General Dental Conundrum

Few organisations within the world of dentistry create as immediate reaction as mention of the General Dental Council (GDC). To some extent, this is historical and also human nature. How many of us like a regulator? Yet the attitude of the Council towards us in recent times has done nothing to sway our sentiments towards liking it. The BDJ Portfolio has recently reflected a dichotomy of views. In the BDJ, Kelleher's drubbing of the GDC finds some counterpoint in an interview with D'Cruz in BDJ In Practice.^1,2Here, the Head of BDA Indemnity opines that the Council has improved its fitness to practise processes considerably in the past year or so, leading to a significant reduction in cases reaching investigation and a concomitant fall in stress levels for registrants. I suspect many readers will feel more supportive of the thoughts expressed in the first article and give grudging 'let's wait and see' regard to the second.

The GDC's website includes some subtle changes which may well have passed many of us by; for example, the leitmotif now reads: 'Working with the dental team for public safety and confidence'. Note 'working with' (my italics). That's new. We used to be confronted with 'regulating the dental team' without any hint of collaboration. Also, what happened to 'protecting patients'? Now, the GDC is more gently seeking 'public safety and confidence'.

Interestingly, the GDC has issued a press release heralding its latest research in relation to 'the ongoing impact of COVID-19 on the dental sector'. The results highlight 'increased patient demand but that dental services were struggling to meet that demand with rising waiting lists reported by professionals. The evidence also showed a shift in patients and dental professionals moving away from NHS dental services to the private sector'.³

The GDC is entirely independent of the workforce it regulates despite being 100% dependent on the same population to finance it.

The GDC's Executive Director, Strategy, added: 'Dental professionals continue to rise to the extraordinary challenges posed by the pandemic, but these findings point towards a system being overstretched. Many of the most pressing and wide-reaching challenges highlighted in this research, such as access to services, health inequalities and pressure on professionals, will require attention and effort from everyone right across dentistry. While some of these are areas outside of the GDC's direct control, we will use this evidence to inform all our work and share the insights with our partners to support those broader efforts to address these problems.'

So, which of these pressing challenges are 'outside the GDC's direct control' and why no mention of government intervention? The Council now describes itself thus: 'We are an independent organisation which regulates dentists and dental care professionals in the UK'. Independent - really? I am reminded of an editorial I wrote entitled 'A profession no longer' as long ago as 2007.⁴ I noted the definition of a profession is that it is self-governing, and as we were being disempowered of our right to elect dental professionals to the GDC, we were no longer self-governing. No one in the last 15 years has contradicted me. So, yes, the GDC is entirely independent of the workforce it regulates despite being 100% dependent on the same population to finance it.

If the GDC is independent, then what is 'outside' its 'direct control' about drawing government attention to the manifest failure of NHS dentistry to be providing 'patient safety and confidence'? Indeed, why has it been silent on this these many years, especially since 2007 and the introduction of the current dental contract in 2006?

Delving a little further, we find that GDC members are 'appointed' by the Privy Council. And who elects or appoints this? 'The privy council is formally a body of advisers to the Queen. It is an important link between the executive powers of ministers and the constitutional authority of the sovereign, largely comprising senior current and former ministers and members of the judiciary…all members of the cabinet are sworn into the privy council'.⁵ Well, no overlap there then.

Doesn't it strike you as odd that an organisation which describes itself publicly as independent and can fund research into a pandemic for reasons of public safety and confidence finds itself voiceless in relation to root causes of other pressing oral health matters? I am no conspiracy theorist so the most I can do is suggest that the C might stand for Conundrum not Council.