GDC chair’s speech asks what do we need as patients?

15 November 2023

Toby Harris, the GDC chair, addressed the dental leadership network at its latest event on November 14, 2023. The theme of the event was ‘The system from the perspective of patients and the public’, where he said:

Toby Harris, the GDC chair, addressed the dental leadership network at its latest event on November 14, 2023. The theme of the event was ‘The system from the perspective of patients and the public’, where he said:

“Good afternoon. I am particularly pleased to be here today and to have had an opportunity to hear the discussions this morning.

“Today’s theme is very close to my heart – especially as I have spent a large part of my life representing the interests of the public and service users.

“Patients and the public are at the heart of what you do and - as you know - the primary purpose of the GDC is to protect the public and maintain public confidence in the dental professionals that we regulate.

“And we can only be a truly effective regulator if we are able to develop and maintain strong, effective collaborative working relationships with everyone here today.

“So that is why I put a particular importance on the regular meetings that the GDC team has with our different and diverse stakeholders across the profession, including the governments and NHS across the four nations, the CDO’s, the professional associations, the education providers, and other groups such as indemnifiers, patient advocacy groups and the charities that support dental professionals.

“And it’s important that we can all gather at events like this today to discuss the significant issues, challenges and opportunities facing the sector. But as we have heard already today, it’s not just about improving access - there are many other things we can all do as dental leaders to help patients and the public navigate the system so that they can access the treatments and services they need and deserve.

“Of course, I’ve been a patient and member of the public for much longer than I’ve been chair of the GDC. And certainly, my experience for twelve years as director of the Association of Community Health Councils was that it is really very difficult for those responsible for a service to know what it actually feels like to use that service and as a patient you may often feel at a disadvantage. There is a power imbalance – the professional is in charge. You may be in pain. In any event, once you are in the chair, you feel vulnerable.

“This was brought home to me again seven years ago or so when I was visiting my then dentist - in the chair - cranked up - lying back - mouth open – my dentist leaning over me – pointy thing poised. And this is the moment she says, ‘So this referendum, what do you think about it?’

“So, what do we need as patients? It is probably not to engage in a political discussion precisely at that moment.

“However, the important thing for the public is that the professionals they encounter are skilled and qualified to make appropriate judgments about treatment and care, work to appropriate standards, and that if something goes wrong, patients have recourse to a proper system that addresses what went wrong and resolves it for the future.

“The basics are simple: the patient, first of all, needs to be able to find a dentist and get an appointment. And the patient needs to have confidence in the dental professional who is treating them, to know that they will be treated as an individual, that the different treatment options will be explained – along with the costs - and what to expect with the treatment.

“But everyone in this room is a member of the public. And, if you’ve ever had the misfortune to suffer ill health or complex or long-term health issues, you might also know how difficult it can be to navigate your way through the various agencies who provide healthcare services. Or if you’ve ever had to do this on behalf of someone else, you’ll have seen their experience first-hand too.

“However, we also know the pressure that the systems of dentistry are under – and the GDC’s own research on the public’s views and experiences of dentistry support this, as Rachel Lopata from Community Research talked us through earlier.

“But I wanted to pick out a few highlights from my perspective too.

“Our research showed that people continue to experience serious issues in accessing dental care, particularly on the NHS, and that the proportion of patients going to private providers has risen.

“The research also showed that around a quarter of patients are making an active choice to reduce their dental care due to concerns over costs. Those who are struggling with the cost of living may be more likely to visit a dental professional only when they are experiencing a problem or know they need treatment, rather than for check-ups and prevention. These are troubling findings, and we will continue to monitor this through future research.

“That said, on a more positive note, the research also showed that there has been a significant increase in the number of people seeing a dental professional, compared with 2021 - although that of course was during the pandemic.

“And encouragingly in terms of public confidence, two-thirds of people told us they were confident in the quality of dental services available, with most people satisfied with the dental care they had received.

“The GDC has its part to play to ensure patients and the public can navigate the system better – after all, our core purpose is patient safety and public confidence.

“And along with all the other health regulators, we are required – by statute - to:

  • Promote, protect and maintain the health, safety and well-being of the public
  • Promote and maintain public confidence in the professions we regulate; and
  • Promote and maintain proper professional standards and conduct for members of those professions.

“But what does that really mean in practical terms? And how does this really help patients and the public.

“At its most basic, the answer to that is simple. We keep the register of dental professionals. Being on that register is a demonstration of professional status, it is what tells patients that they can be confident in the care they receive and is what enables those on the register clearly and simply to demonstrate their professional status. In other words, it’s what allows the relationship between patients and dental professionals to start from a foundation of trust.

“Of course, we do much than that – but everything we do is built on that foundation. And everything we do has as its ultimate purpose the protection of the public.

“So, it matters that we engage with patients and the public and the organisations which represent them and that it is a vital element of our work to understand and to engage with. Let me give you a few examples of how we do that.

“We work with organisations such as Community Research to test proposals and new services with the public. We did that when we launched the Dental Professionals Hearings Service last year, to ensure the new service made sense to them and they understood its purpose.

“We also engaged with the public as part of our work in developing the proposals for the new Scope of Practice, in particular, did what we propose need to be developed in a patient-facing version.

“And just last week, we published ‘The Safe Practitioner: A framework of behaviours and outcomes for dental professional education’, which will replace ‘Preparing for Practice’.

“This is part of a process, in collaboration with the professions, to ensure that new dental professionals have all the skills they need when they join our register. The key changes in the new framework include the introduction of the concept of behaviours and attitudes, with additional content added to strengthen learning in specific areas that are becoming more important to patients, including equality, diversity and inclusion, cultural competence, mental health and wellbeing, sustainability and complaints handling.

“We’re also about to start a review of the Standards of Education, as the current standards have been in place since 2015, to ensure that they are up to date and reflect the changing landscape, including population and technological developments.

“However, we also provide some information directly to patients and the public.

“An example of this is material about tooth whitening and the importance of ensuring that it is carried out by a dental professional. And our engagement work sometimes takes us to some unexpected places – we recently worked with the National Hair and Beauty Federation on an article for their magazine Salon Focus providing information about the legalities of tooth whitening.

“We have also created important information specifically for patients to help them make decisions about whether remote orthodontics, or in patient-speak aligners and braces sent directly to your home, are right and safe for them.

“We also produce a guide to help patients understand the risks of going abroad for dental treatment, so they can make a more informed decision, including some of the questions they may want to ask.

“And in partnership with around thirty other organisations, we produced a leaflet that sets out what patients can expect from their dental team if they want to provide feedback or raise an issue about the dental treatment they have received, which I know many practices are displaying for patients in their dental surgeries.

“And finally, we have the Dental Complaints Service, which helps private patients and dental professionals settle complaints about private dental care – with the valuable side effect of diverting some cases that are better handled in other ways away from the fitness to practise process.

“These are all important. But the reality is that the GDC has very little direct relationship with patients and the public. Most of our contacts are with dental professionals, and it is through these that the professional standards of oral healthcare are maintained and ensured, and patient safety and public confidence in dental services are maintained.

“However, the GDC is just one part of a complex system and I suspect there are other organisations in this room who have a strong interest in patients and the public but, like us, limited direct interaction.

“So, my challenge to everyone here today is to ask what can you as a dental leader do, and what can we collectively do as the Dental Leadership Network, directly or indirectly, to really make a positive difference for patients and the public?

“Understanding the workforce is a key part of providing oral healthcare and the recent work patterns survey we have launched is an example of something the GDC is doing that should have a wider benefit to patients and the public.

“This additional work pattern data, which will be provided on a voluntary basis, will help to build on the very limited workforce data that currently exists.

“And the GDC is able to address this challenge as we are in the unique position of having the most complete data available, a list of everyone who is registered to practise dentistry, across all the professions and the four nations of the UK. However, as you all know, the registration data currently held only tells us who is registered with the GDC and does not provide details of what they are doing.

“Capturing this additional information will help us and others to better understand:

  • Where dental professionals are working.
  • What they are doing, and if they are working chairside.
  • The number of hours they are working.
  • Whether they are working in NHS or private practice.
  • How the way dental professionals are working changes over time.

“But the GDC can’t deliver this in isolation, and I’ve been delighted that what we are doing in this respect has attracted widespread support from stakeholders and the encouragement that is being given to dental professionals to complete these additional questions.

“This is a valuable opportunity to help the sector to understand the workforce better. This should inform discussions and support better decision-making to improve access to services in the future - and help bring about the changes the profession and patients want and need.

“And this is why events like today are so important. There’s no doubt that the systems we all work in are complex, and the Dental Leadership Network has already looked at those systems from the perspective of dental professionals. But today’s event goes further and does so from the perspective of patients and the public.

“It has provided an opportunity for dental leaders to hear from patient representative groups as well as research and insight into the experiences of oral healthcare.

“Of course, patients and the public have been part of the conversation in previous events. However, it is right that the Dental Leadership Network should be focusing on this today and hear from wider stakeholders.

“One of the GDC’s statutory objectives is to protect, promote and maintain the health, safety and well-being of the public.

“And that is an objective that all of us here share. We all want patients to receive the safe and effective oral health care they need. We are all united on that.

“We may have different perspectives of what to change or what to prioritise to achieve it – but the important thing is that we individually and collectively place patient care at the centre of all that we do.

“Everyone in this room has a vital role in delivering safe and effective oral healthcare to patients and the public.

“We need to listen to the perspectives of others. That is what the Dental Leadership Network is about – and today we have been listening, engaging and focusing on the patient and public perspective.

“So, with thanks to all the patient representative organisations for sharing their valuable insight with us today. They have given us much to consider going forward. And this is only the start of a continued engagement.

“Thank you.”