Stress and patient care

Is the pressure and stress regulators place on dental professionals actually improving patient care, Michael Watson questions.

A recent article in the Daily Telegraph caught my eye as it gave a fresh perspective on the increasing levels of regulation that all who work in healthcare, whether NHS or private, experience.

Dentists, not unnaturally, tend to focus on the heightened levels of stress arising from CQC inspections or the attentions of the GDC, but new research at the University of York has shown that ‘costly external NHS hospital inspections’ are not associated with improvements in quality of care.

The results prompted researchers to call for less resource-intensive inspections, allowing trusts to continue with their own internal assessments and ‘focus on making impactful improvements in a realistic timeframe’.

Dr Ana Cristina Castro, from the University of York’s Department of Health Sciences, and lead author of the study, said: ‘Since 2013, CQC inspection teams regularly visit NHS Trusts over several days, with more than 150 inspection measures, and rate them against legally enforceable standards of care.

‘This creates a significant pressure on staff before and during the inspection period, and also significant costs, not just of the CQC inspectors but also the NHS staff who are diverted from other activities.’

Pressure in dentistry

Although this latest study was about the CQC and hospitals, many will see similarities with oppressive regulation in general dental practice.

Recently, Dental Protection said its members admit the fear of being sued causes stress and anxiety.

Raj Rattan, its dental director, said: ‘Stress can impact on a dentist’s health and practice in a number of ways.

‘It can affect confidence, clinical judgement, morale and even lead to performance issues.

‘High stress levels affect performance and increase the potential for adverse outcomes of error.’

The CQC may appear more benign than it did in its early days, but ask any practice manager, who has to comply with their bureaucratic requirements, and you will be left in no doubt about the increased work and stress such inspections create.

It is nearly five years since GDC chair, Bill Moyes, in effect declared war on the profession with a highly provocative lecture at the FGDP (Bill Moyes, 2014), now removed from the GDC website.

Since then stress levels in the profession have risen substantially.

Improvements in care

Now all this might be acceptable if it had a positive effect on patient care.

But the research implies that such actions ‘are not associated with improvements in quality of care.’

Speaking as a patient, when I go to see a doctor or a dentist, I am more interested in whether their care improves my health and keeps me alive/keeps me dentate, rather than worrying whether their record keeping is immaculate and they tick all the right boxes.

Regulation should be in the background and the patient in the foreground.

Satisfying the needs of patients should be dentists’ first consideration, not the requirements of a zealous regulator.

It is time that the CQC and GDC realised this and faded into the background, if only to improve the quality of care dentists can offer their patients.


Bill Moyes (2014) Malcolm Pendlebury lecture at the Faculty of General Dental Practice (UK) 12 June

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