Lost in translation

UK dentistry finds itself in a very strange position. The academic standard required to gain entry to a dental undergraduate degree course has never been higher. The proportion of dentists achieving postgraduate qualifications has never been higher. Without exception, studies looking into levels of patient satisfaction with the care and treatment they have received have found patients to be well satisfied. And yet complaints against dentists are at an all-time high.

A lot of complaints arise from unmet expectations, so it invites the question of who or what is driving patient expectations into the realms of the unrealistic and unachieveable? And whether or not there is any underlying cause for concern about the standard of care being delivered by UK practitioners. There is little doubt that there are many different factors at work, but I have yet to see a reasoned analysis to explain the current paradox.

One of the agencies that has had a lot to say about the escalation in the number of complaints is the General Dental Council (GDC), and this creates problems and antibodies of its own. Anyone hoping to achieve a seamless transition between the ‘old’ style GDC and the new GDC could hardly have been more disappointed. Over the past few months it has been little short of a car crash and – in case you were wondering – this is certainly no cause for celebration.

The very public fight between the British Dental Association (BDA) and the GDC over the GDC’s annual retention fee (ARF) consultation has significance far beyond the reasons underlying it. It represents a milestone on the rocky path that we have been treading since the amendment to the Dentists Act, as the GDC slowly slips away from the profession that it exists to regulate. There is now such distance between the two organisations that they are not even speaking the same language.

There is no doubt that the GDC genuinely believes that it is practising ‘right touch’ regulation, dealing reasonably and appropriately with issues, and acting responsibly and proportionately in terms of the actions it takes, and the way in which it approaches the regulation of the profession. If that is correct, then just about every other dental regulator in the world is (at the very least) on the wrong page. Indeed, they would appear to be lost somewhere within the wrong book or in an altogether different library. The contrast between how the GDC conducts its affairs, and how the same issues would be dealt with by dental boards and dental councils in other parts of the world is now quite startling.

One could argue that such comparisons are meaningless because the UK is a distinct environment with very specific regulatory challenges. But then one is forced to ask why the GDC is also so very different from the General Medical Council and other healthcare regulators here in the UK.

The business of dentistry

There is of course a fatal flaw in the GDC’s budgeting and forecasting. The GDC needs to collect sufficient income (via the ARF and other relatively minor income sources) to cover its operational costs. The GDC is not a profit-making enterprise, but is not meant to be a loss-making enterprise either. You can work out for yourself whose door the GDC would be knocking on if it were to find itself carrying an operational deficit.

When expenditure was found to be outstripping income, any other business in the universe – whether profit making or not – would look closely at the costs it was incurring. It would look at what costs were involved, at what level, and in what connection. Most businesses would start by looking at the major cost centres and look hard at every possible means of bearing down on those costs.

In the case of the GDC, everything else is dwarfed by the staggering scale of the costs of the GDC’s fitness to practise procedures, and in particular, the cost of hearings. Yet the GDC will not countenance the possibility of fewer hearings, or resolving a higher proportion of cases short of hearings. The only way is up, as they say.

No other dental regulator in the world allows so many of its cases to proceed to hearings, and no other regulator seems to feel so powerless to control and rein in the costs of prosecuting cases, including the associated costs of conducting those hearings. The GDC is effectively seeking to persuade the profession and other third parties that it needs to increase its income by almost 70% (when the growth in the number of registrants is factored in), because it is getting more complaints through the door.  

It is rather like a dentist trying to justify a massive increase in the number of crowns being provided, by explaining that more patients were requesting treatment. Just as every patient does not need crowns, so also it is not reasonable to assume that the same proportion of that increased number of complaints, will need hearings. Any such assumption is complete nonsense but it is being left almost unchallenged.

Looking elsewhere

But we need to look upstream to understand why the GDC has embarked upon its present mission of self-destruction. A myth has developed whereby effective regulation is interpreted as meaning more regulation, heavier regulation and (crucially) more evidence of regulatory activity. The number of hearings is measurable, right enough, but it is a measure that tells us more about the GDC than about the standards that the dental profession itself is delivering.

Put simply, UK dentistry does not need this right now. There has been a complete breakdown of trust and confidence between the GDC and the profession, and between the GDC and the profession’s representative organisation. There needs to be an appropriate distance between the two organisations because one exists to protect the interests of patients and the other is effectively the dentists’ trade union. But, that said, it needs to be a functional working relationship. 

I cannot remember a time when the GDC was under assault from so many directions at the same time. That in itself is a worry because it strikes at the very heart of its credibility and reputation as a professional regulator. Where I differ from a lot of the views being expressed in a variety of professional arenas, is of the ‘beware what you wish for’ variety. Many of the suggestions doing the rounds are ill-informed and naïve because they reveal a complete misunderstanding of the statutory remit of the GDC. The GDC may have lost its way but the potential is still there for a reconnection with the dental establishment, if the will is there. It is likely to take many years for the GDC to recover from the succession of disasters (many of them self-inflicted) of recent times, but we do actually need it to survive.

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