GDC Calls For Faster Regulatory Reform, Amid Confusion
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- Published: Thursday, 17 June 2021 07:39
- Written by Chris Tapper
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The General Dental Council is calling for faster reform of regulators, following the publication of its response to the Department of Health and Social Care’s consultation ‘Regulating healthcare professionals, protecting the public.’
The GDC said in a press release that it has repeatedly expressed frustration about legislation. It said legislation is “Too detailed and inflexible to meet modern needs,” undermining its ability to operate an effective regulatory system.
“The GDC is urging the Government to be more ambitious in its approach. In some areas the proposals are still very detailed - such as the defined process for all regulators to follow in fitness to practise investigations - and this, risks locking regulators into a system which may work today but doesn’t have the adaptability it needs to respond to the needs of tomorrow.”
In its response to the consultation, the GDC said “Outdated legislation has fettered the GDC’s ability to be a fully effective regulator for a considerable time.”
Laudably, the GDC opposed proposals to remove health concerns from legislation.
The proposal would mean that the regulator would be provided with only two grounds for action – lack of competence and misconduct. The proposal would effectively mean that any action relating to health would be investigated under the ‘lack of competence’ heading.
In its response, the GDC said “We believe that health should be maintained as a separate ground for action. There are two reasons for this. The existence of health as a distinctive ground for concern means that such cases can be taken forward in a way which can be more supportive and less stressful for affected registrants, in part because they are aware that there is a more limited range of potential sanctions.”
“That means that it can be easier to create opportunities for remediation and to support registrants to remain in the profession. All of that in turn enhances patient protection, since there is an intervention route available which can pre-empt patient harm.”
“Merging the separate ground for health into a combined ground of lack of competence may have two unintended effects. The first is that registrants with health conditions may respond negatively to the assertion that their competency has been affected and this may affect their interactions with the GDC and their ability to remediate.”
“The second is that the proposal suggests that health matters will only be able to meet the grounds when there is a lack of competence, when failure to manage a health condition may in some circumstances become a matter of misconduct.”
The GDC’s response on this matter was mirrored by the Medical and Dental Defence Union of Scotland (MDDUS), which said it opposed plans to remove health grounds as a defence in regulatory investigations.
The indemnity organisation said “Plans to deny doctors and dentists under investigation by their professional regulator a defence on health grounds have been “specifically and strongly” opposed by MDDUS.
While giving a cautious welcome to a majority of the proposals made by the DHSC to reform the UK’s healthcare professional regulators, MDDUS said it was “not appropriate” to categorise health issues as a lack of competence.
Dr John Holden, chief medical officer at MDDUS, said “Health cases need to be dealt with more sensitively than other cases. This is of utmost importance with cases involving mental health problems.
“It is simply not appropriate for health to be placed into the same ground as competency.
“In fact, this seems a pejorative way to view matters and highly problematic in terms of the way in which health issues amongst clinicians are viewed by their patients and the public.”
Stephen Henderson, head of the dental division at MDDUS, said “The mental health of our medical and dental professionals is clearly a very important, live issue.
“To categorise ‘health’ as a lack of competence would be a seriously retrograde step to take.”
“The issue is also not just about registrants. Attending to and respecting registrants’ health is also good for patients and for the retention of doctors and dentists.”
Transparency
Regarding the requirement for regulators to be transparent when carrying out their functions, the GDC said “We agree that transparency is important and that there should be a duty on regulators to act transparently.”
But, as GDPUK reported recently, the clock is running down on the GDC after the regulator was instructed by the Information Commissioner to disclose a copy of an email sent by Chair Dr William Moyes to colleagues on 27th April 2020.
The GDC had withheld information after a Freedom of Information request was submitted by dentist Dr Dominic O’Hooley.
He had asked for information regarding the decision by the GDC to top-up furlough payments to some members of staff. The GDC originally withheld requested information, citing section 36 of the Freedom of Information Act to do so. The Information Commissioner decided that ‘Public interest favours disclosure.’
The GDC could face possible action for contempt of court should the regulator fail to comply with the ICO office’s decision notice.
Confusion
The GDC created some confusion with its response to the consultation document’s question “Do you agree or disagree that the prescriptive detail on international registration requirements should be removed from legislation?”
GDPUK has reported several times over the past two years on the concerns raised by the British Association of Dental Therapists (BADT) and British Society of Dental Hygiene and Therapy (BSDHT) regarding the GDC registering overseas dentists from outside the European Union as dental therapists, without testing their manual clinical skills.
The BADT, BSDHT, British Dental Association and major professional indemnity organisations have expressed their alarm at the GDC’s practice of allowing overseas dentists to register as therapists, when it has been shown that half of candidates taking the Overseas Registration Examination failed the practical manikin test in January 2020.
GDPUK has been told that some candidates who have failed the ORE have gone on to register as dental therapists.
In August 2020, the BADT and BSDHT wrote jointly to GDC Council members calling for the GDC to enforce a test on overseas dentists.
The two GDC stakeholders pointed out that the dental regulator already has the power under the Dentists Act 1984, to introduce a test for such candidates.
Section 36C (5)(a)(ii) clearly states the Council “may determine that a person must perform to the satisfaction of the Council in any test or assessment specified in the determination.”
GDPUK established late in 2019 that the GDC does not require any change in legislation to enable it to bring in an examination for overseas dentists wishing to register as therapists.
When GDPUK pointed out to the GDC that under the Dentists Act, it was already able to impose an examination, a spokesman said “This process requires significant GDC and Parliamentary time and resource.”
The GDC has been made fully aware of its ability to go ahead and introduce such an examination for some time, but in its response, the regulator said “The overseas dental care professional assessment process, set out in primary legislation, has been criticised by stakeholders who have reported concerns that the assessment does not include a test of competence as a mandatory component.”
“Flexibility will support the GDC’s efforts to review the assessment process and consider whether a test is a proportionate measure.”
Debbie Hemington, Chair of the BADT told GDPUK “We welcome the GDC sharing its response to the consultation document. We are particularly interested in its comments on the registration of overseas dentists as Dental Care Professionals.”
“We note that at last, our concerns about this route to registration are acknowledged publicly. We are particularly interested in the GDC’s assertion that "Flexibility will support the GDC’s efforts to review the assessment process and consider whether a test is a proportionate measure.”
“We would like to point out that the GDC is already able to do this under the current legislation and have admitted so, to us. The members of BADT sincerely hope some definitive movement on this issue might finally be forthcoming.”
GDC Chair, Dr William Moyes, said “My biggest concern is the further delay to the reforms as a result of the government’s decision to review the number of healthcare professional regulators. We need more progress in reform, faster, and a clear timetable for delivery.”
“In forming its response to the consultation, the GDC met with over 100 stakeholders from across the sector, providing it with valuable and varied insights on the broad range of issues raised by the consultation. The GDC looks forward to seeing the timetable for reform and the consultation for draft dentistry legislation.”
In its response to the consultation, Dental Protection (DP) said “Dental Protection has called on the Government to make meaningful reform to the regulation of dental professionals, ensuring the nuances of the practice of dentistry are adequately accounted for in any reforms undertaken.”
As well as granting the GDC discretion on when to investigate fitness to practise concerns, Dental Protection called for reforms to the 1984 Dentists Act as a matter of priority. The indemnity organisation urged the Government to clarify the timetable for GDC legislative reform. Currently, only reform of the medical regulator has been confirmed to take effect by spring 2022.
Dental Director, Raj Rattan, said: “Dental Protection has long argued for reform to the regulation that underpins the GDC. Vital changes to the 1984 Dentists Act, which governs the GDC, are seriously overdue. Despite several amendments over the years, the Act remains outdated, requiring the regulator to conduct some of its operations in ways that are not always in the best interests of patients or professionals.
“Much needed reform will enable the regulator to streamline its processes, improve efficiency, and reduce the number of investigations into less serious allegations, requiring the conclusion of investigations in a timely manner.
“Following this consultation, we would urge the government to clarify the timescales for passing secondary legislation to amend the Dentists Act.
“Dental Protection is particularly calling for reform to be prioritised in Fitness to Practise investigations, in order to reduce fear across the dental profession and increase confidence in the GDC. This includes giving the GDC discretion to decide whether and how to investigate a fitness to practise concern to avoid thousands of dental professionals going through an unnecessary investigation each year.
“We are also concerned at the proposal for the GDC to be provided with just two grounds for investigation – ‘lack of competence’ and ‘misconduct’, with the currently separate ground for action relating to ‘health’ removed from the legislation. Concerns relating to a dentist’s health would instead be investigated under ‘lack of competence’ grounds.
“At Dental Protection, we understand how stressful it is for dental professionals to be under investigation by the GDC and we believe that categorising those with health concerns as having a ‘lack of competence’ could exacerbate their health issues, and discourage registrants from seeking help earlier. We strongly believe health should be retained as a separate category.”
The GDC’s full response to the consultation document can be found here.
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