People fall into three categories, those that don`t like or are not bothered about the game of Rugby, those that support and follow Rugby League and those who support and follow Rugby Union. An odd thing has been happening over the last couple of decades though, the rules of both versions of the game have gradually changed in a very subtle way and the fan base of both versions are no longer quite as passionate about one or the other. It is now not unknown for former Rugby Union players to play League and visa-versa. It is almost possible, but not probable, to see the games coalescing sometime in the distant future.
So what has this to do with the new GDC `Standards for the Dental Team` which will have landed on your doorstep in the last few weeks? Well, the changes to the layout and increased content, together with some of the terminology, have taken a ghostly similarity to the CQC `Essential Standards`. I think this is somewhat accidental at this stage, but has come about because of the similar processes involved in writing both sets of standards. However, it does spark the imagination running and daring to think about the possibility of a single regulator sometime in the distant future. The only difference is that, whereas CQC asks the question “What should people experience?” the GDC asks “What should patients expect?”.
It is really important to understand some of the changes and why they have occurred. The GDC undertook a huge `consultative exercise`, starting in 2010 with a Focus Group consultation with the general public. Following this was a road-show of workshops for registrants all over the UK. The evidence that came from this found that the public, that is our patients, were not as trusting of us as we thought. In fact, `Trust` emerged as the overarching issue for patients, which the GDC should consider. In order to do so, patients and the public highlighted three key criteria that need to be met:
I. Communication – patients want to know in advance how much their treatment will cost and why.
II. Evidence – a majority of patients will want an explanation of why certain treatment is recommended, what the benefits will be if undertaken, and what the drawbacks will be if not.
III. Informed consent – patients want a balanced view of their options before proceeding with treatment.
The Consultation document says that the most significant issue relating to standards that arose from these discussions was that of communication. “Whilst important in its own right, communication appears to underpin every other issue and concern arising in the discussions and its importance cannot be overemphasised in the standards review. “
This echoes the CQC guidance on `Respecting and involving people who use services`, in which Involvement and Communication are key issues. Especially highlighted in both publications is the need to promote rights and choices, as well as issues of Informed Consent. Communication gets a section of its own in the GDC standards, with several pages dedicated to the need to listen and to treat patients with an empathy to their needs. “Ineffective communication contributed to a majority of respondents’ negative experiences“ which were recoded from the consultation exercise. Most related to what patients should expect in terms of:
- The cost of treatment before it was carried out;
- The level of pain from impending treatment;
- The reasons why the treatment is being carried out.
Cost of treatment appears as one of the major concerns. This is why the new Standards take a lot of page space in laying down how this should be communicated.
Another concept common to both sets of guidance is the idea of `holistic` care. This involves using what you have learned by listening to patients in order to take into account the patient`s overall health, social and psychological needs. This is going to involve a more subtle use of verbal, visual and intelligent observation, as well as learning about the needs and values of different sub-cultures. The guidance now states, in black and white, that we should be `sufficiently fluent in written and spoken English to communicate effectively`. However, as we need to be achieving this to meet both sets of standards, it should not be doubly onerous. The General Medical Council is actually taking this concept one stage further, by bringing in language tests for all EU registrants.
The guidance on consent is now very close to that of CQC Outcome 2, with an emphasis on `on-going` communication and the type of records that are required to document this. The importance is taken off the process of consent, but placed on the right outcome for each individual. This means it is the continuing discussion which is important and not an initial agreement, with consent required to be tailored to each individual. The Guidance is also now more detailed in laying down what information needs to be documented, again mirroring the standards from both organisations.
Well, what didn`t get into the new Standards? Following the public consultations, two issues came up that are interesting for their absence. One concerns timekeeping and particularly the difference in time allowed for Private and NHS patients. To quote –
“A large number of respondents (actually 49%) felt that dentists should be regulated about their timekeeping. Patients were frustrated at being left in the waiting room, especially when they themselves are likely to be penalised for being late for an appointment.
This proved most frustrating because of having to take time away from work, sometimes having to travel and occasionally being late for appointments due to circumstances outside of the patient’s control. NHS patients, in particular wanted to be given more time in the dentist’s chair when appropriate.”
The other big issue which is not actually addressed in the new publication, but which is due to have its own consideration soon, is the public concern about the title `Dr`. Again, to quote –
“The vast majority of patients and the general public were adamant that dentists without a PhD or medical degree, who present themselves as a “Dr”, should be subject to disciplinary procedures.”
In my opinion, the new Standards have set the right tone for a few more years. They are very succinct without being too prescriptive. However, I don`t believe for one moment that League and Union will ever join together.
