A toxic culture within the regulator - The NMC is in deep trouble. How does the GDC compare?

Anyone that has worked in a difficult environment where fear of raising concerns, bullying and where there is a blame culture will have enormous respect for the whistleblower that took on the Nursing and Midwifery Council for their failure to address these concerns. 

The former Chief Prosecutor in the North West has just published a report of his investigation of the concerns raised by a whistleblower within the NMC. The Nursing and Midwifery Council - Independent Culture Review (nmc.org.uk) The investigation team achieved significant levels of engagement with NMC employees. There has been a background of concerns about the way NMC has operated following the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry - GOV.UK (www.gov.uk) and the The Report of the Morecambe Bay Investigation (publishing.service.gov.uk) The Professional Standards Authority has been a longstanding critic of the way the NMC has operated.

The Afzal report makes very grim reading for any organisation that is struggling to run a modern, diverse and inclusive team, because employees in that situation seem to be understandably reluctant to raise concerns.  The Afzal report reveals examples of overt racism, cronyism, bullying and a dysfunctional management team that has led to very poor decision making within the fitness to practise team that has had a direct impact on patient safety. Unhappy team members would prefer to leave rather than raise concerns because they had no confidence the management would address the issues without detriment to them.  One senior leader in the NMC described the culture as “a low-trust environment characterised by suspicion, fear, blame resistance and silos”

The NMC registers more than 750000 nurses and midwives and has an FTP caseload of approximately 5500 with about 700 being open for more than 3 years. Contrast with the GDC that has of the order of 120000 registrants, has of the order of 3000 open cases and the median time to closure after a hearing is 2.5 years, which means that there are many cases that have been open far longer than that. Both organisations failed to meet the Professional Standards Authority Standard for timeliness in managing FTP cases. The GDC was so bad that after several warnings PSA referred the issue to the Secretary of State, who did nothing about it.

Can we compare the GDC to the lamentable performance of the management of NMC? Are similar problems happening within the GDC’s teams?

There have been two formal investigations into the GDC, one by the PSA at the request of the Secretary of State following Alison Lockyer’s resignation as Chair of the GDC Council Concerns raised by the former Chair of the General Dental Council | PSA (professionalstandards.org.uk) and the second of its own volition by the PSA following a whistleblower’s concerns investigation-report---general-dental-council.pdf (professionalstandards.org.uk). In both of these cases there was a reluctance on the part of the GDC to accept that any wrongdoing had taken place, indeed, as with the NMC case the whistleblower had to deal with a flat refusal to accept their concerns, but eventually the PSA took on the case. The PSA investigations were carried out largely on the papers, without the level of interviews that Mr Afzal’s team has done. Inevitably this makes it unlikely that the personal views of team members at all levels within the GDC will have been considered. Whilst both these reports were critical of the GDC, little changed in their aftermath. It is also fair to say that the incidents concerned happened between 10 and 15 years ago.

Where can we go to see if the GDC has a similar problem as the NMC at the present time or in recent history? One place to look is  on “Glassdoor” General Dental Council Reviews: What Is It Like to Work At General Dental Council? | Glassdoor where current and former employees can leave reviews of their employer.

Here is an example that suggests the GDC seems to be suffering in the same way as NMC from 2023

“It has been very disappointing working for the GDC. I expected high standards from a regulator, but the GDC have fell short on many basic employer standards. New employees do not have a structured induction with any follow up. The GDC hire managers who do not have the experience or competency to manage a team. The existing managers babysitting new managers and micro manage teams that are not their own and misinform teams which causes confusion and delays in work processes. Bullying is a common theme throughout the teams, with managers and team members openly making prejudice and sexist remarks. When reported, this behaviour goes unnoticed and nothing is done about it. Highly skilled and experience team members get overlooked and not given the chance to move up to a higher position.”

Here is a comment from 2020

“Extremely toxic behaviours from management, unable to feel empowered to make your own decisions. Team members are pitted against each other. Newcomers who do not fit into the 'clique' are made to feel like outsiders and are driven out.”

This comment comes from 2019

“No scope for promotion and toxic atmosphere. Questionable all round”

Finally, this is another admittedly from 2018 that tends to confirm what registrants feared at that time.

“To work here you need no moral compass. There is an obsession to damage dentists. Very uncomfortable with the tactics of lying, coercing witnesses and fabricating evidence in order to "get results". I'm still not over the trauma of what I saw.”

The real question for the GDC Council members arising from the NMC report is the effectiveness of the oversight that the Council has over the performance of the executive team. The GDC states that a “large part of the Council's role is to scrutinise the work of the organisation, set a positive tone and culture, seek assurance over the way in which the organisation is run and hold the Executive to account.”  If all the information given to the non-executive directors is filtered by the executive team, how can effective scrutiny take place?

The ongoing and recent public inquiries into the Covid pandemic, the Post Office, the Infected Blood scandal have shown the difficulties that arise when scrutiny of performance and decision making is not carried out properly.

In the light of the concerns arising from the NMC report the GDC should carry out an urgent independent review of its own internal performance to try and understand what the root causes of the delays in case progression are.

It is time for the non-executive members of the General Dental Council to step forward, be brave and start getting answers to difficult questions. How much longer can the non-executive directors tolerate the dismal failure of the FTP team to get to grips the delays in case progression? At what point do the non-executives become concerned about the PSA’s reports where the PSA referred the GDC to the Secretary of State?

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