The sound of silence
Time is a great healer, they say. And so, I might suggest, is putting the right people in place, showing that you are willing to listen and not least demonstrating that you encourage feedback (warts and all) and act upon it when appropriate.
It seems difficult to remember or even imagine the level of noise and pushback that greeted the Care Quality Commission (CQC) when it arrived on the doorstep of the dental profession four years or so ago.
What the CQC has got right is admitting that it doesn’t always get it right – and persuading us that this comes from a genuine acceptance of the fact and not because it’s a smart soundbite. There is something faintly endearing about that – other agencies please note.
Of course the CQC has had plenty of factors on its side through all of this. Firstly, primary care dental practices have proved to be the best of the bunch in comparison to CQC’s other ports of call – hospitals, care centres/nursing homes, and latterly primary care medical practices. That gives us fewer friction points in the first place and provides the CQC with perspective and context when deciding how best to deploy the clipboards and magnifying glasses at its disposal. The CQC readily acknowledges this in its Fresh Start document late in 2014, when announcing the detail of the new dental inspection regime.
‘We found fewer concerns compared with other providers of services we regulate. For example, between April 2011 and October 2013 we found that one in eight dental locations were not meeting the regulations in some way, compared with one in five in adult social care…. Where we did identify concerns, providers acted quickly to rectify them. In the majority of cases where our inspectors re-visited the service, they found their concerns had been addressed. This is demonstrated by the low number of warning notices we have served. Based on our inspection findings and the fact that we receive very little concerning information from the public, providers and those working within the dental sector, we believe that compared with other sectors we regulate, the primary care dental sector presents a lower risk to patient safety.’
Secondly, the decision to include primary care dentistry in the CQC’s purview much earlier than our medical GP counterparts may have been irritating at the time (and illogical, as I believed then and now), but it did mean that the loudest noise and greatest pain was naturally self-limiting. It would abate because – if nothing else – it would get diluted by the further expansion of the CQC’s remit into medical practices.
Thirdly (and perhaps most significantly), the GDC has helpfully interposed itself in the line of fire, and has been such a natural target for the profession’s ire and frustration, and so obliging in providing copious raw material for it, that the CQC has been able to operate under the radar. But in fairness, the CQC has made exceptionally good use of this windfall.
Nobody enjoys paying for inspections and additional regulation that they would prefer not to have in the first place. But even the most die-hard opponent of the CQC must surely concede that there are collateral benefits that arise from the disciplines – and even, the systems, processes and documentation – that the existence of the CQC has mandated. If we had brought in firms of consultants to improve our practices and their ability to resist scrutiny and challenge, we would have paid them a lot more than the CQC registration fees.
Trial by clipboard
The biggest shock at the time, you will recall, fell upon a lot of wholly private practices for whom this ‘trial by clipboard’ was all new and unfamiliar territory. To quite a few of them it felt like a kind of intrusion or even violation. For some it was an expensive but long overdue reality check, bringing them into line with NHS practices that were already well accustomed to the rigours of clinical governance and practice visits. The interesting legacy of that time is that dental practice owners can hold their heads high in the knowledge that the inside of a dental practice is one of the safest places in healthcare – and we can prove it!
The CQC’s new approach to inspecting dental practice locations and the services provided within them came into force on 1 April 2015, now sampling just one in 10 practices in any given year. It is difficult to take much issue with the fundamental standards and regulations that form the basis and structure of the inspections. The routine and much closer involvement of people who have first-hand experience of the inner workings of a busy dental practice is another welcome change since the CQC’s first faltering steps into primary dental care. So all in all it has been a quiet and unheralded success for UK practitioners (and for the CQC too) and one that we all should take pleasure from. The British media reveled in the Di Mello story, but not this one. Isn’t it a shame that a good news story is no story at all for the British media?