A review of dental over-regulation seems to herald a new system of self-regulation which will impose additional burdens on the practitioner
Currently dentists and dental practices are regulated by three main bodies. The General Dental Council has jurisdiction over fitness to practise issues, the Care Quality Commission has oversight of the safety and quality of dental practices and the National Health Service has the power to investigate whether services are being delivered according to the relevant regulations.
It is unsurprising therefore that dentists feel over-regulated. This tripartite system of regulation means that a practitioner may find himself facing multiple investigations arising out of the same facts and allegations.
In September 2014 the Regulation of Dental Services Programme Board (“RDSPB”) – a body comprised of the Care Quality Commission, the Department of Health, the General Dental Council and NHS England – was established to review this issue. This was the first time that national organisations came together to review dental regulation. The process of review was undertaken over a 12-month period and its findings were set out in the “The Future of Dental Service Regulation” (“the Report”) published on the 10th December 2015.
The Report identified seven specific areas of importance:
- Defining respective roles and responsibilities in the dental system;
- Defining a clear model for the regulatory system;
- Improving data, information and intelligence sharing;
- Defining a system with a recognized role for complaints handling;
- Developing a proactive approach to keeping patients informed and involved;
- Defining the role of quality improvement;
- Implementing a communications programme to providers.
This article will deal with the first four of these. In doing so, it would appear that in fact the implementation of the proposed changes is more likely to increase the burden on practitioners rather than achieving the stated aim of making regulation less cumbersome.
Roles and Responsibilities of the regulators
The Report highlights the fact each of the current regulatory bodies does not have identifiable roles and responsibilities. The Report states that a joint working protocol should be developed and monitored between the GDC, NHS England and the CQC, with clear thresholds so that everybody involved understands their relative functions. The Report states that this will be done by October 2016.
In coming to this conclusion, the RDSPB found that the current lack of clarity leads to duplication and confusion. People working in the system found it difficult to understand the regulatory processes of the other relevant bodies. This was cited as a reason for more cases not being resolved at local level or dealt with collectively in a proportionate manner.
Joined up Model for regulation of dental services
The Report makes clear a coherent system of dental regulation should ensure strategic, national alignment with local partnerships. This is to be achieved by next month, April 2016. This model should also outline a clear framework for risk assessment / methodology which should be in place by April 2017.
Currently research indicates people are unclear which organization deals with which type of issues. There is a lack of consistency about whether each regulatory body should deal with an issue on its own or refer it to one of the other bodies, or deal with it jointly. This had led to duplication and is confusing for practitioners.
Improved Data and Intelligence
The Report identifies that data and information sharing including proactive planning of inspection programmes and share learning should be in place. This will be done by next month, April 2016. Furthermore by October 2017, data sharing agreements should be established with a longer-term plan to build a central source of information for the repository of data and data sharing.
The research found that organisations have difficulties in accessing data from other bodies. For a regulatory system to focus effectively on high risk practices and practitioners, it clearly needs accurate and reliable data and information which can be easily accessed by case workers, inspectors and others involved across the regulatory process.
It is suggested that organisations could pool data and analytical resources to create a centralized source of information. Gaps in information about private practices could be addressed by more use of established dental accreditation schemes combined with a system of self-reporting. Indeed, the Report also states that there is scope for a system of self-reporting which meets the needs of both the CQC and NHS England, thus reducing the existing separate data requests.
The Report sets out that by October 2016 there will be a defined system for handling complaints with recognized roles and supported by clear signposting processes.
The Report identifies the manner in which complaints are currently handled as an area of weakness. Patients are confused about how to make a complaint. In addition, once complaints enter the system organisations may simultaneously deal with the same issue.
Furthermore, stakeholders stated that greater emphasis should be placed on arbitration and achieving a good outcome for the patient / complainant which is not necessarily achieved through the fitness to practise procedures.
The RDSPB concluded that there is a compelling case for change and has committed itself to working with the regulatory bodies to effect change over the next 12-18 months. The RDSPB has identified the questions it will be seeking to address as follows:
- Should there be fundamental change to professional and system regulation?
- Is there a need to change legislation to tackle over regulation?
- Is regulation the most effective use of resources?
- Should there be a single set of standards?
- What is the role of self-regulation and performance management?
- What is the level of risk?
What does the future hold?
In considering the RDSPB’s conclusions it is apparent that it is likely that any changes made to current regulation will involve greater self-regulation. This is clear from suggestions made with regard to replacing inspections with self -regulation and the reliance on self-reporting to capture data. Whilst at fist blush, this may seem to be a step away from current aggressive and over burdensome regulation careful reflection makes it plain that quite the opposite is true. Self-regulation must not be confused with a lowering of the regulatory compliance requirements. What it does is shift the burden from the regulator to the practitioner to ensure his/her own compliance.
Furthermore it is self evident that in order to ensure compliance with self-regulation a whole plethora of new rules and legislation will have to be enacted including new sanctions for failure to complete the self-regulation requirements.
In my opinion, self-regulation will inevitably lead to increased paperwork, time consuming form filling and record keeping. No doubt it will also be accompanied by heavy sanctions and penalties for a failure to comply either at all or within defined deadlines.