The requirement for dental care professionals (DCPs) to be registered with the General Dental Council (GDC) is still only a recent introduction and, as the deadline for paying the annual retention fee approaches, it is a good time to look at the mechanics of the scheme and the benefits of registration as well as some of the difficulties that can arise.
One of the key questions general practitioners face is whether to pay the £96 fee on behalf of their employees. While it isn’t a huge sum of money, we are in a difficult economic climate, with many private practices less busy than they would like and many NHS practices finding patients somewhat reluctant to sign up for some of the more expensive courses of treatment. Add to that the fact that practitioners haven’t had a significant pay rise for a number of years – and that this year’s pay rise has to be paid for with efficiency savings – and it is easy to see that it is an outgoing even small practices with just three or four registrants will want to consider carefully.
The matter is generally settled for those in the salaried services or those working directly for the NHS or in a dental school, as they pay the retention fee themselves and are responsible for ensuring it is done. For the rest, I believe a slight majority of employers do currently pick up this bill, many understandably requiring their employees – be they nurses, hygienists, therapists, technicians or orthodontic therapists – to undertake to pay back the appropriate proportion of the fee if they leave within 12 months.
Whatever your decision, those practitioners who don’t pay their employees’ retention fee must remember that they are still responsible for making sure that this has been done and that their registration remains ‘live’.
It is a responsibility that stretches beyond the practice boundaries too. Dentists need to check, for example, that those people who are contracted to supply them with laboratory work are also registered. And the same goes for work that is sent abroad, especially if it is to a country outside the EU. The GDC has issued guidelines for this and dentists need to make sure they follow those guidelines carefully and are fully aware of the implications. While you may have done the groundwork when the requirement first came into being a few years ago, these are checks that need to be carried out on an ongoing basis.
Trainees, of course, don’t need to be registered at all – but they do need to be ‘in training’. This may seem obvious to most, but there have been cases where staff have been taken on in April and not enrolled in a course until September the following year, a full 18 months. While this may be financially beneficial to the practitioner, it is, sadly, not acceptable, as trainees must be enrolled as soon as is practical. Active, forward movement in the pursuit of learning is the key here.
To cope with any delays between appointment and the start of a course, my suggestion is that dentists commence the training of new staff immediately – with a formal induction to the practice or the premises. They should then be enrolled in the first suitable course and, in the meantime, advised to keep a logbook recording their day-to-day learning. In this way, if challenged, dentists can show that the individual was a student engaged in the learning process. Besides, all that note-taking will pay off when the trainee finally comes to sit his or her exams.
No practitioner who wants to stay in business would offer to pay the fees of the self-employed – but employment status can be riven with complications. One area of confusion that I come across regularly is the status of dental hygienists who are considered by the dentist – and who consider themselves – to be self-employed. They might work for two three practices, run a car on the business and be paid gross.
But be warned, unless that hygienist is sitting at home on Monday morning waiting for the phone to ring from any number of potential employers, Her Majesty’s Revenue & Customs will consider them to be employed by each dentist they work for. The result? A hefty tax and National Insurance bill presented to each dentist in relation to their hygienist employee – whether or not that person has been paying tax. So unless, most unusually, you have a letter from the HMRC to the contrary, you should treat your regular hygienist as an employee.
Any discussion of retention fees tends quickly to turn to the differential between the cost of registering as a DCP and that of registering as a dentist, currently standing at £438, and I want to take the opportunity to address this.
There is no question that the GDC tries its utmost to set the annual retention fee such that it reflects the costs of registering DCPs and dentists. Currently, more than half the money the GDC spends is in investigating and pursuing fitness-to-practice accusations against dentists. This is the biggest single reason for the fees being set as they are – dentists, it must be said, have an uncanny knack of getting themselves into trouble.
Generally, problems arise when dentists have done a less than satisfactory job and misled the patient about it. Less frequently, they may be subjected to fraud allegations against the NHS, or accusations they have sexually molested a patient. Often it is simply something silly they have done in their private lives.
It was thought when we registered the approximately 65,000 DCPs that they would get into trouble at about the same rate as dentists – the idea being to adjust the fee as time went on – but this simply hasn’t happened. While a few are getting in trouble, often for making false declarations at first registration, or not admitting to criminal convictions on reregistration, the rate is well below that of dentists.
I hesitate to speculate on why this is the case, and instead point out what is known: that once a dentist is in some kind of trouble, a great many of them fail to seek help until it is too late, thus damaging their own case. Dentists have 21 days to reply to an accusation, but many frequently don’t pick up the phone to their protection agency, the Medical and Dental Defence Union of Scotland, (MDDUS) until day 20 – it should, of course, have been done on day one.
This very common occurrence perhaps has something to do with the personal nature of the job – dentists are, after all, working intimately with people they have often come to know well, and to have this work criticised is a very personal thing. I believe many dentists, when faced with such criticism, are deeply upset and, quite wrongly as it happens, ashamed to share the details with a peer, even if that peer is paid to help – but, believe me, the MDDUS’s advisers have heard it all.
So dentists would do well to remember, should disaster loom or an allegation be made – however unreasonable or seemingly ridiculous – that contacting a professional adviser from the start will ultimately be in their best interest. The MDDUS is there to help, not hinder, you – and there is surely no worse start to defending a complaint than to be chased up over it.
Of course, it would be better all round if dentists stayed out of trouble altogether and, as part of this series of articles, I will in future issues be highlighting the 10 key things dentists should avoid in order to stay trouble-free – so watch this space.
Hew Mathewson is a general practitioner in Edinburgh, a special adviser to the MDDUS and a former President of the General Dental Council