In the 2022-23 financial year, NHS data revealed an ongoing dental crisis, with 47,581 tooth extractions performed on 0–19-year-olds in NHS hospitals. Of these, 66% were due to tooth decay. At the time, Dr Nigel Carter, Chief Executive of the Oral Health Foundation, urged the government "to step up efforts to enhance dental access nationwide". But how does the new government intend to tackle this public health concern and what could this mean for dental professionals?
Labour's Dental Rescue Plan
The new Labour government vowed in their manifesto to "stop the rot" and deliver a Dentistry Rescue Plan if elected. While we wait to hear more about what this may look like in practice, it is important to reflect on the impact these proposed changes may have on Fitness to Practise (FtP) proceedings involving dental professionals.
The rescue plan has 4 key headlines:
- Fill the gap of appointments with an extra 700,000 urgent and emergency dental appointments a year
- Flood dental deserts with new dentistry graduates, with golden hellos of £20,000 for those who spend at least 3 years working in underserved areas
- Supervised tooth brushing for 3 – 5-year-olds
- Reform of the dental contract to ensure everyone who needs a dentist can get one.
How dental reform could sharpen Fitness to Practise standards
From a patient perspective, reform is long overdue, with many patients reporting an inability to book an appointment with an NHS dentist. However, the proposed changes, in addition to improving patient access to an NHS dentist, could have a huge impact on FtP proceedings before the General Dental Council (GDC).
It is unclear how the government intends to implement its proposals for these additional 700,000 dental appointments each year and what these might look like in practice. If these plans lead to longer patient lists and greater demands on existing dental professionals, then dentists will inevitably experience heightened stress. The prevalence of mental health issues amongst dental professionals is still not fully understood. The GDC's 2021 'A welcome mental health and wellbeing review' revealed that dentists were consistently self-reporting high levels of stress, with litigation and regulation being the primary stressors. Further, in a 2023 survey of 125 dental professionals investigated by the dental regulator, 82% said the process had negatively impacted their mental health, with a staggering 28% saying they had experienced suicidal thoughts during the investigation. Elevated stress levels significantly increase the risk of error and burnout, which can have detrimental effects on the profession, patients and the overall success of the proposed Rescue Plan.
The incentive of "golden hellos" to encourage a greater dental presence in underserved areas is a commendable plan to attract newly qualified dentists to areas of need. However, the allure of a financial benefit may come at more than just a financial price. Dentally deprived areas may require more experienced professionals to tackle ongoing issues and placing newly qualified dentists in these areas could present significant challenges and increase the likelihood of complaints and referrals. The GDC will need to ensure proper regulation of the profession if these changes are eventually introduced to maintain high professional standards, patient safety, and a reliable quality dental service. Additionally, it is crucial that any FtP processes are fair for all involved.
The new government's emphasis on preventative care, such as supervised tooth brushing initiatives, could introduce new professional responsibilities. The Dentistry Rescue plan suggests that supervision be implemented in schools. However, it remains unclear whether this responsibility will fall solely on the teachers or if dentists be required to play a more active role in community health initiatives. The implications for FtP proceedings are yet to be determined, although one can't help but question whether a Professional Conduct Committee might draw adverse inferences from a dentist's decision not to engage with community initiatives, and it is an important factor to bear in mind when advising dentists and preparing for future hearings.
If the plans impose stricter regulations or higher standards of care, then this could lead to a rise in complaints against dental professionals. If dentists are held to a higher standard, then comprehensive training and robust safeguarding measures will need to be implemented to ensure that professionals are well equipped to withstand increased scrutiny. The GDC will be closely observed to see how they intend to update their regulatory framework. Any revisions to guidelines or standards should be reflected in the assessment and adjudication of FtP cases.
How will the GDC respond to reform?
The GDC is already undergoing a review of its FtP decision-making guidance to ensure patient safety, public confidence and professional standards are maintained. The GDC have updated their guidance on voluntary removal applications for professionals subject to FtP proceedings. Where allegations are at the lower end on the scale of seriousness, and there is a sincere desire to permanently leave the register, the application is likely to be granted, thereby avoiding a potentially long and stressful investigation.
Whilst these changes predate any Labour reform, the updated guidance underscores the GDC's increasing focus on the potential impact of investigations on a dentist's mental health and wellbeing, whilst maintaining patient safety and public confidence in the profession. The reforms will add pressure to an already stressed profession, where vague or overly complex regulation changes could lead to confusion and increased anxiety amongst dentists. The GDC must remain consistent in its approach to dental reform following any such state led proposals.
Conclusion
With dental reform under much needed state scrutiny, the landscape of FtP proceedings (already under review by the GDC) is poised for significant transformation. The introduction of stricter regulations, increased public expectations, and potentially higher standards will undoubtedly raise the bar for dental professionals. While the Government's goal is to enhance the patient experience, the challenges for dentists navigating and adapting to those changes will be substantial. The success of these reforms' hinges on the GDC's ability to balance patient safety with fair and manageable regulation. Although the GDC bears this responsibility, dentists must also be prepared to adapt, adjust their everyday practices and stay informed about regulatory changes. Legal professionals, indemnifiers and insurance providers will need to be equally aware tin order to advise dentists on compliance issues.
Ultimately, only time will reveal the true impact of the government's proposed reforms on the dental profession, and how the GDC will interpret these changes. However, with appropriate funding, collaborative efforts, and mutual understanding, these reforms have the potential to significantly benefit dental professionals and their patients, giving them much to smile about.
Author: Gina Southwood
Further Reading: Dentistry and the Law – A review of recent cases involving consent, records and treatment abroad.
