The aim of this blog is to compare the scandalous, criminal, modus operandii of the PO and the methods of the UK regulator of dentistry, the General Dental Council [GDC]. There are many, many similarities in the way they persecute their "underlings" by abusing their power, and their institutionally ingrained, total lack of corporate insight.

The inquiry into the Post Office scandal begins taking evidence today from the Post Office and Fujitsu, whose computer programme Horizon ruined the lives of many innocent people. So far only 4 people have been fully compensated. Here's how HIGNFY dealt with the story in 2021... pic.twitter.com/2azU8Vuvpr

— Have I Got News For You (@haveigotnews) February 13, 2023

Following the TV programme and the national outcry; politicians have now got involved in the idea of stopping the involvement of the PO in appeals by postmasters. This interference in justice, and in the fight to maintain power, the PO continues to delay the outcome of clearing the names of every single sub postmaster who has been convicted, injured, or lost money. This behaviour is the same as GDC being involved in appeals against its' own decisions. This has created a duplicate, in the denial of the basic human right to unfettered justice.

 

What has gone wrong in our UK QUANGO based governance system? The Government seems unwilling or unable to control the excesses of the QUANGO. The QUANGO gets involved too far into the quasi-judicial process. The QUANGO wishes to be judge, jury, appeal court, and the executioner. The balance of power has gone way too far towards these seemingly unaccountable bodies.

 

This must change urgently as this power has been used malevolently, yet their actions are still being justified by the GDC, and the Post Office.

Governance malfunctioning continues, and GDPUK has a further news story [due to be published in early January] on the same topic whereby an appeal in the High Court strongly supported by an eminent Judge against the GDC, is now to be appealed against by GDC, at further excessive legal cost to registrants.

There are so many examples of the GDC's egregious institutional behaviour, too many to list here.

During the last decade, GDC were pursuing so many dentists for alleged offences, they almost ran out of money, and this funding was and is raised entirely from its' registrants.  To repair their finances, GDC decided unilaterally to increase its' financial reserves to remain at around £30 million, this was done by taking about £750 from each of 40,000 registrants over a few years, and placing those monies in its reserve fund which must earn a good sum annually.

During this time the GDC Fitness to Practise [FTP] operation was faced with long delays in justice, and this delay remains today. The Professional Standards Authority report condemns this aspect of the GDC operations year after year, yet nothing changes. 

In this period the GDC advertised, [only the once, we believe] in a national newspaper, for more complaints against dentists. This was not repeated due to the enormous exclamation it produced. Was this part of a plan to investigate more dentists and build a larger quasi-non-governmental empire?

The tragic topic of suicides: Sadly, the ITV drama did refer to suicide and depressive illness caused by the PO treatment of sub-Postmasters. Unfortunately dental colleagues are only too aware of this issue in dentistry too. The GDC have been questioned for many years on this matter. They have not had to grace to answer this question properly despite multiple FoI requests.

GDC and their output of information: GDPUK does have an axe to grind; the GDC press and media office continues to refuse to engage with GDPUK, and it’s team of writers. That is, unless one of their junior managers emails us by accident.

Others have also found GDC far from co-operative, and this management style reflects the PO methods. Freedom of Information requests have become possibly the only way to seek answers, and there are multiple [dental] authors who specialise in carefully crafting artful requests to get some information released. It is apparent GDC devote significant resources dedicated to the dark arts of not responding at all, delaying responses, not answering the question, and then of course, redacting answers before sending out.

A simple solution to this would be insight by the GDC as a whole. The Council members and the executive officers. Make the press office transparent, give answers to questions in an honest way, do not act as if there is something to hide in every single enquiry. The present behaviour tells all colleagues across the nation – GDC is guilty of bad behaviour, it is doing everything to obfuscate. And this behaviour in hiding the facts further increases the profession’s suspicion of corporate malpractice.

The Care Quality Commission [CQC], another regulator of dental practice, cannot be spared from criticism here, either. They announced their arrival on the scene about 15 years ago, by publicly threatening dental practices with closure if they did not comply with their petty impositions of tasks and non existent regulations. The CQC has in itself spawned an industry of compliance experts to ensure a dental practice is not closed down. They have ruled by fear for many years, with threats to close the livelihood of dental practices. One example of their stupid over-reach, for more than a decade, every dental practice had to have a nutrition policy for their patients - even though patients do not eat or need to be fed for their dental practice visits. It is confirmed "meeting nutritional needs" remains one of the eleven core standards demanded by CQC. ² 

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The ITV programme, a sensitive and sympathetic tale, has exposed some of the systemic issues within our nation. Individuals in influential roles in the Post Office, indifferent to the concerns of the sub-postmasters, they ignored outside investigations, and prolonged the ongoing problems for the victims.

This unfortunate reality is evident daily to our self-serving politicians, and this TV drama has brought it to the top of the national agenda. It's essential for politicians to reflect deeply, a truly long hard look at the harm being caused in the name of running our country.

Whether this is about the GDC or the Post Office, this is really about the abuses of power by people who hold those reins. The power of unaccountable civil servants or Quangos [from traffic wardens, housing officers to name but two groups) have over the general public. How they systematically exert that power over us daily, it certainly seems unjustified, and more than unreasonable.

Our politicians must establish a stronger framework of accountability to elevate standards comprehensively. After they make a transparent solution in the management and style of the PO, their next target for total reform must be the GDC.

 

1. The ITV page for the programme

2. CQC Regulation 14 

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.

 

 

 

Image credit - Moyan Brenn  under CC licence - not modified.

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?
 

http://www.gdc-uk.org/Newsandpublications/Publications/Publications/Thefirst50years_Gazetteinsert_summer06[1].pdf

http://www.thetimes.co.uk/tto/health/news/article4081701.ece

http://www.breathebusiness.co.uk/blog/make-a-visit-to-the-dentist-more-like-a-supermarket-trip/

https://www.flickr.com/photos/pedrosimoes7/


 

 

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. ^[1] [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.]  ^[2]  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.

Tony Jacobs.

 

[1] see appendix 1 p15 

[2] CQC report updated at time of suspension of dentist.

Image credit - John Morgan   under CC licence - not modified.

 

Social Media outpouring from UK dentists, against GDC ARF rise, July 2014.

 

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.

Dentists are livid and united about this unprecedented rise in costs by an increasingly out of touch, unjust body.

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]

https://www.facebook.com/pages/THE_Project/1378516855727456

 

 

 

 

 

 

 

 

 

 

 

 

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.

https://submissions.epetitions.direct.gov.uk/petitions/66982

 

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.