John Makin, head of the Dental Defence Union (DDU), discusses what needs to be done to reform dentistry in 2024.
The state of dentistry will be one of the big talking points on voters’ doorsteps when the prime minister calls the next general election.
There’s welcome political consensus that hiring, training and retaining more dental professionals must be a priority. Particularly if we want to increase capacity and improve access to dental care. The long-awaited NHS Long Term Workforce Plan included some proposals for achieving this.
They include expanding training places for dentists, therapists and hygienists. Also, doing more ‘to support and encourage qualified dental professionals to spend a greater proportion of their time delivering NHS dental care’. Finally, exploring ‘opportunities to support the professional development of dentists and dental care professionals’ and providing them with fulfilling NHS career paths to ‘minimise the bureaucracy around starting to practise in the NHS’.
‘Protracted, disproportionate and distressing’
An expanded workforce will support overworked clinicians. But there’s another pressing issue which is affecting morale and making it harder to retain dental professionals. The GDC is outside the remit of NHS England, but we are still awaiting a timetable from the government for promised legislation to modernise professional regulation and the often protracted, disproportionate and distressing fitness to practise (FTP) process.
Without reform of the outdated Dentists Act, the GDC itself only has the power to make limited improvements. In September, for example, it began a six-month Initial Inquiries Pilot aimed at speeding up the early stages of investigation.
This should lead to earlier requests for specific information in clinical practice cases involving a single patient. For example, the relevant clinical records. The pilot may be expanded to other types of case. The GDC says this will enable its clinical advisers and casework managers to make informed decisions more quickly.
The DDU welcomes the pilot as we have regularly raised concerns about the delays in completing basic investigation work. However, the GDC is working with its hands tied. The government set out proposals for regulating healthcare professionals in 2021 and there was much that we supported, particularly:
- The creation of a three-tier FTP process comprising initial assessment, examiner stage and panel hearing. This would allow more cases to be appropriately resolved at an earlier stage. At the moment, the GDC refers many of the concerns raised to a case examiner for an investigation
- The creation of a separate independent body to decide whether a registrant is fit to practise, akin to how the GMC operates with the Medical Practitioners Tribunal Service (MPTS). At the moment the GDC performs both the role of investigator and adjudicator of complaints.
Unfortunately, there seems little prospect of the necessary legislation being laid before parliament ahead of the next election (the GMC is first in the queue in any case). This is frustrating those who want to deliver a fairer and more proportionate regulatory system for dental professionals, including the DDU and the GDC itself.
Of course, there are more things that the GDC can do to reduce the burden of dental regulation. The registration and renewal process, for example, is another area (alongside fitness to practise) where the Professional Standards Authority highlighted delays in its last review.
All dental professionals should take steps to minimise the risk of a lapse in their registration. For example, ensuring their contact and bank details are up to date. However, we would like to see more done to make registration, renewal and restoration quicker and easier for registrants. We cannot afford to lose dental professionals from the workforce, even temporarily.
We also hope that the GDC will continue to look at ways to improve the tone and clarity of its communications with registrants and dental students to help alleviate the culture of fear that surrounds it. The GDC’s own research into the experiences of fitness to practise participants, published in November 2022, highlighted concerns about the lack of empathy and punitive tone of voice in its communications.
We welcome the fact that the GDC has begun to make efforts to improve in this area by reviewing the wording of letters and communication used in FTP.
The DDU is always ready to engage with the GDC on this. We see at first hand the anguish that members feel when they contact us for assistance. We’re also doing our bit by ensuring that members are contacted at an early stage by their assigned dentolegal adviser who will introduce themselves, explain the process and offer initial guidance and reassurance.
Given the pressure that dental professionals are under, they need all the support they can get from professional organisations. For example, the DDU, from the NHS and the GDC. However, the levers of meaningful regulatory reform remain in the hands of our politicians. I hope this fact won’t be lost in the campaigning ahead.
For more information, vist www.theddu.com.