Asking the big questions

Nigel Jones speaks to John Milne about being ‘well-led’, fees and working collaboratively with the GDC and NHS England

Complying with the Care Quality Commission (CQC) is a vital part of practice management and something practice teams are keen for more clarification on.

It is clear practice teams understand the importance of meeting CQC requirements and passing an inspection, but, for some, there is a level of uncertainty around how to do so, which brings an extra source of administration and worry.

Bearing these factors in mind, I will be hosting two panel discussions on the CQC, complaints and compliance at the British Dental Conference and Dentistry Show in May.

John Milne, national dental adviser to the CQC, will be on both panels, alongside peers such as Pat Langley from Apolline and Farzeela Merali-Rupani, head of clinical at Dental Directory and a clinical case examiner for the General Dental Council (GDC).

Ahead of the panel discussions, I caught up with John to discuss updates to CQC regulations, the ‘well-led’ key line of enquiry (KLOE) – the most common one practice teams seem to struggle with – and how the commission is working with the GDC and NHS England.

Nigel Jones (NJ): Are there any recent/upcoming changes or updates to the CQC regulations that practice teams need to be aware of?

John Milne (JM): There are no changes planned, but the CQC is committed to consulting fully with the sector if there were any proposals in the future.

We will continue to visit around 10% of practices a year. This is a mixture of random selection and where we have been made aware of risks or concerns.

We will also continue to highlight notable practice as examples we can all learn from.

NJ: The KLOE most practices struggle with is the ‘well-led’ one, what are the common reasons for this?

JM: Managing and leading a dental practice has become a vital part of ensuring that the public receives safe and effective care.

An empowered practice manager is a key element in this process.

I am acutely aware many practices struggle to resource this role appropriately, and the principal dentist may attempt to cover this role in his or her spare time at weekends and in the evening.

Others delegate the task to staff members who may not have sufficient training or the appropriate skills for the role.

NJ: What can practice teams do to ensure they demonstrate being well-led and what support does the CQC offer to help them with this?

JM: As we all know, there are many areas – ranging from the safe recruitment of staff, health and safety, radiological protection, cross infection, and so on – that need to be covered.

A well-led practice has the relevant policies in place, and, importantly, practice staff know what these require of them.

In terms of support from the CQC, we publish a wide range of mythbusters on our website (which can found at and the regulations themselves are a good source of information.

NJ: A little over six months ago, you and I spoke, and you mentioned it being early days of the Regulation of Dental Services Programme Board (RDSPB). How is that going in terms of the CQC, the GDC and NHS England working more strategically together?

JM: This work is ongoing, but all three organisations remain committed to reducing duplication and multiple jeopardy.

Practical examples of our work include the encouragement of peer review groups, and practitioner advice and support schemes. These are led by the profession and aim to help colleagues support one another and avoid problems leading to regulatory action.

Another example is the development of materials to help patients understand that complaints can often be resolved at practice level.

NJ: In the 2018 British Dental Industry Association Spotlight report, regulation was the most commonly cited source of business cost increases. What is the CQC doing to ensure its fees are appropriate?

JM: The CQC is required by the government to recover the full costs of regulating dental practice from providers.

The CQC also has to demonstrate the fees are appropriate. A consultation exercise has been completed and having considered the responses, fees for the dental sector will increase to better align the cost of regulation with the fees collected.

It is important to note that we are committed to openly discussing fees and how they are calculated with representatives, such as the British Dental Association, and those discussions are ongoing.

John Milne will be part of two CQC complaints and compliance panel discussions in the Dental Business Theatre presents ‘The Big Questions’, programmed by Practice Plan and sponsored by Wesleyan Bank.

The panels will take place between 3.45pm and 4.30pm on 17 May, and from 11.15am to noon on 18 May. During the event there will be various other panel discussions taking place in the theatre, including Future of dentistry, Maximise the value of your practice, HR and employment law, and What next for NHS dentistry? For more information, visit

A podcast featuring John and Nigel is available at

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