Don’t be a ‘golden goose’

Neel Kothari is unconvinced by the CQC’s explanation for its fee rise for the dental sector and suggests industry leaders should challenge it

The news that Care Quality Commission (CQC) fees for the dental sector are to rise by 13% has been met with dismay by industry heads, with dental leaders uniting to overwhelmingly condemn this unjustified increase.

The early days of the CQC led to considerable start-up costs associated with physical inspections of all dental practices. This led to the fees being effectively front-loaded.

Details released under freedom of information confirmed estimated costs of £16 million per annum and £1,600 per location per annum (for around 10,000 locations) in 2012/13. These estimates were recalculated to £12 million per annum (£1,200 per location) and in 2014/15, with reduced practice inspections, this was reduced further to £8 million per annum (£800 per location).

A consultation report in March 2017 reported: ‘The sector reached full cost recovery in 2013/14. Since then, the methodology for regulating this sector has been revised, and our review of the impact of this on our costs has resulted in a reduction in their fees this year.’


So, with the dental sector reaching full cost recovery, the slashing of practice inspections to 10% and numerous reports indicating a high level of compliance, why have fees now gone up?

Well, the CQC reported: ‘Over the past three years we have built up a much more detailed model using the increased amount of data we have been able to collect using our national resource planning tool. This shows us we underestimated the costs of regulating dentistry in earlier years.’

I personally find this explanation to be lacklustre and void of substance. It seems far too convenient that other ‘less compliant’ sectors, such as GPs, were found not to be providing safe care in line with the relevant regulations (just under half of consulting doctor services – 32 out of 66), yet, despite this, the fees for our colleagues remain largely unchanged.

Is the CQC acting with the same transparency as expected from their registrants? Are the promises each sector would be responsible for its own costs being eroded? Are we really to believe we are being charged for a miscalculation of fees almost a decade ago?

I believe we have moved beyond the point of accepting the CQC’s explanation for rising costs in an industry deemed to be largely compliant. Serious questions must be asked over whether dentistry is being used to supplement other sectors. If deemed true, this would surely represent a form of stealth taxation on the profession and a breach of the CQC’s own statement about how it calculates its costs.

One would naturally assume a move towards a ‘risk-based’ model for inspections would lead to significant savings. Sadly, these forms of unsubstantiated price rises are commonplace by regulators that seem to consider dentistry as some form of golden goose. Unfortunately, I suspect, with time, this will lead to tacit acceptance by the profession. Unless we robustly challenge these sorts of actions, well, we all know what happened to the goose.

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