How does dental regulation need to change?

What does the future of regulation look like for the dental profession? In a recent ‘In the Loupe’ podcast, Practice Plan Director, Nigel Jones, discussed this topic and much more with Dental Legal Advisor and former Head of Dental at MDDUS, Stephen Henderson. Here’s a brief extract of their conversation.

Nigel Jones (NJ): We’re obviously under a Labour government now, and they seem to be taking a slightly different approach to regulation, and I get the sense that changes are in the air.

What's your take on the current situation with the regulation of the dental profession in the UK?

Stephen Henderson (SH): It's plain that the Department of Health, who will be the driver of any change in regulatory law, is interested in dealing with the big professions. So, the GMC and the Nursing and Midwifery Council are really at the front of the queue for reform of their Acts.

The GDC is relatively far back in the queue, and it's quite well known within the GDC that they're unlikely to get anything done in this Parliament because of the length of time it takes to deal with the reform of the Dentists Act.

There are some reforms that need to be made. There need to be some changes made and one major one for me would be to look at corporates and to see if the GDC can regulate them rather than just dealing with individuals.

I also think the fitness to practise (FTP) procedure needs to be tidied up, but the basic process isn't going to change even if the Dentists Act is reformed.

NJ:  It's very interesting you should mention corporates because I read an article about the veterinary world and the concerns regarding the pressures being put on vets to generate income. What do you see as the main points that need to be thought about when approaching the regulation of corporates?

SH: Corporate dentistry is delivered for the benefit of the public as well as the shareholders. But the change should be that the GDC can control how the corporate acts, as opposed to how the Clinical Director or the individual practitioners within a corporate act.

I see it a lot when I’m talking to dentists and helping people with complaints. The pressures they get from managers to upsell, or to deliver a certain volume of UDAs in England and Wales is significant. Invariably this pressure is placed on the younger practitioners or ones who have come to the UK to work and are not so familiar with the NHS.

Managers seem to have a disproportionate influence, and people are fearful of losing their jobs, so they do what the manager asks. Sometimes that may be contrary to the ethical principles that the GDC wants us to operate under.

So, looking at the veterinary, opticians and pharmacy worlds there are going to be lots of examples of how you can regulate corporates. By thinking broader and looking at other examples, the GDC could sensibly develop a system that works for the public. Because that's really what it's about. They have to work to protect the public.

NJ: That’s interesting because I remember some years ago a quote from the Federation of London LDCs about needing to achieve the gold standards of the GDC on the tin-plated NHS budget made available. So, there is a sense of tension between the activity requirements of an NHS contract in England and Wales and achieving the standard set by the GDC and adhering to the ethical principles you were just mentioning.

If you then throw into the midst of that a corporate entity as well, that is potentially having to cope with rising costs and lack of workforce availability, it's quite a challenging economic environment for a corporate. So, managing that tension between the standards and the activity and income generation must be quite tough.

SH: Absolutely, it's a big challenge for anyone who owns a practice, whether you're an individual, very small practice or whether you're a corporate the size of MyDentist or Portman Dentex, for example. Those are big ventures with huge budgets and inevitably, they want to make them as profitable as they can, and certainly not loss making.

So, I can understand the pressures to upsell cosmetic dentistry, aligner treatments and so on. It's about how you manage that tension and yet still maintain an ethical approach. I'm not suggesting it's easy at all, and I have sympathy with the corporates because they're such big organisations, so I don’t know how on Earth they recruit, retain and motivate their teams. Plainly they're very good at it because quite a lot of dentists are happy working for the same corporate for a long time.

Maybe it's a function of managing individual managers. Time will tell. The GDC would have to look deeply at the patterns of complaints and feedback, carry out a root cause analysis, to see what the problem is. I don't suppose many of these really come to the attention of the local NHS team. Unless patients start complaining through the NHS complaints procedure to the local teams, they're not going to find out about it too much.

Maybe I have a different view because I only ever see the bad news stories. Nobody rings me to say they've had a good day. So, I recognise that I see a very skewed situation really. So, compared to the dental advisor within an NHS team or the inspectors who are seeing good practice all the time, maybe it's inevitable I see the doom and gloom. Which is a shame, but it also is very real. It's like anything, if you can fix the small problems before they get big, there'll be fewer big problems.

NJ: Absolutely. You touched on something there which made me think about overseas dentists. We know we have a workforce crisis at the moment. Yes, there's been the NHS Long Term Workforce plan, but that seems to have some flaws in its methodology and calculations. However, even if that went according to plan, it's still going to be well into the next decade before it has a major impact, whether that’s through skill mix, hygienist/therapists or dentists. So, the overseas dentist seems to be the answer that a lot of people are looking towards.

That still leaves the GDC with a challenge. While it would be helpful to have an increased workforce, they can't risk standards in the process of trying to bring people over.

SH: Yes. The GDC's job is very simple. It's to ensure that anyone joining the register is good to go. That they’ll be a safe beginner. That they've had an appropriate education, and they're competent to do dentistry in the UK.

That's done by following the university curriculum, passing the exam and then you register followed by foundation training. International students either come from Europe or have to complete the Overseas Registration Exam (ORE). Now, the ORE is very good for testing competencies, but it doesn't help anyone understand how the NHS operates.

So, at the moment the GDC can register as many overseas dentists as it likes who are competent to get on the register, but they won't get a performer number until they've satisfied NHS England that, not only are they competent in delivering dentistry, but they're also competent in understanding NHS administration, processes and contracts.

So, as Ian Brack, the former Chief Exec at the GDC, said, ‘That's not our problem. Our problem is to register dentists and dental care professionals.’

The problem often is how quickly can you get somebody onto the Performers list. A By assessment that can take six weeks, a year, could take longer before somebody's given a performer number. So, yes, you can register international dentists, but they won't immediately be available to deliver NHS care because they have to satisfy the NHS as well.

With all the reform of NHS England, I'm not sure how that will impact local teams. For the commissioning groups and the commissioning teams managing the performers list that function must continue. It'll just be called something else and managed by somebody else.

Maybe there's an opportunity to look at how rigorous that performers list process is. I suspect what they don't want to do is give Performers list numbers out without validating people's competencies.

NJ: Some interesting food for thought there. Thank you, Stephen.

Listen to the podcast in full

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About Nigel

Nigel Jones is a Director at Practice Plan. He has been working in the dental sector for around 35 years and has a special interest in the development and future of NHS dentistry in the UK.

His knowledge and passion for dentistry has led him to become a trusted voice, offering invaluable advice on how to strategically and successfully run a practice and a member of Dentistry’s Top 50 of the most influential and innovative individuals in the UK dental profession.

About Stephen

Stephen Henderson is a very experienced dento-legal adviser and Specialist in Oral Surgery. His current work includes consulting with AllMedPro assisting clients dealing with complaints. He also works as an independent dental adviser, presenter, writer, expert witness and mentor.