The General Dental Council - Our Empathetic Regulator

I don’t trust the General Dental Council.

There! I’ve said it. I feel much better now.

To be specific, I don’t trust the GDC’s judgement as a regulatory body, I have sound reason to question its veracity, competence, and I cast much doubt on its sincerity, powers of reasoning and grasp on economics. They also obfuscate like they are the Olympic champions. Most of all, I don’t trust them with money.

Stick with it, it’ll all become crystal.

Quick rundown of what’s been happening over the past couple of months in case you missed it: The majority of the UK’s dental professionals have been temporarily redundant over the past few weeks due to the shutdown of all dental activity except in urgent referral centres and on hot triaging phones. Dentists are also currently caught in a maelstrom of uncertainty and confusion about the immediate and long-term future of dental practice particularly with regard to new post-COVID cross-infection measures, but that’s another matter.

A survey carried out by Dental Protection looking at key factors thought to affect the mental wellbeing of dentists showed that as well as concerns over protecting their staff and patients on a return to work, over 53% of dentists said that financial worries were having a big impact on their mental health in the face of the COVID-19 crisis. I know from speaking to friends in dental practice, that many of them are deeply concerned about not only the survivability of their practices, but the potential damage to the livelihoods of their employees and associate colleagues, many of whom had been furloughed on reduced pay.

Because many dental professionals are struggling financially, particularly dental nurses, many have said that they would welcome a reduction in the Annual Retention Fee (ARF) or the introduction of a scheme to enable payment by instalment (PBI).

Around the 19^th April, I ran my own unscientific poll on Twitter in an attempt to gauge what percentage of the dental population would struggle to pay their ARF. The result showed that 60% of the 215 respondents felt that they would struggle to pay the ARF this year, and 7% felt that they wouldn’t be able to pay it at all.

These figures were put directly to the GDC by a journalist, who said: “I would be grateful you would ask the GDC for a statement on its current position with regard to reducing the ARF while the UK dental profession is effectively closed down. Is the GDC reconsidering its position on maintaining the current ARF levels, by  recognising the difficulties faced by many dental professionals and reduce the ARF appropriately?  I understand the fee levels are set by the GDC and do not require legislative changes. The GDC must be aware of the financial hardship dental workers are facing and must also be aware of the financial concessions made by sympathetic  professional bodies like the BADT (which has suspended its membership fees) and the  professional indemnity organisations.”

Note the term ‘current position.’

In response, a GDC spokesman merely referred the reporter back to the blog written by Executive Director, Strategy, Stefan Czerniawski, which basically stated that the GDC would consider the possibility of an ‘emergency instalment scheme.’ Since the request for a statement on the GDC’s ‘current position’ was answered with a referral back to a statement made a few weeks earlier, it was naturally taken as confirmation that Mr Czerniawski’s comments were the GDC’s position at that time and a story to that effect was published briefly by GDPUK. There was then a polite but sniffy email to the reporter from the GDC press office saying that the GDC HADN’T confirmed there wouldn’t be a reduction in the ARF, despite the fact that it referred to the blog that had clearly said that for the moment there wouldn’t be any ARF changes. Obfuscation of the highest order.

So NOW we know that what GDPUK said, merely pre-empted Mr Czerniawski’s announcement/blog of 28^th May that said there would be no reduction in the ARF and no payment by instalment scheme which would have helped out thousands of hard-pushed furloughed registrants.

As an excuse, Mr Czerniawski used the ‘our hands are tied’ excuse, pointing to the GDC being a statutory body and was unable to stop its activities. He said “We are obliged to continue to maintain the register and protect the public.” Sure. Those fonts they use in the register need constant monitoring and the public needs protection from dentists who…er…hadn’t been working for weeks prior to the publication of his blog.

The strategic director bleated that a London office had to be shut down due to the discovery of a suspected case of COVID-19 and had to be closed down and deep-cleaned. After the lockdown order from the Government, many GDC staff were advised to work remotely, but praise was heaped on the GDC’s IT team. They apparently “Did a great job reconfiguring it and getting hold of the additional equipment needed to make it possible for that group to work from home.” They didn’t, of course, turn out, risking contraction of the coronavirus in Urgent Referral Centres. That was SURELY, a ‘great job.’

Just a reminder, Mr Czerniawski is still currently defending the GDC for not lowering the ARF or introducing an easy-payment scheme. “Some of our processes – particularly for registration – still involve paper documentation, so we had to develop safe ways of bringing small groups of staff into our Birmingham office to open and scan incoming post.” Valiant, in the face of almost insurmountable difficulties indeed. I’ll ask our postman next time I see him (from two metres away of course), how the Royal Mail copes with paper.

The blog then whinged on about the ‘biggest challenge’ to the GDC, which was how to hold fitness to practise hearings. The GDC was apparently flummoxed by the hearings taking place in a confined space and “participants normally have to travel to get there.” The blog went on to say that “From a standing start, we held our first fully virtual hearing on 26 March.” Hardly insurmountable odds, but you’d think the GDC team had just conquered Everest wearing only their M&S underpants and a carrying a mango smoothie.

He then went on to say “Members of staff had to find ways of coping with often imperfect working conditions, and of balancing work and caring responsibilities.” Yup, like we all do. Still doesn’t explain why they couldn’t introduce a payment scheme.

Mr Czerniawski admitted the number of new registrations in April and May has been running at a lower level than in the same months of 2019 – “but not dramatically lower.” He also conceded “There has been a sharp fall in the number of new fitness to practise concerns being reported.” The silver lining to that, as he saw it, was that disciplinary cases in progress could be expedited. That would doubtless be welcome news to the unfortunate registrants on the other end of those cases, but with fewer hotels and restaurants being required, it still doesn’t explain the GDC’s refusal to budge on fees or payment schemes. Keep going, Stefan!

The bit that made me laugh was this:

“Our Communications team has redoubled its efforts to make sure that we are clear as we can be about the impact of the pandemic on regulation and professional practice and that we can provide guidance about some of the new challenges which have arisen. And so on, across the whole of the GDC.”

The GDC provided naff-all guidance to the profession – the only advice being to follow the lead of the CDO’s. The GDC’s get-out being (I paraphrase), ‘It’s not our responsibility to give advice on clinical matters.’

The Strategy Executive Director then gave a great insight: “We are acutely conscious that our costs are ultimately met by the fees registrants are obliged to pay.” That was a great relief. I wondered if the GDC thought the Gum Fairy made a contribution to the coffers. He then said the GDC has to demonstrate value for money – again, what is this to do with introducing a payment by instalment scheme?

He went on to say that the GDC faces major uncertainties. Mr Czerniawski then made this incredible statement:

“But one of the big factors which drives our income is the number of dental professionals who register each year. This year, that is much more uncertain than normal, because we don’t know to what extent the impact of the pandemic will result in some dentists and dental care professionals choosing not to renew their registration.”

BINGO!

If the GDC is going to make it harder for registrants to pay their ARF (remember from above, 60% of registrants said they would struggle to pay this year), they are bound to lose dosh because registrants will lapse and flee to careers that aren’t overseen by incompetents with no grasp on economic realities.

Stefan then made the case that the GDC needs to create some financial ‘headroom’ in case our income drops. This was apparently the reason the GDC didn’t reduce the ARF. What will make your JAW drop is the fact that the GDC Council decided against introducing an emergency payment by instalment scheme because doing so would have introduced extra costs which would have to have been borne by dental professionals - as at 31 December 2018, the GDC’s reserves totalled £24.7M. Really?

What was appalling about that blog was the complete and utter lack of empathy with members of the dental profession. It was full of praise for the way the GDC itself had figured out how to work laptops from home and get a Zoom link working, but no recognition for those dental professionals putting their health at risk in URC’s by treating patients in pain.

Stefan closed his blog with “I know that will be of little comfort to those facing very real financial pressures as a result of the need to suspend so much dental activity. The best solution to these pressures – and the best way of providing much needed dental care for patients – is to start the process of resuming dental treatment.”

In other words, ‘get on with it’ so you can pay your fees!

Now that was a quite lengthy preamble to the revelation that came out this week – namely, that at the remote GCC Council meeting on 13^th May, the meeting at which the Council decided not to introduce an emergency payment scheme, the Council agreed to use the GDC’s staff payroll budget to top up staff furlough payments to 80% of salaries (where this was higher than then Government cap of £2,500).

Yes. Those people who couldn’t manage on the Government’s £2,500 per month had their salaries topped up. No such consideration was given to dental professionals in the form of an easy-payment scheme.

So, at a time where various professional bodies and indemnity organisations have reduced or suspended subscriptions to help out dental professionals, there is nothing from the GDC. For example, the British Association of Dental Therapists has suspended subscriptions for six months, and is even taking on new members and offering normal services, with no fee payable for six months.

I do question the judgement of the General Dental Council generally though and the latest errors fit in with this. The ARF debacle has been a particularly fine example of poor assessment of a situation. There have been a number of instances over the past year when there has been good cause to question the regulator’s competence.

Last year, for example, the GDC withheld significant evidence from a Professional Conduct Committee which mean a fraudulent dentist could be restored to the dental register, and it is still to address concerns raised by the British Association of Dental Therapists (BADT), The British Society of Dental Hygiene & Therapy (BSDHT) and the British Dental Association with regard to a patient safety issue.

The BADT and BSDHT became alarmed when it was discovered that the GDC is registering qualified dentists from overseas as dental therapists without testing their clinical practical skills as is required under the law for dentists who wish to register as dentists in the UK. The latter have to pass the Overseas Registration Examination or the LDS before they can register. Despite the fact that by the GDC’s own figures, the failure rate for the practical (manikin) test has been as high as 62%, it is allowing overseas dentists from outside the EU to register as dental therapists without an assessment of their ability to perform restorative procedures involving cutting tooth tissue.

The GDC’s approach to this concern has come across to many, as dismissive. The GDC was adamant that its paperwork assessment of applications from overseas dentists was ‘robust,’ but reluctantly agreed to meet with dental therapist representative bodies on February 18^th, following pressure from the BDA and indemnity organisations.   I am advised that copies of the minutes from that meeting, promised several times to the chair of the BADT, have still not been sent. The meeting took place weeks before lockdown began. Despite the proclamation from the GDC that it is working hard and still needs to protect patients during the shutdown, it’s clearly not doing so with such a glaring omission.

Right at the beginning of this piece, I mentioned questioning the veracity of the GDC. While looking into the dental therapist question, a reporter asked the GDC why it couldn’t make candidates take tests. The GDC implied it was bound by legislation, as it is by the need to impose the ORE examination on dentists. A spokesman said “Whilst we are able to seek changes to the Dentists Act 1984 by virtue of section 60, this process requires significant GDC and Parliamentary time and resource.” The truth, however is, the GDC CAN order tests of candidates under Section 36C of the Dentists Act, which says:

“(5) For the purpose of establishing whether a person has the requisite knowledge and skill for the purposes of subsection (4)(b), the Council…

(ii) may determine that a person must perform to the satisfaction of the Council in any test or assessment specified in the determination;

The reason I mention the therapist worry is that in the same week as the ARF debacle, the GDC announced the results of their Scope of Practice Review, an extensive look at the GDC’s scope of practice document following surveys and consultations with the public, dental professionals and stakeholders. They could apparently afford to engage an outside company, IFF Research, to carry out the review project.

The GDC said: “Whilst the SoP guidance document covers each type of dental professional and the kinds of tasks they could be expected to carry out or develop, the SoP guidance document was never intended to be an exhaustive list of what dental professionals could or could not do.” So, they’re sitting on the fence then, but Lord help you if you deviate from it.

But one of the points the dental therapists raised with the GDC is that overseas dentists will not be familiar with the scope of practice allowed in the UK – an incredibly important aspect of practice if you are to stay out of trouble. The GDC glosses over this by saying that it is up to the individual practitioner to ensure they know the scope of practice expected of them. Fat chance of that. Although the review document showed dental therapists and hygienists were the top users of the Scope of Practice document, only six in ten dentists use it. Not a good start when it’s overseas dentists who will be working in an area where they don’t really know what they can and can’t do. Dental therapists aren’t practising in every country in the world, so why would overseas dentists be fully aware of the things they can and can’t do, which is a point the BADT and BSDHT drove home?

So far, the GDC prefers to ignore the patient safety issue and the financial stress of registrants.

Still, they’ve got the Microsoft Team Viewer sorted.

Didn’t they do well?