Fooling around

Enough has probably been written and said about the CQC, which swings into official action this very month. The now famous YouTube video on the subject brought more smiles onto the faces of the dental profession than I have seen for a long time. But compared to the fun times ahead, doing all the paperwork to put yourself on CQC’s radar was always going to be the easy bit – apart from the ones that CQC wasn’t able to process in time because of their unfortunate underestimation of the likely number of providers, of course.

And, sadly, the ones that were held up by the staggering incompetence of the eCRB check fiasco. Not to mention, alas, the four thousand computer-generated ‘Registered Manager’ letters that were sent out in error. And, dare I mention the teeny detail that two weeks before the deadline, nobody knew for sure what the cost was going to be for registration.

Fortunately, the CQC will already be intimately familiar with its own Outcome 16, which deals with the need to have reliable quality assurance systems in place, processes for learning from mistakes, underperformance and adverse incidents, and of course with Outcome 17 (Complaints). After they have successfully dealt with tens of thousands of complaints from the dental profession, they should be ideally placed to assess and help us with our own complaints handling processes.

And they will be only too aware, I am sure, of their own requirement that organisations should welcome feedback and suggestions, and learn from them. Complaints must be listened to, and acted upon in a sensitive and responsive fashion – so we can look forward to that, I am sure. I did have a bit of a rant in my previous column about the GDC’s painfully embarrassing debacle over the ‘ethical advertising’ guidance, including (but by no means limited to) the ‘Call me Doctor’ nonsense.

But during the present intermezzo, before the GDC returns to this subject after its promised impact assessment has been carried out – don’t think for a moment that the pain is over yet – I feel the need to get a few other observations off my chest.

Why, I keep asking myself, do we feel the need to patronise members of the public when it comes to choosing a dentist?

What is it about healthcare that prompts this incredibly paternalistic approach whereby we continually talk up the ‘information, choice and patient experience’ agenda, then micromanage their decision-making process by manipulating the criteria by which patients are permitted to choose their dentist. The evidence points to the fact that personal recommendation and word of mouth has always been the main way that patients select a dentist. And if you are useless they will leave you, whatever you call yourself. And is this not also how patients choose restaurants, hairdressers, and many other things in their life?

Those providing other professional services such as solicitors, accountants etc, are often chosen in similar fashion. Some solicitors have a university degree but many do not. Some solicitors call themselves solicitors, while others call themselves lawyers, but nobody suggests for a second that this might mislead the public. Which other professional regulators believe that the way to assist patient choice is to deny patients the knowledge that someone has certain qualifications, when they have?

In these days where information is king, and patients are sifting information, asking questions and using search engines all day, every day, is it not better to provide information than to withhold it? Indeed, the contrast between the GDC’s approach to this issue, and its own published guidance on consent – which every registrant is expected to follow – is quite remarkable. Surely, the answer is to place objective facts in the public domain, while having much more effective controls over any other claims and statements that are of a more subjective nature.  The latter is, in my view, where patients are much more likely to be misinformed and misled.

Soft target
The harsh truth is that the preoccupation with dentists using their qualifications, or adopting the courtesy title ‘doctor’ is more easily explained by the fact that it is seen as a soft and easily policed target, creating the illusion of protecting the public when in reality it is doing nothing of the sort.

Under the watchful gaze of CHRE, it is, at first sight, a quicker and easier win for the GDC than grasping the more painful nettle of registrants talking up their act on websites and in-practice promotional material. With a big enough marketing budget, even a goose can start to look and sound like a swan and, with its stated intention of removing the courtesy title ‘Dr’, and stripping away the use of postgraduate qualifications, the GDC would simply move the point of impact into these other areas which are even less meaningful.

Do we really want patients choosing their dentist on the basis of who has the sexiest website? This is where we are heading unless the lunatics take annual leave from the asylum.

The supreme foolishness of the time and energy that is currently being spent on marginal issues like the title ‘Dr’ is best viewed from the perspective of what lies ahead. Creeping up over the horizon in the middle distance are two more developments of monumental potential significance – one of which, like the two topics discussed earlier in this column, will impact upon every dentist both private and NHS. It will also span both primary or secondary care, academia, research or administration/management. I refer to revalidation, the timeline for which the GDC has sensibly shifted back a little distally.

The second is the NHS reforms (in England and Wales) which cannot and should not be viewed in isolation.

Unintended consequences
The amusing thread running through all of this is that in a desperate attempt to ‘join up’ the governance, regulatory and quality assurance aspects of all these bits of the healthcare jigsaw, we see one example after another of collisions of intent and unintended consequences.

Practitioners are urged by the NHS contract, by CQC and by the GDC to follow the evidence base and guidelines. But many of the guidelines have no evidence base at all. Compliance with HTM 01-05 best practice, for example, will close some practices and force others to reduce their number of surgeries and, therefore, the amount of dental care that they can provide. The time and money invested in HTM 01-05 compliance, CQC registration and compliance, and (in due course) revalidation will be time and money that cannot be invested in other aspects of patient care, staff training, etc.

And some practices that have hitherto offered NHS services will discover it is no longer commercially viable to do so, and they will either go private or shut the door and head for the armchair of retirement instead of rearranging the deckchairs on the Titanic.

So, let us salute the masterminds who thought this all through, and suggest that they should keep their head down. It was Mark Twain who famously observed that it’s better to keep your mouth shut and be thought a fool than to open it and leave no doubt.

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