A new treatment plan: John Makin reflects on the state of the dental service at the end of the year and what needs to change in 2025.
From The Sound of Music on TV to the annual reappearance of novelty jumpers and Slade on the radio, the Christmas season is all about repeats.
While I enjoy these traditions (well, some of them) unfortunately a sense of déjà vu also creeps in when I look back over the past 12 months in dentistry and the all-too-familiar challenges we face.
Over several years, the profession has come under mounting pressure from capacity and funding shortages, the failing GDS contract, negative media coverage and a growing complaints culture – to name just a few.
These have taken their toll on dental professionals’ morale according to the latest Dentistry Census which revealed that more than half (52%) of respondents had sought help for mental health issues (an increase of 21% from 2021).
This was echoed by a DDU member survey in June in which eight in 10 (80%) respondents felt negative about the future of the NHS and only 17% said they always felt able to deliver optimal patient care (27% said it was possible half the time or less). Unsurprisingly, 96% wanted political parties to commit to supporting the health and wellbeing of the dental workforce.
Legal concerns
Sadly, another thing that hasn’t changed is the demoralising dento-legal climate in relation to GDC investigations and claims. Despite the GDC’s efforts to improve the fitness to practise process, it remains a time consuming and highly stressful experience for dental professionals which is largely set in stone by outdated legislation.
This year, DDU members faced delays of more than six months at the case examiners stage with some waiting up to six weeks for a decision that they had been told to expect within 28 days. Those referred to a practice committee hearing are kept in suspense for much longer.
The most recent GDC Annual Report and Accounts 2023 (July 2024) revealed that ‘the median time for initial hearings to start from referral by case examiners was 10 months and one day’, far short of the GDC’s nine-month target.
Imagine the devastating impact of being under scrutiny for so long with your career and livelihood on the line. Meanwhile, the clinical negligence system remains hopelessly out of tune with the times as claims costs rise at an unsustainable rate and legal costs stay disproportionately high, often higher than the compensation award itself.
This puts pressure on dental indemnity costs for dental professionals but also has wider implications for the healthcare system which is already facing severe financial constraints.
In NHS Resolution’s latest annual report and accounts, a total of £2.8 billion is reported to have been paid out in compensation and associated legal costs. That money would go a long way towards recruiting and training new staff, helping to cut waiting lists and improving outcomes.
A new landscape
But while 2024 has been the same old story for dental professionals, the political landscape is new. Not only did the woeful state of UK dentistry become a campaign talking point during the election but the new secretary of state for health and social care, Wes Streeting, has now said there is a mission to ‘rescue and reform’ the dental service.
One thing is certain. If the government wants to turn things around it needs to start with the people who are going to be instrumental in delivering its rescue plan.
The DDU’s An Agenda for Change addresses three policy areas where reforms can be made quickly and at relatively low cost but would make a big difference to dental professionals:
1. Reform the GDC
We need a modern, proportionate and timely regulatory regime but dental professionals are currently regulated under some of the oldest legislation of any regulated healthcare professional in the UK. The GDC is limited in what it can achieve without legislative change so the government urgently needs to implement the proposals set out in Regulating Healthcare Professionals, Protecting the Public back in 2021.
In particular, we want to see a three-tier FTP process comprising initial assessment, examiner stage and a panel hearing with case examiners empowered to resolve more cases at an earlier stage and the creation of a separate independent body to decide whether a registrant is fit t o practise, akin to how the GMC operates with the Medical Practitioners Tribunal Service (MPTS).
2. Action on clinical negligence costs
Patients harmed as a result of negligence must receive appropriate compensation but the clinical negligence system needs to be fair and sustainable rather than the outdated and creaking version we have today. Root and branch reform is needed, starting with the repeal of the Personal Injuries Law Reform Act 1948 s.2(4) which requires courts to disregard the existence of NHS care when determining compensation awards.
Second, the government must tackle disproportionate legal costs by enacting fixed recoverable costs in clinical negligence claims up to £25,000 with a commitment to extend that to claims valued up to £250,000.
3.1 Support the health and wellbeing of the dental workforce
The DDU has always supported the ideal of a community of practice where dental colleagues look out for each other. However, we think the government also has an important role in sustaining professional morale, from funding support programmes and services like NHS Practitioner Health to the way that ministers talk about and value the contribution of dentistry within the health system.
If there is reason for optimism, it lies in the can-do attitude of most dental practitioners, who want to make a positive difference for their patients. I hope the new government can work positively with the profession so that we have a new story to tell in 2025.
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