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“For the times they are a-changin'” – thanks to Bob Dylan for a neat introduction to this blog. The landscape of our profession is changing rapidly. This certainly isn`t the same job I started in 1978, but most change has happened in the last eight years. I won`t take up precious words with the complete lyrics to this song but if you Google it you will find relevance in every word that Dylan wrote.
There are changes afoot in the way that we are contracted, the way we are governed and the way we are assessed. The NHS contract is not working in the best interest of either side, so the Department of Health will be altering the way we get paid. The General Dental Council is inundated with complaints about practitioners so they will be seeking greater control over registration and continued requirements. The Care Quality Commission is seeking a more realistic and targeted way of policing quality of care, so the inspection process will change.
Practice as a business
The Chief Dental Officer recently said “Dentists need to do the right thing without suffering financially”. However, this is as much driven by consumer satisfaction as it is by clinical need. The probable result of this way of thinking is that the UDA-based contract will be retained, but with a greater emphasis on patient gratification, in other words, providing what people want and being paid for that rather than for what people actually need.
Review those practice policies concerning patient satisfaction as they will become more important in the near future.
Balancing this is the changed attitude of the GDC towards upholding standards rather than dealing with disasters after they have happened and being over-run with complaints. It wants to become more involved in day-to-day regulation and reduce the height of the pedestal it seats itself on. However, the down side of this is the probability of a ‘Section 60 Order’ by the Government which will give it greater ability in policing actual practice. This relies again on being led by patient complaints and unhappiness.
Review your Complaints Handling Policy and Procedure; try not to let complaints escape from the practice into the wider world.
The CQC has announced changes to the inspection process (more on this soon) which will involve a more targeted approach to inspection. This is partly by a greater `intelligence-led` procedure which will look at the 10 per cent of practices which they feel need a magnifying glass, and partly by involving more dental ‘experts’ in the inspection process. I imagine that patient satisfaction will play a major part in the initial investigations.
Walk around the practice a bit when it’s not too busy and have a look at what patients might see. Would you have confidence in the practice from what you notice?
What people want or what people need?
The issue with all these changes is the consumer-led approach. Patients actually have no idea whether care has been clinically sound or effective because they have no idea what they can expect. All they know is whether their journey through the practice has been friendly, whether complaints have been handled to their satisfaction or whether they would recommend the practice to family and friends. Most of these issues are superficial and can be addressed with increased quality of ‘customer service’. As professionals we still need to measure our own effectiveness in dental care. Unfortunately, the future pressures are going to be dragging us away from evidence-based clinical care towards more effective people pleasing. The crystal ball is now getting a bit cloudy, so let’s see what happens in real-time.
Dr John Shapter – QCS Expert Dental Contributor