Act 2008, and said they will do what they want, the law says they can. No negotiation, no compromise, no concept of listening to the senior dental people they were visibly insulting.
They got it wrong then and things may be improving [with added DENTAL input] but the D'Mello case shows how the CQC were getting it wrong. The report on that Mansfield practice shows an inspection was passed, but the main concern was that the mops were the wrong colours.  [For those who do not know, a system exists, which all dental practices must follow - mops used for the floors in each room must be the right colours, and cleaners educated and make tick charts of the use of the mops in differing areas.]  However, the lay CQC inspector did not note other more worrying aspects, such as, this dentist was seeing, to meet the demands of that particular NHS general dental contract, around 55 patients per day.
Even assuming a full 8 hour day, and knowing all professionals flag after a long day of executive processes and clinical decision making, that is close to seven patients per hour, an average of less than nine minutes per consultation. And we know some of those visits must have been for treatment, not just examination. And dear reader, think about the time it really does take for a patient to enter a room, take off their coat, say hello, be quizzed about their medical history, examined, explained, full informed consent given, explanation of costs, then final greetings, rinse, stand, coat back on. Could you do this in around 8 minutes? This is without allowing for the natural breaks in the day. Even if this dentist worked 10 hours every day, that only gives 12 minutes per patient, including treatment, day after day, hour after hour.
I omitted one thing here - time for cross infection control, several minutes each patient - and this was the thing D'Mello is now notorious, having been proven to have cut this essential aspect out.
But the lay inspector missed this massive aspect of how this practice was being run, something a dentist might not have picked up, but it is much more likely a dentist would have seen in a long, detailed, inspection visit.
So my words for politicians, civil servants, British Dental Association negotiators, and Department of Health; reforms of dental regulation are needed again, and do not cut the corners this time. We need appropriate intellectual and professional input at all levels of new regulation processes that urgently need re-specifying.
I wasn’t going to write any more GDC related blogs for a while, as I don't want to be seen as a one trick pony, but the situation with the GDC is the singular most important thing to have affected our existence as a profession, and continues to have more twists and turns than a white knuckle roller coaster, so my apologies for writing about it again.
Seriously, was anyone surprised by the GDC’s decision to increase the ARF to £890 on the 30th October?
After the sham of a consultation, it’s not entirely surprising that this should be followed by what was probably a sham of a discussion at the Wimpole Street Lublyanka (for those unaware, that was the name of the HQ and prison of the KGB), and an ARF of £890 has been set.
Nothing has really changed though; despite now slightly reducing the amount for DCP’s (the majority being nurses who I suspect have that actually paid for by their practices), this would appear to have been the classic “give ‘em 3 choices and they’ll pick the middle one”.
The BDA is now set on its path for Judicial review; and this will be heard before the 17th December. The BDA stops short of recommending what its members can do up to this point, but If I may suggest the one thing that absolutely everyone can do now is cancel their direct debit, and write themselves a reminder to pay the GDC before the 31st December. That way they CANNOT take the money early, and whilst it may only be three or four weeks more before they can get it, at least if the BDA win the Judicial Review then people wont have to be waiting for a refund from a regulator that has no sense of respect for the profession. You will not be acting illegally, just stopping the GDC from getting its hands on your money sooner. Incidentally, according to a recent freedom of information request, the decision to engage KPMG was a decision taken by the Executive of the GDC and not by the council. One would have thought that engaging a company like KPMG with its associated costs would have been something put to the Council to vote on. Anyhow, the GDC will need even more money to pay for the services of KPMG, and guess what? We get to pay again.
This brings me to the point of this blog.
What would happen if every one of us rang the GDC between Christmas and New Year to pay? If a few thousand registrants rang over that 3 day period it means hundreds of calls would need to be taken every hour by the GDC if they had an 8 hour working day. What if their systems collapsed under the weight of having to take so many online or telephone payments? Apparently they are so arrogant they do not have the facility to take payment in cash, so the very press worthy images of a few hundred dentists turning up with buckets of £1 coins in order to pay are not going to hit the pages of the Daily Mail anytime in the future.
So what’s wrong with paying £10 on each of 89 cheques, and requesting a receipt for each one? Or making multiple credit card payments of the same amount? Given that it is also legal to write a cheque on just about anything, may I suggest that a few 6’x4’ pieces of chipboard, properly filled out with sort codes etc delivered to the GDC in Mid-December from registrants wouldn't go amiss. How about arranging a mass payment in between Christmas and New Year, and on the days that the LAT’s insisted we should all be open for normal business? If just 100 of us turned up and wrote cheques out on pairs of boxer shorts (new ones obviously!) that might get some press attention. All at the same time as they're manning the phones taking the card payments above. One idea being floated on Facebook is getting the GDC’s bank account details and paying them directly by BACs. Its actually quite difficult for the GDC to trace who has paid at their end, but we will all have documentary proof at our end that it has been paid.
All a bit tongue in cheek admittedly, but with a serious side; if the judicial review fails, then we will have to pay this ARF. The BDA will continue the fight I know; but this particular avenue will then have closed, so a little bit of civil (legal) disobedience would show the GDC we are still up for a fight, but just looking for the next opportunity to open up a chink in their armour.
I also think that with Thursday’s decision the position of the remaining dental registrants on the GDC has now become untenable. I’ve stopped short in my past blogs of directly levelling any personal criticism at any members of the council, including the Chair and the Chief Executive. But with the emasculation of the profession so effectively by this council structure and those at its head, and the lack of any PUBLIC individual vocal defence of the profession by those who are members of it on the council, then they can no longer use the excuse of trying to change it from the inside. Thursday’s outcome should surely have delivered that message resoundingly to them. If they were against the ARF rise then they cannot now remain in the council; if they were for it, then they are not representatives of the profession. Either way, that makes their positions untenable. They look to be completely sidelined in the council processes that seem to be railroaded through at the whim of those who appear to be building a personal fiefdom with the seeming remit to destroy the entire profession it regulates. Indeed, they don't appear to write their own articles, as those published recently in the dental press which purported to be from them were 80% similar to one another when run through anti-plagiarism software. I also understand a large amount of the council business is now held behind closed doors, and only lip service is paid to the public aspect of the meetings these days which generally give the appearance of being stage managed for those observing.
As a Yorkshireman from the Loxley valley now living in Derbyshire, and working in Nottinghamshire, one legend that has been very close to me throughout my life is that of Robin Hood. I was brought up a stones throw from one of the reputed birthplaces of Robin of Loxley, am now living near the reputed burial place of Little John at Hathersage, and work close to the Major Oak near Mansfield, and I can see a huge analogy in this story.
We have a Sheriff of Nottingham, collecting taxes from the downtrodden masses, ruled over by a King John figure who’s got no real chance of a proper throne. The peasants don't like either of them but they don't care and keep finding more and more reasons to persecute the peasants whilst charging them for the privilege. This makes the remaining members of the GDC the barons at the table of the Sheriff with no real power whilst paying lip service to the Sheriff and King.
We've then got our Little John and Friar Tuck rolled into one, (ok, so its actually Fat Mick but the sentiment’s the same), and the BDA collectively as our Robin Hood (probably the Errol Flynn one rather than the Kevin Costner one given the size of its cojones recently!). That makes the profession the downtrodden peasants (metaphorically), some of whom became the Merry Men and Women. GDPUK is a collective Will Scarlett as the mouthpiece of a storyteller and bard. Hopefully the righteous King Richard is going to be the judiciary who will hear the BDA’s case.
Robbing the rich to give to the poor? How much money has the GDC had from us over the years? Having enough money to spend on QC’s and £78,000 Fitness to Practice cases over silly matters that should dealt with locally at lower cost to the profession shows it has no respect for the money it is given. It has become like a like a rich man who knows the cost of everything and value of nothing. Whilst its remit is to protect the public, this does not mean it should have the sort of reserves it wants. It should have enough to function effectively and no more.
Legend or not, every version of the story ends the same; good always triumphs over evil; a disorganised band of individuals becomes a force to be reckoned with after starting out with a bit of Civil disobedience and brings down a brutal Fiefdom that sees its subjects as legitimate source of money for its own ends, and for summary punishment at its whim.
At first the people can’t see how they will defeat the Sheriff. But up steps a leader and a small number of supporters. The impetus grows and grows until eventually a tipping point is reached. They eventually win by sticking together and keeping up the pressure. King Richard steps in and justice is restored.
Only we can decide if we let the Sheriff and King try to divide and conquer us. It’s still up to us to unite the profession against the GDC.
So to coin Moyes’ phrase of yesterday; ‘Are We Comfortable with that?’
* Image from Wikimedia Commons.
“If we’d asked people what they wanted, they would have said faster horses”, Henry Ford is famously quoted as saying.
And this week we have news reports about the car insurance industry being subjected to further “market reforms” in order to deliver cheaper end-consumer prices.
But this is a fundamental misunderstanding of the markets.
If you look at the résumé of our first appointed chair of the General Dental Council [GDC], Bill Moyes, you will see that he has led several market-driven initiatives in various roles, and it wouldn’t be a leap of the imagination to consider that he has been appointed into the GDC to fulfil a “market-driven” reform. Dentistry has long suffered an image problem; consumers feel that prices (and pay) are too high, that dentistry delivers poor value to the consumer and that there is a conspiracy of the profession against the public – it is only necessary to have the briefest of reads through the comments section on any newspaper that publishes a dental article to see that the accusations of “rip-off” rear their head at a very early stage.
But this premise is entirely wrong. The problem with a free market is that the results are entirely unpredictable. Economic journals are full of perfectly logical explanations as to why markets behaved in a certain way – crucially, behaved and not behave. That is, the analysis of the markets and the rationality of them is done post hoc.
One of the most fundamental problems I can see with the approach of trying to manipulate markets in order to deliver a specific outcome is that it rarely works, or often, even where it does work, often this is not what the consumer demands or buys, although they may insist at the outset that that is what they want.
In our particular dental industry, I would hazard a guess that many people (of a non-dental nature) believe that market reforms will deliver cheaper dentistry, through increasing the supply of the dental workforce. I would suggest that this is unlikely to work for a variety of reasons. Firstly, costs represent some 60-70% of the price that the patient pays. Given that the average pay for dentists has been declining in real terms for some time, if we were to cut pay for dentists by 10%, then this can translate into only a 3-4% price saving for patients. And I don’t believe that we can cut pay much further without running into another economic problem – that of a shortage. If you pay too little for something, you create a shortage. In this case, how many dentists do you think would leave the profession if average pay drops below a certain point? (I would suggest £50,000 for associates, on average, and £75,000 for principals)
So if cost savings are to be made for the end consumer prices, this will have to come from reduced costs. And here we already have an idea of what happens from another industry – the British car industry. Throughout the 60s and 70s, the British car industry suffered a slow and agonising death over many years, selling outdated cars, with poor workmanship and a reputation for declining quality, and in some cases, with cars selling at less than the cost of manufacture. Do these problems sound familiar?
Of course the British car industry eventually collapsed, superceded by German and Japanese competitors who were operating on free market conditions, and produced innovation and rapid improvements in delivering things people wanted rather than what they told government-led focus groups that they wanted. The eventual death of Rover marked a turning point and renaissance of the British car industry, and now we have world class manufacturing and design, but for this to happen we had to see the government leave the industry and several companies to go under.
I sincerely hope that dentistry has its “Rover moment” soon. I believe in the free markets, but a belief in the free markets also means accepting when they don’t deliver quite what you thought they would. And that doesn’t always mean that what will be delivered will be cheaper: sometimes, what is delivered is “better” rather than “cheaper”. I believe that health and dentistry falls into this camp.
After all, when was the last time you saw a car maker advertise how cheap they’d made the braking system?
Free markets tend to deliver better healthcare, by and large, which is often but not always cheaper. I would therefore issue a challenge – if this is truly the purpose of Mr Moyes’ appointment, I would suggest that he can best serve the public by completely withdrawing any government interference in the market, but only on the proviso that he and they MUST accept that prices will almost certainly rise, but also must accept that this may result in longer term reduction of cost. Otherwise we run the risk of delivering the cheapest horses in the world when the rest of the world has moved onto cars.
What happens when an Immovable Object meets an Irresistible Force?
Impasse. And so it would appear to have been for the last couple of weeks after the initial thrust of the BDA’s threats, and the parry and riposte of the GDC’s response.
However, I always thought it was going to be right at the end of the ‘consultation’ process that the BDA would make their next attack, and as we have seen yesterday, Mick Armstrong has told the GDC in no uncertain terms ‘ it’s 1 minute to midnight’. Waiting until the last minute has made sure the Judicial Review can’t be halted or paused to allow the consultation to finish, had it been launched prematurely and has made sure the GDC don’t get to see the BDA’s hand of cards early.
But this hasn’t actually seen the announcement of the BDA taking legal action to go to Judicial Review, and as such I bet a lot of people will be disappointed if they just look at this video superficially. I can see the posts on GDPUK forum that this is just BDA posturing again, and they haven’t the guts to carry out the threat.
But if you read the full press release as well as watching the video, and especially take time to look at the additional information within the release regarding the figures in the consultation, it is obvious the BDA are actually giving the GDC a final chance to back down. The GDC will suffer a humiliating loss of face if they do, but we as registrants and members won’t then have to foot both sets of legal bills.
I don’t get the impression Mick Armstrong is messing about when he says the BDA are committed to following this through. But as a fellow Yorkshireman I appreciate the sporting nature of letting your opponents know you’re going to hit them, hard, and give them a final chance to back down. But you only do that once you know you have the upper hand. The BDA might not have a Royal Flush, but it seems like the GDC only has a pair of Jokers at the moment. Reading the documents attached to the BDA’s submission leaves one in no doubt of the intention of the BDA to go to JR.
By engaging the services of a FORENSIC accountancy company the BDA appear to have pulled off a masterstroke; utilizing the skills of professionals specializing in detecting high level fraud, regulatory scrutiny and anti-corruption, and then publishing a précis of the findings publically must surely send the a big signal to the GDC that the BDA is not playing brinkmanship here, but actually means business. This is serious stuff now, and the BDA have now shown their cards to the GDC by revealing financial inconsistencies are what the JR will probably be based on.
The forensic analysis of the accounts has apparently shown the GDC’s own published figures for the ARF hike are somewhat contradictory. These inconsistencies not only call into question the validity of the need for the ARF increase by questioning the basic level of evidence, but the inconsistency of the figures must surely now call into question the bigger picture of the integrity of the GDC in all of its financial matters. Whether this is part of the Judicial Review or not, the financial matters of the GDC must be impeccable, and they appear not to be.
The analysis of the figures would appear to go beyond the fact insufficient and inconsistent information has been given to registrants so they can’t actually make an informed response to the consultation. It seems to confirm the GDC is actually so contemptuous of us as intelligent people that they feel they can knowingly release confusing figures, expect us to then swallow the ARF rise, (after what we have all agreed is a sham consultation) and carry on as before. If a dentist were to confuse a patient in that manner, it would be cause for a registrant to be hauled before the GDC. Alternatively, it suggests incompetency and a lack of communication in the organizational structure of the GDC. Once again, they are grounds for a registrant to appear before the regulator. Whichever way you look at it (and it may be a combination of the two), our professional association appears to now have more robust evidence of the failings of the regulator and is prepared to act on it.
However since the GDC’s regulator is the PSA, and they seem to be about as threatening as a periodontally compromised 3 legged chihuahua with trismus and a sore throat, and as much use as a pair of waterproof sandals then you can’t really blame the GDC for not being too worried about the consequences of their actions.
Judging by the interview with Ms Gilvarry in Dentistry magazine, she doesn’t have appeared to understand what the profession is finding such a problem with. The penny certainly hasn’t dropped with her; perhaps this is because there aren’t actually any spare pennies left to drop at the GDC since their accounts seem to be in such a tangle.
But surely there must now be a realization by at least someone in power at the GDC that the BDA and the profession as a whole just might have a point. It would be useful if it dawned on them simultaneously that they have picked a fight with what seems to be a quickly developing Irresistible Force.
And they as the Immovable Object appear to have some ominous cracks developing, which wouldn’t do them a lot of good if they continue on the course they seem hell bent on taking…….
The revelations of a recent FOI request showing the cash reserves and short term access assets of the GDC potentially raise questions of the financial fortitude of our regulator.
If indeed the figures supplied by the GDC are correct, and represent the full and correct answer to the question asked, then it would appear they have access to about £11.9million of funds within a 5 day period. (I’ve got that figure from 10.5m less 4.8m at 22/7/14 added to the 6.2m at 1/8/14)
Given that the GDC costs £104,000 per day to run by their own admission, then this sees us with a regulator that looks like it is going to have no more cash by the end of November 2014. Coupled with the £7.1million that it is spending on refurbishing its HQ on Wimpole Street, it doesn’t seem all that surprising now that the GDC is threatening the BDA with its losses if the judicial review fails (if it goes ahead).
The GDC usually takes its run of Direct Debits for the ARF in the first week of December, so this would then have the effect of restoring its cashflow straight away.
However, what if all the registrants cancelled their direct debits? What if the BDA were to lead a concerted effort to get us to do this? It won’t fall foul of the legality of having to pay the ARF, it’s just that the GDC won’t be able to actively take it to help their cashflow; we will give it to them when we decide. As long as it is paid before the end of that month, then we cannot be erased for non-payment of the ARF. Wouldn’t it be great for the BDA to suggest ALL registrants cancel their Direct Debits with the GDC?
If this is the case and the GDC is running out of money, then in all likelihood they will just delay the FtP cases and other hearings until the cashflow looks better. Since these equate to the majority of their expenditure this would be a fairly easy way to massage the situation swiftly; but this then becomes even more intolerable to those stuck in the ever increasing queue for the March to the Scaffold. That means that yet again there will be practitioners that indeed represent a danger to the public still unpunished and still working, along with those in the queue probably because they used the wrong grade of soflex to polish a composite. Is that any way to protect the public?
But what happens if a regulator is effectively insolvent? Has this ever happened before, and if it is boracic, will it get bailed out by the Government? What happens to the role of protecting the public if this happens, and how does this square with the requirement in the Dentists Act to have a regulator? If it does indeed become insolvent and is bailed out by HMG, then this shows us that it is indeed a wholly owned subsidiary of HMG, so if they want it to remain solvent , then they and not us should fund it.
Many a profitable business has gone bust in this and the recessions before due to a cashflow problem, so why should any other type of organisation be immune from this when it gets its sums wrong or experiences an increase in its expenditure?
Would the duty of the GDC then be better served by the CQC instead? After all, the CQC now realises dentistry isn’t that bad, and that it recognises the need for experts to be involved in its inspection processes. It appears to have grown a pair of ears more recently. If we are going to have a super-regulator foist upon us, wouldn’t we rather have one that whilst it still seems a bit dim, does appear to be learning from its mistakes, or continue with one that treats us with arrogance and contempt whilst (possibly) overspending its funding? That’s discussion for another day.
This is all probably hypothetical and the figures have been interpreted incorrectly and they don’t include the contingencies for the refurbishment etc; if so the GDC isn’t going to run out of money .
But if this IS the situation, the GDC isn’t just Broken, it's Broke.
That is indeed a question!!
Phew, what a scorcher.
If you think the meteorological heat is oppressive, you want to try working in Wimpole Street. AirCon does nothing to relieve the heat of the pressure the GDC should be feeling.
What interesting, perhaps desperate times we live in.
The world is awash with wildfire wars with all the suffering that ensues. The state of children’s teeth of those who do not ‘get’ the dental health message in this country remains an unresolved scandal. Contract Reform of NHS Dentistry in England has become a fictional event of the future. The CDO England must be playing a lot of golf these days because there is naff all else going on. Dento-legal indemnity has started to rise in cost alarmingly as the GDC and it’s woeful Fitness to Practise regime comes off the wheels.
But it takes a proposed rise in ARF to really galvanise the profession in a unanimous outpouring of anger.
Well directed anger?
This is being expressed in many ways – letters to MP’s, the professional Standards Authority, letters to the GDC allied to Freedom of Information requests to name but a few. At meetings, the conversation is grim and consistent – it’s the GDC innit?
Even our old muckers the BDA have bared some teeth which, to judge by their public statements, are finally sharp enough to threaten injury.
What is happening so far can be summarised as a collective professional rant. There is nothing wrong with that. This process of ‘ranting’ is a precursor to something much more effective
It is well know that RANT is actually an acronym
The RANT acronym
Where are we?
I think we are heading out toward the last element, if only driven by the timescale.
A request for legal review, a BDA driven legal challenge, and protesting by payment in cash at the front desk of the GDC are just some of the actions being proposed. What about resignation of a significant cadre of the dentists they need to make the processes and systems function?
What about calling for the resignation of the Dental Professional GDC members en masse? It certainly seems to have merit.
Will the ARF be less than proposed? My money says “yes”
Will we see heads roll at the GDC? The CEO, Ms Gilvarry for example? Its hard to see how her position can possibly remain tenable. She certainly has lost our confidence, but I would imagine the GDC staff are pretty low as well.
What about our new appointed Chairman, Mr William Moyes? His condescending e-mail to registrants allied to his Pendlebury Lecture suggest a level of isolation and ignorance that make you wonder how he ever got the job. Based on his utterances so far, he simply does not get it. Based on the lack of communication by the GDC’s Dental Professional members, I thinks its safe to assume the GDC has battened down the hatches and GDC Council Members are prevented from public comment. So much for transparency. The ARF was not even an agenda item at the GDC Council meeting of 24 July.
Problem? What problem?
The GDC have absolutely lost the confidence of the profession. The have proved themselves to be the most incompetent of Regulatory bodies, and they are asking us to pay for their ineptitude.
The short answer Madam Chief Executive and Mr Chairman is “NO – NOT ON OUR WATCH”
You fix your problems first and we might talk then .
Until then, we will continue with the biggest professional RANT seen for many years.
Once again I profess my grateful thanks for the GDC’s role in uniting the profession, finally.
Enjoy your break people. Be assured, the heat will still be turned up when you return.
Yours, rantingly :)
Having just read the response from the GDC to the BDA’s questions about the Telegraph advert, it would appear that there is a distinct tone of avoiding answering the legitimate questions posed.
Coming from the Chair of the GDC, with his background at the Office of FAIR Trading, this again seems to be at odds with a desire to be open and transparent, and indeed with his recent comments about ‘doing the right thing’.
The admission that the cost of the advertising campaign cost over £27000 should now start a new round of questions to the GDC, since we as registrants are funding this exercise in awareness (the adverts were in Saga Magazine and The Guardian) to a demographic who are largely likely to already know of the mechanisms available to them to complain. In addition, in order to justify any money spent on advertising, this requires some form of review as to its success, so there will be yet more expense following this, otherwise it will have been a total waste of our money. Even if it is reviewed by salaried members of the DCS, whilst doing this pointless analysis, the time spent on this would be better utilised elsewhere.
But more importantly, how would we be treated by the GDC if we avoided answering their questions? We have a regulator who now seems to run itself by a different set of values to those it expects its registrants to adopt.
Far from allaying any of the concerns of the profession, I feel the response from the chair has once again shown the contempt dentists are held in by the GDC.
Like many I am grateful for the services of the GDC. I pay the ARF secure in the knowledge that my patients are safe and the money well spent.
Presently though I feel I have more to thank them for than usual. I hope my readers understand irony ...
Just when the state of the dental profession cannot look more perverse, the GDC have achieved something that the last 8 years of the DH and their man at the helm of the 2006 UDA disaster has failed to cause.
Numerous LDC Conferences calling for this and calling for that – the ever calm and serene profession of dentistry has just adapted and carried on.
Implosion at the BDA and barely an extra glass of claret was supped at the ripples on the water of our profession as calm discussion took place about politics.
A raft of daft changes came along such as the UDA system, the HTM document, the OFT report you all now the form – and we ranted for a few months but quietly took another blow to the body, absorbed the costs and “moved on”.
The public acknowledgement that the Contract Pilots have been a sham and that any changes to come will be merely prototype in nature and at least 2 years down the line. Dentists have had a bit of a cough to their colleagues and carry on, “being busy”.
The dreadful farce of Foundation Dentists lacking places allied to their debt and many were heard to comment widely and indeed care deeply, but the rump of the profession have likely returned to their skate-like lying on the bottom. “They’ll get by” we all thought. “Wouldn’t recommend it to my chidren” we muttered. Next please.
The CQC came over the horizon brandishing a large bill and a lot of empty folders and by and large we have paid the charge and filled the folders, only to carry as before doing what we do – meeting, greeting, interacting with & treating patients with their range of ailments and fears.
Incoming, incoming ...
But the GDC, in their proposed hike of the ARF to £945, allied to a comical consultation so pre-determined as to be reminiscent of a past communist regime have caused the profession to both awaken and threaten to unite in a way never seen before.
Just when it was looking very interesting, the satellite of the GDC, the Dental Complaints Service fire their own salvo at the profession. The DCS may be “at arm’s length” and independent or so they claim – but they are wholly funded by the GDC, ergo our ARF’s – so how independent they are is, shall we say, somewhat debatable.
What effect was intended, I wonder when the DCS took a full page advert in the weekend colour magazine of the Daily Telegraph claiming to act on anything less than COMPLETE satisfaction for every patient.
I have a three letter acronym of my own - FFS!!
Never in 35 years have I seen such united sentiment and anger, perhaps however more importantly associated with individual response and action. The electrons are red hot with e-mails, complaints and letters to MP’s and these bodies. How ironic that when a patient complains about us, we are always assumed to be in the wrong. When we complain about these bodies, they are always correct and indeed learning. Is it just me?
So, what now?
Well this is an unprecedented time, and it will call for unprecedented action.
Perhaps a mass sentiment requires a big organisation to coordinate a big response. There seems to be a widespread sentiment that the GDC has lost completely any confidence it may have had with the profession. Of course they will blandly point to some piece of biased research they did to show how well regarded they are.
They may not realise but the rules have changed and the gloves are off. Big boys games demand big boys rules. And it is the GDC and the DCS who started this.
Who will rid us of this poison organisation, who will deal it a fatal blow, for it is a big monster and well protected by the armour of politics?
We must thank the GDC & DCS – the profession appears to have finally awoken, and if I am not mistaken, this time it is getting to its feet.
Interesting times with a little smoke of excitement. Who will wager what we see next? I won’t!!
Have a good week, worker bees. Tootle pip.
Since news emerged at the very end of June that the General Dental Council [GDC] was planning to raise its annual retention fee [ARF] from £576 to £945 per year for all dentists in the United Kingdom. This coincided with an announcement of a consultation on the matter of this fee, yet the fait accompli of the rise proposed was publicised.
GDC maintains a register of all dentists working in the UK, and it remains illegal to practice any form of dentistry without this registration. This monopoly held by the dental profession is there to protect the public from imposters, and despite this serious registration process there are always queues of impending prosecutions of people who feel they can practice forms of dentistry without a degree, training, nor the proper registration and indemnity cover.
It appears the large rise has been caused by the exponential increase in complaints against dentists administered by the GDC, a very stressful process for dentists who remain innocent until findings are proven. GDC accepts cases, investigates, and will proceed with a risk to the professional future of a dentist even if there is a single incident of complaint. This wall of actions has led to delays and blockages in the GDC processes, something dentists are finding unacceptable, and this is one of the factors behind the social media congregations in the last 48 hours.
GDPUK has had a large rise in visitors, one thread on the topic has had over 90 replies from dentists within 36 hours of the first posting on the topic. Twitter has been ablaze, and on Facebook, one page, The Project, in which dentist Prem-Pal Sehmi has commenced a campaign for colleagues to pay £576 when the ARF becomes due next December has attracted more than 2400 colleagues on Facebook, also within a very short time frame. [At the time of writing]
On twitter this image shows the sort of exchange progressing. The profession is like a bear which has been poked in the eye too many times, says Eddie Crouch of the BDA PEC and Birmingham LDC.
On the Government’s e-petitions page, Dr Vereen Gupta commenced a petition on the matter, and within 24 hours, this has over 5,500 signatories.
Statistics emerging on GDPUK show that the anger is derived from this rise in Fitness to Practice [FtP] cases, which GDC figures state are stand at 3,700 presently. There are around 24,000 dentists in general practice now, so almost 15% have a case against them. Foir na serious and learned profession, this alone shows the system is very wrong.
The Professional Standards Authority, which oversees the GDC, has reported its grave concerns with the running and governance of GDC, which seems to roll along, unfettered.
All the groups must unite and harness the energy being generated on this matter, so it is up to BDA, Facebook groups, GDPUK, Twitter devotees to keep up the pressure, ensure this campaign goes to the heart of its target.
Mrs Thatcher went to her dentist. As she lay back she asked, “Now Dr Rill – may I call you David? How are things going? Do not spare me – I am here to listen”.
The dentist proceeded to let her have it in true Exocet style.
“Mrs Thatcher, I run a micro business, it is my business and I get no subsidy from anyone. I pay my taxes and employ my staff. I am the most efficient arm of delivery of Government policy. The banks lend me money which I pay back. The dental laboratories rely upon me for my dental work and their businesses in turn. The dental supply businesses rely upon my successful business and the investment I make in this new chair for example.
So why are you lot attacking me and my colleagues from all angles? It almost like politicians are jealous of all we do and all we achieve.
I have to pay £800 to the CQC to tick a load of boxes. We all know how efficient they are – they could not find a rabbit in a phone box, let alone a dud practice. They do not change anything about what I do in day to day practice. What they do is create a heavy load shelf full of manuals.
We have to pay to be CRB checked before we even get to work [or whatever they call themselves today – barely worth the expensive anti fraud paper it is written on . And remind me – how many dentists have assaulted their patients?
Your Department of Health has produced the HTM documents , and in dentistry we have HTM 01-05 which others clutch at as being as though handed down from the Cross Infection God when in reality they are merely the assembled. Remind me … how many patients have dentists infected or killed?
Now we have a new NHS and no one knows how it works or who to write to for queries. Meanwhile our UK graduates cannot get NHS Provider Numbers and are unemployed , God help us, without undertaking first year post graduate training [so called FD1] but our EU colleagues can by and large waltz in and start work unhindered by such detail. This is madness, sheer madness.
There is a new NGS contract being piloted but the CDO has gone off to NHS England to enable all the changes to the NHS – so there is a feeling of impending worse chaos down the line as once again those of us who are the most efficient contractors the Government has are once again expected to squeeze an impossible litre out a 100ml bottle. The DH expect us to believe that all is hunky dory with selective statistics when you and I know that extracting children’s decayed teeth is the third commonest reason for admissions for Gas & wrecking hospital paediatric plans It simply cannot go on Mrs T. The Big Lie of successful politics in dentistry is getting Bigger.
We have a GDC that seems to be seeking to grab practitioner by the nether regions and is chucking unlimited amounts of money at their cases, which seem to consist of one charge and 20 charges in the “and another thing” classification of i-dotting and t-crossing. Meanwhile any Tom dick or Harriet sets up a whitening parlour and simply snubs all and sundry with two very white fingers. And don’t get me started on Dental Nurse registration which is by any description nothing more than a tax on employment.
Now Mrs Thatcher, I do not need to remind you that we need each other, and in particular you need my skills with a local anaesthetic.
What we need is a proper recognition that dentistry is the original Privatised Industry – we lead the way and you lot are trying to stop us.
What do you say, Mrs T?”
As Mrs Thatcher fell asleep, she murmured “Leave it with me Dr Rill. I will see what I can do”
What a week!
Well, what a week it has turned out to be. Just as the BDA go all inclusive on us, ‘inviting’ membership of this august Trade Union-esque body at various levels, they go all protectionist on us with their latest missive . Maybe they are modelled on the old dinosaur Unions after all? What on earth are they on about? If ever there was a bullet in the foot, this latest BDA tripe is worthy of ribald derision. Whether this stance will prove a monumental cock up or success will of course remain for the future to know.
It all started of course with what many might consider to be perhaps one of the earth shattering weeks in the history of the UK dental profession.
Actually, not true: it all started with the OFT report of 2012 in which the threat of a full market review was hung over the profession and the GDC. The condition for its NOT being actioned was, amongst other things, the opening up of access to DCPs.
The GDC of course like being a strategic body. But I am sure they felt like a rabbit in the headlights of the OFT and an academic onslaught from Dundee, Manchester and Kent.
With too many opinions to be able to “lead”, they did the classic “Large Committee” thing and sat on the fence examining their navels, asking the whole world what they thought about something of which they had not heard [Evidence Based Policy … hmmm ] and then promptly fudged through the Direct Access changes come what may despite many shortcomings and misgivings.
This was not, it might seem, because they genuinely felt it was an appropriate release of professional skills. It seemed that they were more concerned that having built up such a head of advance steam with the various reports and consultations that the only release was DA at any cost of any sort. Just get the OFT off their backs …
So what have we got?
Well, on Easter Tuesday, not much has changed. Relax mes amis.
Go to work and start to think about it. As of March 2013 there are 38777 registered dentists. There are 6265 hygienists and 2077 therapists, and encouragingly all have a known gender.
In practice I simply cannot see how DA will change much – other than oiling the wheels of efficient Dental Health Maintenance. The need for a periodic dental examination to simply re issue a prescription for care can be eased back – who knows to what interval? Would a 5 years examination be acceptable in the presence of a trail of DA Maintenance by a DCP?
If I were a Clinical Dental Technician I would feel I had been shafted and ignored – but since there are only 230 of this rare breed, I sense they were trampled by the rush. It seems they may be doomed to remain a niche business – but good luck to them for they are a light of success in many cases.
But in a fine example of joined up Government there remains the lack of freedom to prescribe simple analgesic drugs for placement in the mouth – how stupid can they be? If ever the GDC missed a trick of leverage, it must be here. Still I am sure it is high on the MHRA’s agenda. Yeah, right.
DA is a bit like all the hype about 4G mobiles – it would be nice if they got 3G working everywhere first. The OFT and GDC “selling” DA as “the next big thing” seems to have a whiff of snake oil about it if you ask me – and I work closely with a hygienist so declare an interest.
On the other hand, that occasional comprehensive examination by a dentist will now become a full works task – full charting, full mouth photographs, appropriate radiographs, TMD and parafunctional evaluation, aesthetic discussions, orthodontic review – you get the idea.
Every Challenge is really an Opportunity
Maybe suddenly the periodic dental examination is actually a marketing opportunity to add value instead of down selling a simple “check up” [Don’t you HATE that phrase anyway ?]
But for the 6500 odd practices who employ DHs and DTs, little will change. In house protocols WILL change but surely this will be to the benefit of all involved. Patient care will become better for being seamless. Surely even the BDA can see that?
Will DCPs be rushing out to start their own practices – well not without substantial access to the capital funds required. And I cannot see HMG suddenly discovering a pot of money in the next 10 years.
Will DCPs now be able to obtain a Provider Number from the NHS Commissioning Boards? – well, there is an interesting prospect. Because many might feel that this OFT driven change by the GDC is barely worth the paper it is written on without such a possibility.
Will the long term NHS Access strategy be to allow access to employed DCPs in enhanced outreach? While many would see that as a very positive step [just thinking of the Scottish model] that raises issues of employment such as access to the NHS pension.
Perhaps what is clear is that there remains a conflict between the many thousands of Practice Owners and how they lead their teams, and a very small cadre of Dental Academics  who, seeming to have the ear of the CDO and his DH advisers, are re-writing the agenda for the provision of State funded dentistry.
It’s simple guys and girls: Stop panicking like headless chickens and take a chill pill. This “DA” seismic shift is fantastic news but not in the way the Government would like it to be.
The market is no sensibly estimated even by the OFT at £7.2B, and Private Practice is now £3.88B and rising. [Why the OFT excluded the ‘cosmetic element ‘ of £1.47B remains a political mystery – I don’t think so!] 
The Business of Dentistry needs DA to develop proper dentistry in high investment, high technology ultra professional Private Practice while the Government and its academic luvvies merely fans the flames of Rome-like “access” while living the NHS Big Lie of “Problem, what problem?”
Private practice needs DHs and DT more than the Government will pay them, and so exactly how will DA help Government policy? Well, it won’t and by the time the next Government start installing the next contract, dentistry will be up and away and the NHS offering will be sidelined to a minority social backstop.
I put it to my assembled colleagues: in the classic event driven by The Law of Unexpected Consequences, Direct Access alongside the New Contract will be the death knell for Government management of NHS Dentistry because Private Dentistry will make better use of the work force and skill mix , more efficiently and more quickly than anything the DH can achieve. And it will pay better.
Finally we will have a core service indeed from the DH.
It is perhaps a shame that the apple is rotten.