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Published: Monday, 29 October 2012 14:21

Written by Tony Jacobs

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Now that Professor Kevin O'Brien has completed a year in the Chair of the General Dental Council, he responded to an earlier request for an exclusive interview with GDPUK and its' membership. GDPUK members formed questions for the interview over the summer on the site's forum, and then these were supplemented by a face to face interview with Tony Jacobs near Kevin's home in Manchester.

At our meeting I was able to learn more about the man behind the title, and hear more about his early career in general dental practice in Manchester in the early 1980s. It turned out we knew many of the same colleagues, and over the years, must have been to the same BDA and other postgraduate meetings in Manchester.

I asked some further questions which are more topical, and started with the topic of the change in EU law relating to whitening of teeth, covered in detail on the GDPUK forum. Kevin will be speaking shortly to the All Party Parliamentary Group and he had spent the afternoon reading in detail about the subject. He made it absolutely clear that the GDC states that whitening of teeth is the practice of dentistry, and the public is protected by this distinction.

When we discussed the changes in tooth whitening regulations that are due to come into force on 31st October he pointed out that the GDC will not enforce the law around the directive as this is the role of Trading Standards Service. However, if the GDC receives a complaint about the strength of a bleaching agent used in tooth whitening, the complaint will be assessed on an individual basis and the registrant could face Fitness to Practise proceedings.

We also discussed a question that was not asked by GDPUK colleagues and this was concerned with the full addresses of registrants being published on the web by the GDC. I pointed out that the GMC do not do this, yet dental registrants feel forced to keep their registered address as their practice address due solely to this policy of the GDC, which may not always be convenient, yet using their home address may affect their actual personal security as well as their feelings about their safety.

He said registrants addresses used to be published in the printed form of the register, which were publicly available. In September 2006, the Council agree the printed version should be stopped and that the online register would contain an address. It should be noted that the GDC does not require a home address and is planning a review of this policy.

A few other topics relating to registration were next to be aired. When retiring, some dentists have complained they get no recognition of their years of service. He told me that he has been asked this several times and let me know that if a registrant informs the GDC that they are retiring they receive a letter acknowledging their retirement. This has been analysed, and is because they retire and simply do not renew their registration. So the message is don't just let it lapse.

This led me to ask about retired dentists and their position regarding registration. I pointed out that some retired dentists would like to remain on the register. He explained that this was not possible as the GDC is a regulator and the register is intended for the protection of the public. As a result, if a registrant has stopped practicing there is no provision or need for them to remain on the register.

Another specific group who have issues are dental nurses, who feel their annual fee should be less than that for hygienists and therapists, who have a greater earning potential. Kevin told me that the policy concerned with this issue is currently under review and will be discussed at the next Council meeting.

We then discussed other topics relating to the GDC. One of these was the CHRE enquiry into the allegations made against the GDC by the former Chair, Alison Lockyer. He told me that when the report is published he will carefully consider all the recommendations and take any necessary actions.

He also explained that he feels that there are going to be many changes to regulation over the next few years and he outlined the importance of the Law Commission recommendations on the future of regulation to the Government. He felt that one advantage of the potential changes is that this may enable regulators to make their own rules and become more agile. Currently, making changes is slow and frequently mean that the GDC has to seek changes in government legislation.

Finally, I asked him about whether he reads the GDPUK forum. He told me he had not been too aware of the site, but on the day of his election to the Chair, I had been able to publish the news in the site less than 10 minutes after the event. A colleague at the Council showed his mobile - there was the news on GDPUK. Kevin finds this site to be a useful barometer of the dental world, he views this and many other sites almost daily. He feels strongly that the Chair of the GDC must be informed and must listen to the profession and public. If the chair doesn't listen, they are not being as effective as they should be. Reading GDPUK is part of that listening.

Kevin also reaches out widely using Twitter, and invites dental colleagues to follow him @OBrienK57 .
 

I qualified from Manchester in 1979, and went straight into General Dental Practice in Middleton, North Manchester with a great principal Allan Kirsh. I learnt a lot from him. After two years, I then moved to a practice in South Manchester where I worked for another two years. At that point I decided that I wanted to be an orthodontist and took up a position as a House Officer at Manchester, then SHO and Registrar posts at Newcastle. I then got on the Manchester orthodontic programme, which was two years without pay! I had a young family at that point and I worked part-time in several practices (one for Lester Ellman) in the evenings and weekends.
While on the ortho programme I became interested in research and got a research fellowship from the Medical Research Council. We then went to the USA for a year and returned to Manchester where I was made Professor of Orthodontics in 1996. I was then made Dean of the School (2004) and then Associate Dean of the Faculty (with responsibility for Education of all healthcare professionals at Manchester).
I first got involved with the GDC when I was made chair of the Specialist Dental Education Board, then I was appointed to Council and elected Chair in 2011. I will be the last elected Chair of the GDC.

This is a question that I am commonly asked. The Chair of the Council should be appointed against a person specification that ensures that they can satisfy the demands of the job. As regulation has evolved over the last few years, these requirements have become more exacting. As a result, the Chair should have experience of public roles, have proven leadership experience of complex organisations, be a good public speaker, have the ability to process large amounts of information and understand financial management of large organisations.
Furthermore, the Chair and Council act as Governance body to the work of the GDC executive (staff). It is, therefore, possible for a lay person or a registrant to be appointed to the Chair providing they satisfy the criteria for the post. It is not essential for this person to be a dentist or have experience of general dental practice.

Chas Lister asked:

Should the GDC, in the interests of patient protection and its own independence, challenge HMG, aka the DH, and therefore de facto the Member CDOs, as to why they organise NHS dentistry the way they do when any other country can so easily demonstrate that effective and good dentistry is so different?

This is not our role. The GDC has a very clear role and that is to regulate individual dentists and dental care professionals. Nevertheless, we do contribute to consultations that influence the regulation of dentistry. We do not have role in the delivery of services.

Pyandath George asked:

Should they not have more clinical members to the ratio of lay members?

There is no need to have more clinical members than lay members. It is important to point out that the members of the Council are not representatives. The present Council was appointed to ensure that we have a balance of skills, for example, legal and financial experience within the Council members. This ensures that the Council can hold the Executive to account and ensure that their work is effectively scrutinised, planned and executed.

Under my leadership the Council has set priorities that are relevant to risk. As a result, the issue of titles was not felt to be an immediate priority. Resources are currently being utilised on greater priorities. The GDC’s Ethical Advertising guidance – which came into force in March – sets out our expectations about using titles and qualifications:

Andy Bates asked a couple of questions too:

Why is it so difficult for the GDC to prosecute NON-registrants such as illegal tooth whiteners?

We consider each complaint individually. It is important to note that we do not have powers of investigation. We gather evidence of the offence taking place; visiting witnesses, taking statements and carrying out site visits prior to making a decision regarding whether or not to prosecute. The case then goes through the Magistrates Court. We have had a number of successful prosecutions and have plans for more. We also provide information to the public on tooth whitening and this can be downloaded from our website. We have had a number of successes and have plans for further prosecutions. We have a patient information leaflet which can be ordered free of charge from our website and can be downloaded here.

And secondly:

How best can registrants help the GDC to bring such places [of illegal practice] to book? Just reporting it? Gathering evidence in some way? Who to lobby to make things easier for the GDC?

We have the greatest chance of success if we have willing patients who have suffered harm from illegal tooth whitening – if you have a patient willing to co-operate with the GDC, please get in touch.

The greatest issue is to persuade the public not to use these illegal tooth whiteners and highlight the risks involved if they do. Removing demand is as important as removing supply.

Tim Coates asked:

Is the GDC's role to protect dental patients against mistreatment by dentists only or do they also have a role in protecting patients against negative outcomes as a direct result of DoH policies?
Following on, is the GDC aware of the BIG LIE and how is it protecting patients from it? [There were several questions on this one topic.]

The GDC has and will continue to respond to Government consultations linked to the regulation of healthcare workers – it does not have a view on Government policies about access to healthcare or contracts.

Alix Furness had two questions:

What is being done for the 100 new graduates with no FD post? It has cost £250,000 to train each of them and now they can't work in the NHS and without experience will have difficulty getting a job in private practice. I'm having difficulty comprehending their predicament.
What about the high need patients having difficulty accessing treatment since 2006. I'm horrified at the devastated mouths being seen by my FDs. It seems to be a never ending stream of new patients who have been rejected elsewhere as uneconomic to treat?

This is workforce/employment issue and is not an area for which we have any responsibility. The GDC has and will continue to respond to Government consultations linked to the regulation of healthcare workers.

Jennifer Pinder asked a number of questions:

• Please explain how going down to 12 members all of whom are appointed will be of benefit to regulation?
• How can you get a decent spread of experience within the profession with such small numbers, say 6 lay members , 2 DCPs, 4 dentists?. How could such a small group make the major decisions on the professions regulation?
• I was elected in 1984 , when there were only 7 elected members , and it was felt that it needed to be 14 , and there was a special election for 7 extra members . The rest were dental school deans, plus the 4 CDOs , plus a dental 'auxiliary ' We are going backwards in this as well as everything else which the DH touches.

I feel that one of the biggest advantages of a reduction in size of the Council will be a streamlining of the decision-making process and making us more agile. There is also some scope for costs savings although these may not be so significant, depending on the adjustments that are necessary e.g. extra meetings, to make a smaller-sized Council work well. I also believe that the benefits to be achieved from moving to a smaller Council depend to a large extent on how the move is implemented. It is clear to me that we need to have some continuity of the Council membership and we need to avoid re-designing all our processes. One of my most important tasks over the next year is to ensure that we have a smooth transition to the new Council so that we do not jeopardise our important programme of the changes that we are making.

 
With regards your comments on expertise and experience:
While the Council will be smaller this does not mean that we will rely totally on the Council for expertise. We will seek the opinions of experts in the relevant fields and also consult widely.
We have many examples of where we have done this over the past two years, for example, the new pre-registration curricula, the CPD review, Direct Access and our new draft standards for dental professionals.
Finally, Dental professionals sit on FTP panels, Investigating Committees, education inspections, registration appeals and so on. We have also recently introduced early clinical input into our FTP process through a partnership with NCAS – the National Clinical Assessment Service.

Paul Isaacs asked:

Can the profession trust the GDC not to make a dogs breakfast out of revalidation?

Yes, I am content that good progress is being made in developing a process of revalidation that is “right touch” and focussed on risk. We have a programme of work underway to develop a scheme of revalidation for the purpose of providing assurance of ongoing fitness to practise. The detail of this can be found on our website in the revalidation programme initiation document.
A range of research, stakeholder engagement across the dental professions and industry and policy development is taking place as part of this and we have been clear that we want to hear from dental professionals about our emerging proposals via our This email address is being protected from spambots. You need JavaScript enabled to view it. email address and a range of other channels. We are committed to developing a proportionate, workable and cost-effective model of revalidation.
Our review of our mandatory requirements of continuing professional development is firmly underway and we are about to launch a public consultation on our proposals for the future. These will emphasise quality of CPD, directly linked to the needs of the individual dental professional and in support of practice in accordance with the GDC’s Standards. An enhanced approach to CPD will be a core step towards a fuller range of policies and procedures to enable the GDC to assure the public of the continuing assurance of fitness to practise of dental professionals.
We are pleased that the Council for Healthcare Regulatory Excellence (CHRE), that regulates the regulators, has acknowledged our CPD review in its most recent Annual Review of the GDC.

The GDC is regulated by the Council for Healthcare Regulatory Excellence (CHRE) our overall activity is reported on annually and they also take an in depth audit of our Fitness to Practice function. All our activities are scrutinised closely and if we fail in any area we are expected ta address any problems within a set time frame.

Andrew Adey asked:

Who will be the real regulators of dentistry? The GDC or the CQC? Who will take the lead in persecuting real (or perceived) breaches? One, the other, or BOTH?

The GDC has a clear role in the regulation of individual members of the dental team, while the CQC regulates service providers and premises. This maybe someone who is not a registrant. Any breaches of the standards of either regulator are dealt with by each body. However, the CQC can, and does, share information with the GDC about breaches that it detects that are relevant to the GDC. We also have input from the police, the Independent Safeguarding Authority and NHS Counter Fraud Service.

Philip Chambers asked:

Why does the GDC need expensive London premises when they could just convene in local conference facilities?

The Wimpole Street offices are rented to us on a “peppercorn rent” of £5,000. We have investigated moving out of London but this is not financially viable. The GDC is more than the Council and the organisation employs over 200 staff so we cannot simply convene in local conference facilities.

Sunder Dharmar posed the question:

Does registering dental nurses really help to regulate dentistry?

Yes, it is clear that we need to regulate the whole dental team.
The presence and activites of the regulator give confidence to the public. Through this, the public knows all parts of the profession are properly trained, regulated, and continuously educated. This is the same for dental nurses, whose role these days is ever more complex.

Arthur McGroarty said:

Given that evidence exists that the current CPD system is not having the desired effect of raising clinical standards, what plans does the GDC have to rectify this before the introduction of revalidation?
I cannot be alone in believing any Revalidation scheme founded on an ineffective CPD system will never be a good thing. Improving standards is a worthy and necessary goal for any profession, but surely we all have the responsibility to ensure that any scheme actually works for the benefit of patients before embaking on "Improvements".

We are currently working very hard on revalidation and an integral part of this is the CPD scheme. Our first focus is to re-evaluate the role and nature of CPD and we have researched and consulted widely on this important issue. We are determined to develop and effective CPD system that measures the outcome of CPD activity and not simply the inputs. We also intend that the effectiveness of CPD is measured as part of a personal development plan for registrants. This is obviously a complex area and we are consulting on the way forward in the next few months.

Audoen Healy asked many questions:

• Given the nature of the current pilot schemes, as an indication of the likely structure of future NHS care delivery, it seems apparent that there will be a far greater emphasis on the use of DCPs in delivering dental care. This, coupled with the stated intention of the GDC to look positively at introducing direct access to these DCPs, raises the question of what precisely the role of the dental surgeon will be in the future. How do you envisage dentists being employed in the future, and how do you envisage dental practices being funded?
• Will there be a significant and adequately rewarded role for dentists at all, or are our young undergraduates wasting tens of thousands of pounds and five years of their lives working towards a professional qualification which will lead nowhere?
• With the changes which are in the pipeline, will there be any change in the career structure of the profession? •Will there be properly recognised and adequately rewarded training pathways that will be inclusive of the whole profession, allowing those who have to work for a living in practice to take part? Or will we carry on with the situation we have at present, where there are a tiny number of hospital trained specialists in narrow fields, and the rest of the profession are treated as second class professionals, to be used as cheap labour by the DoH, or simply discarded as excess to requirements?
• Put simply, the question is . . .

Squeezed between the "specialists" and the DCPs, what precisely will be the role of the GDP?

These questions are concerned with workforce planning and delivery of care. This is not the role of the GDC.

Several have asked:

Please analyse the fall in numbers of DCPs registered in the last two summers?

We always see a drop in numbers of DCPs around the ARF period as DCPs either choose not to renew their registration or simply forget to pay the fee and have to go through our restoration process
The figures below from our registers show that DCP numbers are continuing to rise steadily since mandatory registration
Year No of DCPs

• Current figures (Sept 2012) 59,039
• Dec 2011 58,883
• Dec 2010 57,204
• Dec 2009 55,543
• Dec 2008 55,926

Stephen Day said:

I have been concerned for sometime at the dental care I see coming from local corporate practices. I use the words dental care meaning the whole patient management as well as the practical work carried out. I feel that there should be more attention paid to incoming foreign dentists with regards to how they practice and how the corporates allow them to practice. Perhaps the corporates should fund a mentoring system for their dentists overseen by the GDC.
Will the GDC point out to the profession that ‘pills no drills’ approach to treating irreversible pulpitis is not acceptable or necessary? Patients are just handed out antibiotics when they attend with toothache and are given the expectation that this will suffice.

This question is concerned with working to standards. If you see patients who are not being treated to the standards, then you can and should make a referral of the registrants involved to the GDC.

Stephen Shimberg asked:

We all welcome the appointment of a dentist as head of the GDC, but coming from a wholly academic background do you Professor O'Brien really appreciate the stresses of working in an NHS dental practice?

This question is concerned with expertise and suitability for the role as Chair and I have answered a similar question earlier. While I spent four years in full-time general dental practice many years ago, I do not pretend that I have hands on experience of current general practice. However, this is not relevant to my current role of governance of the organisation. There are other council members who have that experience.

Jim Page 12 years

See no evil, hear no evil

From GDC website: -

"Protecting patients

Our key purpose is to ensure patients are protected."

From the interview : -

" . . . - This is not our role. The GDC has a very clear role and that is to regulate individual dentists and dental care professionals." and " . . . - it does not have a view on Government policies about access to healthcare or contracts."

This confirms that the GDC is an agency of Government not an independent body.

If it were an independent body it would be prepared to hold the Department of Health to account for the 'Big Lie' Patients are not being protected either by the profession or the DoH or the GDC :roll:

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