Standards in dentistry

Dentistry’s gold standard – aspirational or attainable?

Nigel Jones NHS Dental Landscape Leave a Comment

Nigel Jones discusses the feasibility of achieving dentistry standards with professionals from the industry…

We are two years on from the comment made by the Federation of London LDC about dentists being expected to deliver ‘a gold standard’ of care on a ‘tin-plated budget’, yet it feels just as pertinent now as it did then, if not more so. Especially as, in the latest round of the NHS Confidence Monitor survey of more than 400 dentists, the vast majority of both private (85%) and NHS (88%) dentists said they think it is harder to adhere to GDC standards in the NHS compared to private dentistry.

In addition, 85% of those working in the NHS said it was difficult to balance professionalism and working within an NHS contract.

Since that comment, which seemed to resonate deeply with the profession, from the LDC was made there has been little, if any, improvement politically in terms of dentistry’s prioritisation within the wider healthcare setting and no corresponding change in funding. Some may even argue that the situation has gone backwards.

“85% of those working in the NHS said it was difficult to balance professionalism and working within an NHS contract.”

Having said that, there does seem to have been some, albeit relatively limited, improvement in the expectation of the standards dentists can achieve under the NHS contract. Last year, at a CDO Briefing Day, the GDC acknowledged the challenges dentists are facing in achieving the standards they are held to; although it’s a safe bet that many professionals would still like to see more action than words on that front.

Bearing all this in mind, I asked some well-established professionals, as well as those just embarking on their career, for their views on how realistic they think it is to meet the regulator’s standards.

Jasmine Lobo, a recent graduate, suggested that whilst previous generations of dentists may have felt more able to take a bolder approach and ‘sink or swim’ upon entering practice, today’s dental students are very much aware of, and therefore cautious of, missing those standards and the associated legal risk.

“At university, there is a lot of emphasis placed on just how much litigation you can face as a dentist” said Jasmine.

“You are taught that the gold standards are the way to avoid that, which sounds fine in theory, but in day-to-day practice life it is a different scenario. In real life, sometimes, you have to do things differently in order to provide a satisfactory standard of care for everybody. Because you have to adapt to work efficiently in practice, you find yourself looking for reassurance from your peers and trainers.”

“At university, there is a lot of emphasis placed on just how much litigation you can face as a dentist” said Jasmine.

Dhru Shah, the founder of Dentinal Tubules, agreed with Jasmine’s view, and suggested that more focus on peer reviews and providing a support system could help with dentists’ nervousness around meeting standards.

He said, “When I first found myself in vocational training, it was a 12-surgery practice with about 15 dentists who were like a family that look after each other. If I was concerned about a particular course of treatment, I knew there were peers I could talk to and who could absolve me.”

“That’s not as common now, so not only are younger people entering the profession not likely to have this support network, but, due to the focus on gold standards and litigation whilst studying, they also panic when anything is less than perfect.”

“People join our study clubs to have a support network and dentists they can talk to. Having something like that within your practice where you can engage in peer reviews is hugely important and is something, I believe, is not stressed enough during their training.”

Simon Thackeray, well-known in the profession for his forthright views, said that the gold standards should be viewed as aspirational and what is needed is a more defined set of standards that reflect what is achievable.

Simon said, “There’s a lot of gold standards, from the FGDP, etc, and a lot of minimal standards, i.e. not getting in trouble with the police. But in the middle of it there’s no one taking a stance and saying what is realistic in terms of things like, what your notes should look like, or what you should say in certain situations.”

“The gold standards should be viewed as aspirational and what is needed is a more defined set of standards that reflect what is achievable.”

“Whose responsibility is that? You could argue it’s something the BDA could do, as an arbiter of the profession, but they have a lot of other things to do. Or the CDO, who has been promoting the Dental Check By One initiative, which is really just reinventing the wheel. What we need is to define a set of standards that are attainable by the vast majority of the profession. We can then have the gold standards that sit on top of that.”

Simon’s thoughts echoed those of Tony Kilcoyne, who I was recently speaking to about the issue of standards and who suggested that there could be different levels, e.g. gold, silver and bronze.

A fellow BDA colleague of Tony, the Vice Chair of the Principal Executive Committee Eddie Crouch said that the organisation was never going to say that there should be a different set of standards in the profession. However, he added, “We are close to vocalising the fact that it’s becoming almost impossible to stay within the system and deliver quality.”

Eddie also said that whilst the CDO was introducing initiatives, the wider issue of contract reform was the elephant in the room.

He said, “The real problem is that whilst you start projects getting children into the dentist’s chair and doing some prevention here and there, you’re ignoring the real problem which is that we’ve got a contract that won’t deliver. We want a contract with clarity, and one that works for patients and practitioners.

“You’ve got a prototype that doesn’t appear to deliver on that either. It would be helpful if the CDO works with the BDA to solve what the real problem is.”

*For more information about the full NHS Confidence Monitor results and insight from professionals visit: nhsdentistryinsights.co.uk