Canmore Trust Wellbeing Conference: regulator’s speech
Theresa Thorp, Executive Director of Regulation at the GDC, speaking today at the Canmore Trust Wellbeing Conference, 8 November.
Introduction
Thank you very much and thank you for inviting me to your conference today. It has been a privilege to hear from the other speakers too, and learning more from the perspective of doctors, nurses and veterinarians. I am sure that there is value in inter-professional learning and this conference is an excellent opportunity to do so.
By way of introduction, I am Theresa Thorp, the Executive Director of Regulation in the General Dental Council, or GDC. The Regulation Directorate was established in September 2023, and it includes Registration, Fitness to Practise up to and including Case Examiner decisions, the Dental Professionals Hearings Service and the Dental Complaints Service.
I joined the GDC around one year ago, and my background is in law with a particular focus on working and delivering services which focus on the public interest and public protection.
I thought I would start by providing an overview of the GDC’s understanding of the pressures affecting dentistry, including the mental health of dental professionals and share what we have been and are doing to reduce the negative impact of regulation. We have much more to do.
You are welcome to ask questions in the Q&A panel or speak to me and my two GDC colleagues who are also here today – Stefan (the GDC’s Executive Director for Strategy) and Joanne (our Associate Director for Communications and Engagement).
Our understanding of the issues
Turning then to our understanding of the issues, by way of background and for the benefit of those here from other professions, the GDC regulates seven dental professions across the UK.
The number of dental professionals in the UK continues to grow. In 2019 we had just over 113,000 people registered. There are now over 120,000 registered dental professionals who can practise in the UK: that’s around 45,000 dentists and around 75,000 dental care professionals, this group includes dental nurses, dental hygienists and dental therapists, dental technicians, clinical dental technicians and orthodontic therapists.
We are aware of the acute pressures within the NHS and access, in particular, to NHS dental services – we recognise that this has an impact on the wellbeing of patients and dental professionals.
We know that the public report difficulties in booking appointments, in securing a dental practice to visit regularly, and having frequent cancellations, particularly affecting younger individuals, ethnic minorities, and urban residents. This inevitably creates pressure for the dental team too.
This summer we reported on research into the experiences of early career dental professionals. Although the majority felt well-prepared for practice when they first joined the register, dentists felt less prepared than dental nurses, hygienists and therapists, which is a worry.
And dental professionals who have been registered for more than four years reported feeling less happy and more anxious than those who have been registered for less than one year. Dentists, particularly, said that they were least happy and most anxious.
Overall, the dental sector and those who work in it are experiencing a lot of pressure.
We are committed to learning and building our understanding of the issues that affect everyone in the dental sector – that includes the people who work in it – and patients and the public who rely on their work. And we are also committed to understanding more about the impact of fitness to practise upon registrants, informants and witnesses.
The impact of fitness to practise
In 2022 we commissioned research, which was undertaken by Hull York Medical School, because we knew there were issues with fitness to practise which we needed to understand better so that we can address them more effectively.
Some of the key findings from our research into registrants’ experiences of fitness to practise proceedings were that while most of those who had participated in investigations or hearings perceived the outcome to be fair, they also told us that the process itself had negatively impacted their health, wellbeing, behaviour and practice.
We have also found that the ‘fear’ of regulation driven specifically by experiences and perceptions of FtP impacts on registrants’ decision-making and practice, in a way that we are told contributes to what is known as defensive practise.
Earlier this week we reported on dental professionals who died while fitness to practise concerns were investigated or remediated, between 2019 (twenty 19) and 2022 (twenty 22).
The report made clear that some individuals took their own life while fitness to practise concerns were being investigated or remediated.
Any death by suicide is a tragedy. The impact on the health and wellbeing of dental professionals during what we know can be a difficult and stressful process is of deep concern to us.
We recognise that the death of a dental professional that occurs while fitness to practise concerns are investigated or remediated is the death of a person who was still very much in their working life, leaving behind loved ones, friends and colleagues. These are people who have died too young, which is in itself deeply sad, and we offer our condolences to the family, friends and colleagues of those who have passed away while facing an investigation or hearing.
When a concern is raised and investigated, what we have also heard is that there’s a considerable impact on a dental professional’s family, friends and colleagues too, as well as on their own health. All of this compounds an already difficult situation.
Without a shadow of a doubt, regulatory proceedings are a cause of stress for many people, but also the cause of Fitness to Practise proceedings may itself be a challenging and complex set of factors. In addition to acknowledging that the GDC must do better, the GDC’s report serves as a call for everyone in the dental sector to reflect on the environment, systems and processes involved in being a dental professional.
Improving the experience of fitness to practise
Looking ahead, the GDC’s direction of travel is moving towards supporting positive professional practice and away from an enforcement culture. We want to help practitioners to avoid becoming subject to regulatory proceedings in the first place.
One way we do that is by setting and assuring the standards for undergraduate education, to ensure that people joining the register are safe. Another is that we provide guidance on the professional standards required throughout a dental professional’s career.
There is more we would like to do here to share learning from fitness to practise, and to work with stakeholders to help dental professionals to understand what is expected of them.
Ultimately within fitness to practise, we want to:
- Get faster, without compromising quality outcomes and
- Make sure the process is fair to witnesses and registrants
And this is to serve our overarching objective, which is to protect the public.
We are committed to making improvements, but delivering all the changes needed is likely to take some time. We are prioritising work with the aim of improving support for dental professionals during the process. We are also prioritising work to ensure we identify learning from any serious incidents that occur.
Some of the things that we have done include:
- We have amended our publications and disclosures policy to ensure that untested allegations presented to the Interim Orders Committee are not shared publicly before there has been a determination by a practice committee.
- Our caseworkers and managers in Fitness to Practise have received training from a specialist mental health charity, helping them identify those who may be in distress and signposting them to support earlier and more effectively. Independent panellists and their legal advisers have also received training to help them to support vulnerable individuals during hearings.
- Our standard communications have been revised, adopting a more empathetic tone, and better signposting.
- Our decisions now give additional weight to the impact of investigations on health and wellbeing when we consider requests for voluntary removal from the register.
- The Hearings Service has updated case management procedures to reduce administrative delays to the listing of hearings, to improve timeliness of proceedings.
- Hearings now include a Participant Support Officer to support individuals, particularly unrepresented dental professionals, throughout the proceedings and during the hearing when asked to do so.
Some of the activities we will be looking at in future include:
- Improving practical support for registrants, informants and witnesses, through Hearing Support Coordinators and applying measures for vulnerable witnesses in hearings.
- We will have a learning programme for senior leaders and all staff involved in FtP: so that we better understand the impact of regulatory processes on mental health and stress in those we regulate.
- There will be a rolling programme of mental health training for those dealing with fitness to practise cases, to refresh knowledge and keep mental health awareness in the forefront of our minds when dealing with cases.
- We are going to look at ways we can encourage remediation from an early stage, so that dental professionals are able to present evidence of remediation should a case reach the Case Examiner stage or beyond.
And we announced this week that we are making a permanent change to how we assess single patient clinical practice concerns. For a year we have piloted a new process where our clinical dental advisers make an early request for the patient records and give their opinion, as dental professionals, about the seriousness of the concern.
One of our casework managers then reviews the case, and if the treatment is of an appropriate standard, can close it with no further action.
During the pilot, the average time taken to complete the assessment stage was 13 weeks, which is much faster than the key performance measure to assess cases within, which is 30 weeks – so we are pleased to make this a permanent change.
Summary
I started by saying that inter-professional learning is an opportunity for us all here today. I hope that the information I have shared is useful; I have certainly benefitted from hearing what others have said and spoken about today, and I am sure I will continue to learn by listening this afternoon and tomorrow – and beyond this event.
We would like to work with stakeholders across regulation and dentistry to reflect on the environment, systems and processes involved in being a dental professional. It is clear that excessive pressure and expectations are harming some of the people in it, and it is essential that we all reflect regularly and consider how we must respond to that.
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