Has common sense has broken out at the GDC?

In all the excitement surrounding the General Election and the arrival of a new government the GDC has been busy. It has slipped out several items on its website including its 2023 Annual Report and Accounts.   It has published new guidance papers and launched consultations as well as approving a new BDS course for international graduates.

GDC Annual Report and Accounts 2023

Deep in the weeds of the accounts section it emerges that the GDC’s former Chief Executive, who left the organisation suddenly and unexpectedly in November 2023, had his salary paid until the end of his formal notice period (to May 2024) along with a “loss of office” payment. The report states:-

 “Five employees (including the chief executive) left under voluntary exit terms during 2023. They received a compensation package of between £7,562 and £161,541”.

So, the former CEO’s package (he was the highest paid member of staff) adds up to the ARF paid by approximately 230 dentists or the ARF paid by 1300 Dental Nurses. Fortunately for the registrants paying the salaries, the former Chief Executive “historically elected to retain his salary below the market rate banded range for his role.”

Obviously, there is no further information about the reason why the former Chief Executive departed, and all HR matters must remain confidential. Natural curiosity leads me to wonder what on earth has gone on at the top of the GDC.  

It seems that under the new Chief Executive the GDC has been very busy. Here are a few thoughts on the GDC’s recent activity.

GDC Guidance on covert surveillance.

Unfortunately, the GDC has got a bad record when it comes to covert surveillance. Dental Protection fought for years to challenge the GDC into what it believed was an unlawful investigation into one of its members, eventually securing the payment of damages to that registrant.         

Dental regulator pays damages after unlawful under-guise operation (dentalprotection.org) and https://www.gdpuk.com/news/latest-news/4118-cost-of-under-guise-investigations-by-the-gdc-ico-decides-in-favour-of-the-regulator

So, its about time that the GDC came clean and told the public how it manages these undercover investigations. Here is their new guidance Covert surveillance in practice: Guidance on conducting surveillance in fitness to practise and illegal practice investigations (gdc-uk.org) In the guidance the GDC recognises that registrants (and the public) have rights that must be protected. It also recognises that the law allows covert surveillance in a small number of circumstances under the Regulation of Investigatory Powers Act 2000 (RIPA) 

• for the purpose of preventing or detecting crime or of preventing disorder;
• in the interests of public safety;
• for the purpose of protecting public health

The problem with this guidance is that the GDC does not share the level of authority within the management structure that can approve a request for covert surveillance. In the interests of consistency and proportionality this ought to be at Director level, given the rarity of such a request and the balancing exercise that needs to be carried out, particularly as the GDC is not a recognised authority under RIPA.

Interim Order Hearing Determinations

Interim Orders hearings are typically called within a couple of weeks of a concern being raised at the GDC, when the GDC needs to decide whether or not to take any interim steps to protect the public whilst the full facts of a concern are investigated. These hearings are in essence a risk assessment procedure where the facts alleged are not tested in any way. Sadly, a practitioner took their own life shortly after an IOC hearing leading to HM Coroner writing a formal letter to prevent future deaths to the GDC on 15.8.2023.

In July the GDC announced that it has changed its policy concerning publication of the details alleged against a dental professional. Change of policy on Interim Orders Committee outcomes (gdc-uk.org). Further, the GDC has removed any ongoing IOC case determinations from its website, leaving the decision (suspension/conditions) visible.

Oddly the GDC makes no reference to HM Coroner’s letter. More information can be found here GDPUK.com - Eleven Months Later, GDC Act On Coroner's Serious Concerns

 Specialist List Applications

The GDC is consulting on the application process for dentists to enter the specialist lists. The consultation is now live and is closing on 12^th September 2024 GDC launches public consultation on revamped specialist list application routes (gdc-uk.org)

The Specialist lists were introduced under The European Primary and Specialist Dental Qualifications Regulations 1998 with the most recent version of the rules came in in 2008 under The European Qualifications (Health and Social Care Professions) Regulations 2007.

Its important that dentists that have followed an unconventional training pathway are not excluded by this process. The real solution is to expand the number of NHS training pathways, perhaps allowing part time training that recognises the experience gained in practice during the training pathway.

GDC Record keeping advice

The GDC has just published some guidance as to what their in-house clinical advisers look for in clinical records when a Fitness to practice investigation is being considered Dental record keeping: what is professional, reasonable and in the interest of patients? (gdc-uk.org). If this document is the start of a conversation, it is to be welcomed because in the past the clinical advisers have held dental professionals to a very high standard of record keeping, even when the records concerned do not refer directly to the complaint or concern being looked into. It is very easy for a dental professional’s record keeping to fall “far below” a gold standard. Some might argue that Standard 4.1: “You must make and keep contemporaneous, complete and accurate patient records” sets the standard so high that there is no wiggle room at all. In an FTP case an allegation of a breach in this standard needs to be considered compared to what an ordinary group of dental professionals means by “complete “. If the GDC clinical advisers are working to one interpretation, the gold standard, and the dental professionals to the ordinary standard, then many cases that could otherwise be closed will still have to go to Case Examiners. Its just as well that the FCGP and now CGDent take a more sensible view as set out in the latest edition of “Clinical Examination and Record Keeping” published in 2016. It recognises that the aspirational standard is what should be aimed for, but accepts the basic standard is what  is sufficient for safe patient care.

The challenge for dental professionals under investigation is to demonstrate what they did and why they did it in clinical cases. If there is sufficient evidence in the records for a third party reader to understand that without the need for further information, then the records are likely to be satisfactory, but perhaps not excellent.

 

GDC Guidance on Voluntary Removal (VR) requests.

A registrant can decide to come off the register at any time. A formal request must be made that includes a statement that the registrant has ceased to practice dentistry and seeks removal from the register will immediate effect, rather than waiting until the ARF is due in July or December. GDC updates guidance on voluntary removal applications (gdc-uk.org)

The GDC seems to be under the impression that registrants apply for VR so that they can avoid a Fitness to Practise investigation. They cannot. Each application is checked to see if there is an open FTP case. The registrant may not yet know about the investigation because it is at an early stage. Where a case is open and at an early stage it is unlikely that GDC will approve a request for VR because it does not have enough information to determine the level of seriousness. Once the GDC is satisfied that the allegations represent a low level of seriousness it will approve VR. It is very frightened that it will be accused of not meeting its statutory obligations to protect the public by “letting dental professionals off”

GDC approves BDSi  at UCLan

The GDC has approved a shorted BDS course at UCLan for international dentists that allows entry at year 4 of the BDS course. The course is a route to entry onto the Register as an alternative to the ORE. The main difference is that the BDSi has a significant practical element, both in the skills lab and in practice, whereas the ORE is entirely exam based. There will be of the order of 30 places per year, so it will take a long time to address the access issues if this is the only new route opening.

And finally…

Credit where credit is due to the GDC. Most of these changes are a good thing. Clarity and transparency should help reduce the cynicism and disrespect the dental profession has for the GDC.

What’s still to come? The GDC Scope of Practice Guidance must be due shortly. Given the NHS push for the development of the skill mix within dental teams and the importance of making sure the right team members do the most appropriate tasks we shouldn’t have to wait long.

Finally, given that the GDC has just launched a consultation of guidance for GDC FTP Practice Committees which is very detailed Consultations and responses (gdc-uk.org) it looks like the GDC doesn’t expect to see any changes to dental regulation anytime soon.

  

    

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