Major reform is on the cards for dental regulation, here’s what we find promising and concerning about the proposed changes.
A major consultation by the Department of Health and Social Care (DHSC) has just closed. This was aimed at setting out a blueprint for the UK’s health regulators, and it looked at governance arrangements, registration, education/standards and fitness to practise.
The intention is to allow regulators more flexibility to adjust to a changing world, but what is this likely to mean for dentists and dentistry?
Steps in the right direction
On the plus side, the proposals seem to provide regulators like the General Dental Council (GDC) with new and more flexibility to develop rules and other guidance in line with today’s needs. Some of these include:
1. Impact assessments: Regulators will be required to assess the impact of proposed changes to their rules, processes and systems. We welcome this; morale in the profession is low and regulation is often cited as one of the main stress factors. Meaningful consultation and impact assessments are necessary, especially as the proposals also suggest that there will be less oversight of the regulators’ development of their rules.
2. Rules rather than legislation: Having the fundamental systems enshrined in legislation but giving the regulators the powers to define their processes in rules will hopefully make regulatory systems more agile as we go forward. This will apply to many of the processes within registration, education and fitness to practise. We do have some concerns about oversight, however.
3. Administrative removal: The GDC may be able to change their approach to ‘administrative removal’ for non-payment of fees or non-compliance with CPD requirements. Regulators might have an option to suspend rather than erase under certain circumstances. The detail of this will have to be worked on, and we will argue for a better and more proportionate approach to reduce the stress that this currently causes.
4. Assessment of overseas qualifications: The problems of the Overseas Registration Exam (ORE) have long been raised by us and others. However, the GDC will hopefully soon be able to improve its approach to the assessment of overseas qualifications and we expect another consultation to consider future processes for this very soon.
Areas of concern
However, it’s not all progress and plain sailing. We’ve also got significant concerns about some of the proposals, including:
1. Reduced inclusion of dentists: We’re concerned about the suggestions for Council/Board structure and constitution, which would take away the minimum 50% registrant share required on the Council. This seems to us a huge risk that there will be a lack of professional input in decision-making, affecting trust by the profession; and we reiterate our policy that the Chair should be a dentist.
2. Reduced support for ill registrants: We’re strongly opposed to the proposal that health will no longer be a separate fitness-to-practise ground and is instead being ‘roped in’ with lack of competence cases. This creates a significant risk that health cases will not be dealt with in a supportive way and is a really regressive step.
3. Case examiner powers: We’re concerned about the proposal that case examiners will have powers to suspend or erase a registrant through ‘accepted outcomes’. We do not believe that fairness to registrants can be guaranteed through this approach or that the expected time and cost savings would be achieved.
4. Tying the GDC’s hands on illegal practice: Proposals to change the way regulators would address illegal practice are also concerning. Dentistry currently has protection of function through having the ‘practice of dentistry’ and the ‘business of dentistry’ enshrined in our legislation. These are worth keeping together with the protection of titles. However, there is now a danger of this being reviewed. Combined with another proposal, namely that regulators would have to show ‘intent to deceive’ by anyone performing dentistry illegally, would really tie the GDC’s hands with moving prosecutions forward. In the interest of patient protection, we’re arguing strongly against the introduction of ‘intent’ and for the retention of the protection of function.
5. Third party involvement: We have not supported the possibility of delegating regulator functions to third parties as we believe they carry risks to stable processes and cost levels. We can see that many might regard this as a way of regulators working closer together and as a cost-saving exercise but are generally more concerned about the inherent risks.
6. Risk of combining regulators: We have reiterated our preference for a dental-specific regulator, as the consultation makes reference to reassessing the number of regulators through a separate view, without providing any further information. Clearly the GDC is not perfect, but if professional input is maintained and they work in partnership with the profession to improve things, they’re preferable to the alternative. We need a regulator with a leadership and a team that understands the many facets of dentistry. This understanding would likely be lost if another regulator took over the role of the GDC.
The new legislation will set out an overall system, and regulators can develop the rules within which they operate. As part of this, the GDC will need to consult the profession, improve transparency, and assess the impact of any changes they propose.
The GDC moving towards right-touch regulation is welcome, and its attempts to better engage with the professions must continue. However, the continued distrust many in our profession have of the regulator after the experiences of the last decade may still make this a bumpy road.
Now we wait for the government to work through the responses. The General Medical Council is likely to see its reform quickly. The GDC is also pressing for quicker change to its legislation, and we will likely support this, because we all want a regulator that understands dentistry and works well with the profession.
BDA Board Member
Chair BDA Education, Ethics and the Dental Team Working Group