Regulatory reform: an opportunity to modernise and enhance public protection in dentistry

The Government consultation period for proposals to update healthcare professional regulation is drawing to a close. With under a week remaining to submit responses, our Head of Public Policy, Osama Ammar, explores some of the opportunities and challenges presented for dentistry.  

Since the launch of the consultation we have been examining the proposals, thinking about what they might mean for the future of dental professional regulation, and talking to our stakeholders about things we need to take into account in formulating our response. 

We’ve already talked about what the proposals may mean for how the GDC is governed, how we may consider concerns, and set standards and quality assure dental education. 

We welcome much of what is being proposed, but there are some areas where we think more thought is needed. 

The consultation from the Department of Health and Social Care (DHSC), Regulating healthcare professionals, protection the public, has 418 paragraphs and poses 70 questions. This can make it difficult to see the wood from the trees. So, before the consultation closes next week, we wanted to take a step back and reflect on what we think the overall reforms need to achieve to ensure our regulatory framework supports the provision of safe, effective oral healthcare.  

Has the balance between accountability and flexibility been struck? 

The proposals look to release healthcare regulators from some of the bureaucracy surrounding amendments to the legislation under which we operate. That means the ability to change our legislation, free from some of the currently required parliamentary approvals.  

Balancing this new flexibility are proposals for more accountability; including extending powers to intervene where a regulator has failed to carry out its statutory functions to cover the GDC. Greater accountability is also proposed through enhanced transparency and a duty to assess the proportionality of any future changes to rules and procedures, which would need to include an assessment of the cost to the public and patients, professionals and relevant stakeholders. 

But there is a risk that some of the rigidity of the current system gets carried forward into the new one. The proposed three-stage process for investigating fitness to practise concerns has some real attractions. But the proposals provide a single model for all healthcare regulators that could be difficult to adjust for issues specific to particular groups of professionals and their patients, or for new models of healthcare delivery that cannot be predicted. In essence, we believe that more flexibility is needed to ensure the new regulatory framework is future-proofed.   

Are we overlooking an opportunity to modernise and enhance public protection? 

One area that we know is distinctive to dental regulation are the powers to restrict the practice and/or business of dentistry to registered dental professionals. We use these powers to protect members of the public from harm or potential harm from illegal dental practice.  

The definitions of both the ‘practice of dentistry’ and ‘business of dentistry’ are helpful, but really do need updating. We are currently using definitions that are 40 years old, pre-dating the internet and new business and community interest structures. It is vital that these definitions are now revised, and regulatory reform provides the opportunity to do just that. Reform here is essential if public safety is to remain paramount and responsiveness to change is to be secured.  

Linked to powers to restrict the practice of dentistry are the provisions for the protection of a professional title. Professional titles give assurance to the public that those using the title are trained, competent and safe to practise.  

The proposals suggest that all regulators should have the same set of offences relating to the misuse of titles to ensure that all healthcare professionals have the same level of protection. For dentistry, this would mean the offence of illegal practice would need to include some intent to deceive others; not something required under the current strict liability offence. 

We do not think this change is necessary and may weaken public protection as offences become more difficult to prosecute. This is an example of where features of dentistry may have been overlooked in the drive for consistency.  

Are there opportunities to think differently about our registers? 

The proposals for the way registers will operate largely reflect the current position, but there are some proposals that may mean things could be done differently in future.  

The GDC technically holds two registers, one for dentists and one for dental care professionals. The dentist register also has 13 separate specialists lists. The consultation proposes a single register, which can then be subdivided by the regulator, and the ability to add annotations to that register. These annotations could be used to show additional skills e.g. prescribing, or to show that a healthcare professional is working under an enhanced or restricted scope of practice.  

It is a little early to say how these proposals could benefit dental patients or professionals without further details or discussions, but there will be opportunities to do things differently. We have started thinking about how these proposals combine with those for more flexibility in quality assurance of education and training, particularly specialties, and how annotations could support drawing more on the skills and qualifications of the whole dental team.  

What happens next? 

Change will not come quickly. Healthcare professional reform will be done consecutively, with the General Medical Council first in the queue. Our time will come, but the sequence or timetable is not yet known.  

When reform does come our way, it will be with a consultation on draft legislation for the GDC. We will be continuing to raise the need for regulatory reform as a matter of priority, and particularly ahead of any reorganisation or restructuring of professional regulators. 

If you’ve not already submitted a response to the consultation, we would like to encourage you to do so. The DHSC submission deadline for responses is 16 June.