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Can a practice principal really be liable for an associate dentist's criminal behaviour?

Can a practice principal really be liable for an associate dentist's criminal behaviour?

The question posed to the court was whether an employer can be vicariously liable for sexual assaults perpetrated by an independent doctor?

Between 1968 and 1984 Dr Bates was engaged by Barclays Bank to carry out medical examinations on potential and existing employees of the bank. Barclays at that time were undergoing a positive drive to recruit women into the bank and as a result a number of the individuals assessed by Dr Bates were women, some as young as 16.

Accusations against Dr Bates

The employees would go to Dr Bates’ home, where he had created a purpose-built treatment room. He would see the patients on their own with no chaperone present. They were required to undress to their underwear. The allegations against him included inappropriate breast examinations and digital vaginal or anal contact. Following the examination, Dr Bates would send a pro-forma document setting out the details of the examination to the bank. If the report was satisfactory the individual would be offered employment.

Dr Bates died in 2009, however in 2013 a police investigation was carried out which concluded that had he been alive, there would have been sufficient evidence against him to warrant a criminal prosecution.

Barclays’ vicarious liability

In 2016, 126 claimants sought damages against Barclays Bank in relation to the sexual assaults they had suffered. They claimed that the bank utilised the services of Dr Bates in the role of medical examiner in order to satisfy themselves that the person was fit to work for the bank and to confirm that they would be suitable for the life assurance policies in place.

In July 2017, the Hon Mrs Justice Davies ruled that, yes, the bank was vicariously liable for the actions of its self-employed contractor. The reasons she gave were as follows:

A two-stage test must be considered to determine whether or not a vicarious liability exists:

  1. Is the relevant relationship one of employment or “akin to employment”?
  2. If so, was the tort sufficiently closely connected with that employment or quasi employment?

When is a relationship “akin to employment”?

When the following criteria are satisfied:

– The employer is more likely to have the means to compensate the victim than the employee and can be expected to have insured against that liability;

– The tort (act) will have been committed as a result of activity being taken by the employee on behalf of the employer;

– The employee’s activity is likely to be part of the business activity of the employer;

– The employer, by employing the employee to carry on the activity will have created the risk of the tort committed by the employee;

– The employee will, to a greater or lesser degree, have been under the control of the employer.

 

The bank argued that Dr Bates was an independent contractor, and that he bore personal liability for the acts. Had the claim been made much earlier his personal estate would have been able to settle the claims.

 

However, to determine whether the relationship was “akin to employment” the judge applied the five criteria set out above:

– The judge concluded that whilst Dr Bates would have had indemnity insurance, that insurance would not have covered him for cases of sexual assault; his estate was distributed many years earlier.

– Employment was conditional upon the bank being satisfied on the basis of the medical examinations that the applicant was medically suitable for service. Dr Bates was the chosen doctor of the bank and he used their stationery.

– The purpose of the examination was to enable the bank to be satisfied that a potential member of staff would, health wise, be an effective member of the workforce. This was an intrinsic part of the business activity of the bank.

– The bank directed the employee where to go and gave no freedom of choice. They directed the doctor to undergo an examination, including a chest measurement! Many of the claimants, who were as young as 15 and 16 saw the doctor alone in his room and were asked to remove their clothing. The judge concluded that the bank created the risk of the tort (sexual assault) taking place.

– The fact that Dr Bates organised his own diary and carried out other medical activities did not negate the argument that he was under the control of the bank at the relevant time. The fact that the assessment took place at his home rather than the bank made no difference to this conclusion.

 

Tort closely connected with the employment

When considering stage 2, she concluded that the sexual assaults occurred during the course of a medical examination which the bank required the applicants to undertake for the purposes of securing employment. Dr Bates was trusted to do the work and placed him in a position to deal with the employees. This gave him the opportunity to abuse his position. The abuse was inextricably interwoven with the carrying out of his duties.

Would a practice principal be vicariously liable for the tortious acts of their Associates?

In short, the answer is yes. Whilst many associate dentists prefer to maintain their self-employed status for tax purposes (the Tooth Counsel has blogged on worker v self employed status on a number of occasions) the relationship that they have with the practice is almost entirely “akin to employment”. It is now common practice for associate dentists to appear to members of the public to be an integral part of their dental practice, bookings are made and diaries organised by the practice, patients and referring dentists are introduced to the associate via the practice, uniforms are often worn and the practice systems and stationery utilised. If an associate dentist commits an actionable tort against a patient or other member of staff whilst engaged by the practice, then the practice itself would be liable.

Whilst the principal of the “independent contractor defence” remains intact, this judgement sees the court extending the scope of vicarious liability significantly. Whilst the facts of the above case are extremely unlikely to arise in today’s society, particularly in a dental setting where nurses are present at all times when a dentist is seeing a patient, it is a valuable lesson to reinforce the view that the employers should not be complacent about the potential for poor behaviour by their independent contractors and the liability that may follow.

If you have any questions about this blog, or require advice and assistance in relation to your liabilities within the work place please feel free to email Julia Furley on This email address is being protected from spambots. You need JavaScript enabled to view it., or call us on 020 7388 1658.

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Stephen Henderson

Unusual circumstances

Great summary of a curious case. The claimants came after the bank because it has deep pockets and the doctor is dead and his affa... Read More
Tuesday, 03 October 2017 07:22
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JUN
06
0

Goodman Grant win award at Liverpool Law Society Legal Awards

Goodman Grant win award at Liverpool Law Society Legal Awards

 

 

And the winner is…

 

The Goodman Grant team is delighted to announce that they have recently won at the prestigious Liverpool Law Society Legal Awards.

 

At a black-tie awards ceremony held at the Rum Warehouse in Liverpool, the Goodman Grant team were awarded the Best Niche Law Firm Award, for their work in the dental sector – a fantastic accolade that demonstrates the commitment Goodman Grant has to providing dentists with expert legal support.

 

Ray Goodman, joint managing director at Goodman Grant Solicitors, says of the firm’s win: “This award shows the amount of hard work and devotion the Goodman Grant team puts into helping each and every one of our dental clients and it is an honour to have this recognised by the Liverpool Law Society.”

 

Goodman Grant are renowned for providing a wide range of specialist legal services to the dental profession, from employment contracts and disputes, to CQC applications, due diligence and all aspects of practice sales and acquisition.

 

To find out more, contact the expert team at Goodman Grant today.

 

For more information, visit the Goodman Grant website at www.goodmangrant.co.uk or call us on:

Leeds office: 0113 834 3705

London office: 0203 114 2133

Liverpool office: 0151 707 0090

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OCT
09
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Balancing Probability

Case Examiners

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AUG
04
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The GDC Specialist Lists; What does the future hold?

The GDC Specialist Lists; What does the future hold?

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?

Becoming a Specialist:

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.

Is this fair?

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.

Looking to the future, what could the GDC do to improve the current position?

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.  

 

Julia Furley is a barrister with a special interest in dentistry. She has assisted and represented a large number of dentists at both the application and appeal stages of their specialist list applications and has an extremely good record of success. If you are interested in applying for entry onto the GDC specialist list you can email Julia on This email address is being protected from spambots. You need JavaScript enabled to view it., or call us on 020 7388 1658.

 

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JAN
12

Provide the best service, to everyone - Nicola Lomas Goodman Grant Lawyers for Dentists

Provide the best service, to everyone

A Tesco store recently made the headlines when an employee posted on Facebook about how the company had gone above and beyond contractual obligation to provide her with the facilities to breastfeed her new baby in comfort and privacy.
 

The feature truly highlighted how important it is to offer support to new mothers at this important stage of parenthood and Tesco has been rightly praised for its efforts. Unfortunately, however, there are just as many cases that show the opposite – from mothers who have been asked to leave restaurants or other public spaces or who have been shamed into thinking that breastfeeding in public is taboo.
 

Of course, breastfeeding is protected by law – from as far back as the Sex Discrimination Act of 1975 which stipulates that breastfeeding mothers should not be harassed or discriminated against in any situation. This has been reinforced more recently in the Equality Act, 2010 which clarifies that a business must not treat any woman who is breastfeeding unfavourably. Indeed, employers must be aware of these stipulations, since they are required, by law, to provide adequate facilities for breastfeeding mothers.
 

Dental professionals must be particularly considerate of this. In many dental surgeries, space is a rare commodity, so ensuring that there is enough room for a breastfeeding mother – either employee or patient – to rest may be more difficult. The allocated space must be comfortable, private and be large enough to allow the individual to lie down.
 

Other than the requirements to regularly risk-assess the working environment, however, there is no legal requirement to conduct a specific separate risk assessment for a breastfeeding individual – but a prudent employer may wish to do so, to best provide an environment which is safe and comfortable.
 

Employers are not required to provide specific areas in which breastfeeding or expressing can take place, nor do they need to provide paid breaks for this purpose. But they must be aware that sometimes the staff room or the waiting room will be inadequate and the toilet facilities are simply inappropriate to breastfeed. Importantly, they must remember that under the Equality Act they cannot provide a service on different terms; meaning you cannot ask a breastfeeding mother to sit somewhere different than your usual waiting room unless there is a safety concern – so it is better overall to make provisions for a comfortable area which meets the specific legislative requirements to avoid any complications or potential dispute.
 

Not only will this be in keeping with current laws, it will be an effective way to show your support for new mothers – and this can be a particularly powerful tool. Whether it’s online or in person, new mothers will certainly discuss different service environments – your dental practice included – and if you are providing a comfortable, caring environment for them and their babies, they will most likely tell their friends about it. As a way of attracting new patients, new mothers may be a positive place to start.
 

In this regard, providing appropriate areas for breastfeeding mothers is simply the start – there is a myriad of other opportunities for you to take to strengthen the relationship between your business and new parents. Providing information can be another powerful way of doing so. For example, did you know that is has been show that breastfeeding a child will significantly reduce the risk of dental caries, malocclusion and fluorosis – it is also suggested that breastfeeding will promote optimal jaw and tooth development.[1]
 

There is also a helpline available in the UK to check the suitability of certain drugs for breastfeeding mothers; Drugs in Breastmilk helpline is contactable through 0844 412 4665 and is an effective way of staying up-to-date on behalf of your patients.
 

Similarly, it is worth making it clear that mothers are exempt from patient charges under the NHS whilst they are pregnant and throughout the first year of their child’s life.
 

Taking these steps is a great way of providing an excellent service to everyone – offering effective information as well as a comfortable, appropriate environment for breastfeeding patients and employees will certainly attract positive comments, just as Tesco enjoyed recently.
 

Goodman Grant Solicitors are the lawyers for dentists in the UK. With nationwide offices and an expert team, they understand the specific issues that dental professionals are beset with on a daily basis. If you need assistance with any of the legal aspects of running a dental business – from how to best cater to breastfeeding mothers to incorporation or employment contracts and tribunals – they can help. As both NASDAL and ASPD members, they know precisely what dental professionals need to run an effective business and will assist in a positive, friendly manner.
 

Do not risk alienating breastfeeding mothers – make sure you take the right steps to ensure you accommodate their needs just as you would any other.

 

Nicola Lomas Goodman Grant Lawyers for Dentists

For more information call Nicola Lomas on 0151 707 0090 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

www.goodmangrant.co.uk
NASDAL and ASPD MEMBERS



[1] LA Leche League GB leaflet: Harry Torney, BDS (QUB), M DENT SC (TCD)

 

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JAN
12

Are you up-to-date with the National Living Wage? - Michael Lansdell

Are you up-to-date with the National Living Wage? - Michael Lansdell

For an employee to feel truly valued, they need to know that they are being paid adequately for the job they do and that their employer is committed to their welfare and wants them to stay. As a dental practice owner, you will probably employ part-time staff – are you sure that you are paying them enough, even if they are not working as many hours as others are?

 

This is essential after the prime minister unveiled changes to the rules around the National Living Wage (NLW) in September 2015. The measures significantly toughened the regulations that were already in place, emphasising a message of ‘zero tolerance’ for employers who fail to comply.

 

Under the new laws, the NLW for workers over the age of 25 will be £7.20 an hour from April 2016 and by 2020, it will be at least £9. To ensure that employers comply with this, the government also announced a new unit at HMRC created specifically to deal with firms that are not paying the NLW.

 

Until the measures were announced, if an employer was caught out, they had to repay the amount they had underpaid plus a non-payment penalty. In September, the prime minister confirmed that this penalty would be doubled to a whopping 200% of the underpayment. Moreover, any business owner found guilty may also be disqualified from being a company director for 15 years.

 

These penalties are harsh and a small-to-medium-sized business, which many dental practices are, would simply not survive them. Whilst some employers are making a genuine mistake, it is still the responsibility of the business owner to make sure the new rules are properly enforced and all criteria met.

 

Don’t get caught out! Part of running a successful dental practice is looking after every member of staff and making it a great place to work. Get expert advice to keep you up-to-date with the law, so that everyone can focus on delivering the very best in patient care.

 

Specialist medical and dental accountants Lansdell & Rose can help you understand and apply employment law. The team also has a wealth of knowledge on a range of topics from pensions to tax to help your business grow. Visit www.lansdellrose.co.uk or call 020 7376 9333.

 

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NOV
24

Protect yourself and your staff - Goodman Grant Lawyers for dentists

Protect yourself and your staff - Goodman Grant Lawyers

On average, there are approximately 6,000 employment tribunals being presented each month in this country. In dentistry, we see a large volume of cases in which practice principals have failed to issue their staff with proper employment contracts. Despite the fact that the provision of such contracts has been a statutory requirement since 1978, there are still many practices that fail to do so – why this should be the case is hard to determine, but it is indicative of an attitude that fails to recognise the importance of the staff. 

 

Failing to provide employment contracts to any member of your team is not only a breach of statutory requirement, it can also leave practice owners vulnerable should there be dispute with a member of staff. For example, without an employment contract, there is no clear procedure for staff holidays, sick pay, overtime of discipline.

 

It is also quite likely that if a tribunal comes across a case where an employer has not provided a contract, they are likely to sympathise with the employee’s position. Thus, the lack of a contract can actually jeopardise the chances of successfully defending against such proceedings.

 

But by including a clause in an employment contract, that defines the procedures that will be followed in all aspects of work within your practice, you will be suitably protected.

 

To reinforce this, it is also prudent to supply a comprehensive staff handbook. This must be bespoke to your dental practice and will expand upon the terms detailed in the employment contract, focussing on specific circumstances that may be unique to you and your team. Of course, it must be regularly updated to reflect new legislation and practice changes, and it is absolutely vital to include a thorough introduction to the handbook in any staff inductions.

 

Ultimately there are two reasons to invest yourself in a comprehensive handbook like this. Firstly, you will be able to significantly reduce the chances of becoming embroiled in a dispute and being taken to a tribunal. The second is that your business will come across as professional, serious, fair and competent.

 

Of course, these precautions are not guaranteed to stop all staff misconduct, but they do provide an efficient safety-net to fall back on if matters turn nasty. What’s more, it will promote staff happiness, because they will feel protected and valued – and, of course, happy staff should equal happy patients.

 

John Grant of Goodman Grant Lawyers for Dentists - a NASDAL member

For more information call John Grant on 0113 834 3705 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

www.goodmangrant.co.uk

A NASDAL and ASPD MEMBER

 

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SEP
18
1

Specialist Lists and the GDC Review

Specialist Lists and the GDC Review

 

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).

Background

Registration

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.

Title

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.

Cost

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

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Andrew Shelley

Missed the point

The GDC, as usual, have missed the point. Other dentists refer to specialists and the specialist lists help them choose the approp... Read More
Monday, 21 September 2015 19:00
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