Another layer of regulation?
Dentists throughout Scotland cannot have escaped the uncertainties currently being experienced by their English colleagues in relation to the Care Quality Commission (CQC) and the requirement to be registered with the CQC from 1 April. Many dentists working in Scotland may also be wondering about the introduction of a similar requirement. The question being asked by many dentists is: “Will we be next?”
The Scottish Commission for the Regulation of Care, otherwise known as the Care Commission, was established in April 2002 and was intended to regulate and improve care services in Scotland, including GP services and dental services. However, the Scottish Government announced some time ago that, from 1 April 2011, the functions of the Care Commission will be split and there will be a new single body to scrutinise health services, with another new separate body regulating care services and social work.
The new health scrutiny body, Healthcare Improvement Scotland (HIS), will bring together a variety of functions, including the scrutiny of independent healthcare, which was the original remit of the Care Commission; although for a variety of logistical reasons the Care Commission didn’t actually introduce anything that affected dentists in Scotland.
The legislation implementing these recent changes is The Public Service Reform (Scotland) Act 2010, which came into force earlier this year. Part six of the act established HIS and provides powers in relation to scrutiny of NHS and independent healthcare services.
The act provides HIS with responsibility for a variety of functions, such as a duty to provide information to the public about the availability and quality of services provided under the health service and a duty to provide the Scottish ministers with advice about any matter that is relevant to the health service.
The Act also amends the NHS (Scotland) Act 1978 and the powers of HIS cover both NHS and independent health care services, including independent clinics where services are provided by a medical or dental practitioner. Apparently the practical implications of this are still being considered by the Scottish Government.
HIS has powers to inspect and also has the power to investigate an incident, event or cause for concern. An inspection must be carried out by an authorised person and there is authorisation under the act for inspection of records. The new chair of HIS took up office on 6 September 2010 and the appointment of a chief executive is apparently in hand. HIS will have 250 staff and an estimated initial budget of around £19 million.
At this stage, it is uncertain how matters will develop with regard to the regulation and inspection of dental services in Scotland by HIS. It should be noted that HIS will regulate and inspect dental services, but not the dentists who are already regulated by the GDC.
The Healthcare Improvement Scotland (Requirements as to Independent Health Care Services) Regulations 2011, came into force on 1 April 2011. These regulations provide some insight into future plans for private practices in Scotland. For example, there is specific provision for the preparation of Patient Care Records which must include details of every consultation or examination and the outcome, plus details of any treatment.
Obviously dentists are well used to their obligations in relation to clinical record keeping but these regulations are quite specific and, among other things, include the requirement to record the name of the healthcare professional providing the treatment.
NHS dentists and their practices in Scotland are already inspected on a three-yearly basis as well as by NHS Education Scotland if the practice is a training practice. This doesn’t take into account other bodies who can attend and inspect various aspects of a practice if they see fit. The current issue is whether HIS will also be inspecting NHS practices.
Where matters go from here is still not clear. The British Dental Association in Scotland has replied to the Scottish Government’s consultation and has been prag- matic in suggesting that there is no value in re-inventing the wheel and, given that NHS practices are already inspected regularly by Scottish Health Boards, it would make sense that any new arrangements should only apply to wholly private practices which are not inspected in the same way. Not to do so would leave HIS with the fairly onerous task of trying to organise the regulation and inspection of the 900 or so Scottish practices.
The Scottish Government’s response to the consultation process is due to be published in the spring and it remains to be seen how things will evolve in practical terms. Given the situation in England, Scottish dental practices and dentists may well have some valid concerns about yet another level of inspection and regulation. One obvious downside for dental practices is that there may well be costs that could be imposed that they may think they can well do without.
Hopefully, a more sensible and pragmatic approach will be taken here than in England. Ongoing discussions suggest that further announcements will be forthcoming. So, watch this space…
Helen Kaney is a dento-legal adviser for Dental Protection in Edinburgh.