General Dental Council

Dan Poulter Excerpts

Tuesday 9th December 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and a great pleasure to respond to my hon. Friend the Member for Mole Valley (Sir Paul Beresford). I congratulate him on securing the debate and on bringing to bear his front-line experience of working as a dentist, both in this debate and more generally. He has shown his experience today in getting to the heart of some of the issues he raised, as he has done in many debates in the House on issues relating to health care.

The General Dental Council is an important part of the health care regulatory framework that ensures the fitness to practise of health care professionals and the safety of patients. It is right that we should debate the GDC’s performance, particularly in the light of a less than complementary performance review by the Professional Standards Authority, and given the major rise in the fee that dentists will be expected to pay to their regulator.

My hon. Friend will be aware that the General Dental Council is an independent statutory body that is directly accountable to Parliament. However, as he rightly highlighted, I have no legal basis to intervene in matters such as the level of the fee, which are deemed to be part of the body’s operational running. However, in my role as Minister, I have a keen interest in the performance of the professional regulators and have regular contact with them, including the GDC, on a whole range of issues.

The background to today’s debate is that the General Dental Council recently took the decision to increase the annual registration fee for dentists by 55%, from £576 to £890, which is a significant and unprecedented increase. All professional regulators, including the GDC, are aware of the Government’s position, as set out in our 2011 Command Paper, “Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff”: we do not expect registration fees to increase unless there is a clear and strong case that the increase is essential to ensure the exercise of statutory duties.

While the General Dental Council has consulted its registrants on the proposed fee rise, I am aware of, and sympathetic to, a strong body of opinion among its registrants that they are yet to be presented with compelling evidence to justify such an unprecedented fee increase. The proposed fee is more than double the £390 that the General Medical Council requires licensed doctors to pay. That is why, when I met the GDC, I raised concerns about the fee increase and reconfirmed the Government’s position on the need for a strong and transparent case for any such increase.

I have also strongly suggested to the GDC that it considers a differential rate for newly qualified dentists. Newly qualified doctors are required to pay £185 for their registration with the GMC, while newly qualified dentists pay the same as established dentists. The GDC stated to me as justification for its fee rise that there has been a 110% increase in the number of complaints from patients, employers, other registrants and the police about the dental profession, and that the cost of handling such complaints has been the key driver of the increase. However, I have not been presented with what I consider to be compelling evidence that a fee rise of that magnitude is justified by a 110% increase in the number of complaints.

It is worth noting that other health care regulators, as my hon. Friend suggested, have experienced increases in complaints but have not felt compelled to raise their fees to the same extent. I therefore understand why the British Dental Association has chosen to test this decision and issued judicial review proceedings challenging the setting of the fee. The hearing is set to take place next week, so I am sure that hon. Members will understand that it is inappropriate for me to comment further on those proceedings.

[Toby Perkins (Chesterfield) (Lab)]

I am grateful to the Minister for giving way, and I congratulate the hon. Member for Mole Valley (Sir Paul Beresford) on securing this debate. I have been written to by Derbyshire county local dental committee, which is concerned that the General Dental Council, under the leadership of its current chair, is investigating much more minor concerns than it did previously. That expansion in its role is one of the reasons why it is now asking dentists for more fees. Will the Minister let us know whether he thinks that the direction that the General Dental Council is taking is the wrong one, as my constituents clearly do?

[Dr Poulter]

As I said, under legislation, I am unfortunately powerless to intervene directly on fee setting. We recognise the independence of health care regulators and would not want them to be micro-managed by Government; that would be wrong. However, my view is very clearly, as I have outlined, that a strong evidence base is needed to justify a fee rise. Given that other health care regulators faced with similar challenges have not raised their fees to the same unprecedented degree, I have not myself been convinced that the evidence base is strong enough to justify this fee rise. I hope that that answers the hon. Gentleman’s question.

In that context, it is worth drawing attention to the section 60 order currently in progress in the House, and to the consultation process that has been taking place. The fee rise is perhaps all the more surprising as we are making good progress with the GDC on bringing in the legislative changes that will reform the way that it operates. Those changes, in the form of a section 60 order, will assist with reducing its operational costs by an estimated £2 million a year through potential efficiency savings. My hon. Friend the Member for Mole Valley made the point that all regulators need to look at better ways of working and efficiency savings in their own practice. Of course, that, as well as patient protection, is a benefit of introducing a section 60 order: it will help to reduce the running costs, potentially, of the GDC and streamline processes.

The public consultation on the GDC-related section 60 order recently closed, and the vast majority of respondents were supportive of the proposals. We therefore intend to proceed with the measures and will publish our response to the consultation in due course. My hon. Friend may be surprised to learn, as I was, that the GDC did not wait for the outcome of the section 60 order consultation before announcing the fee rise.

The changes proposed in the section 60 order will: enable the GDC to delegate the decision-making functions currently exercised by its investigating committee to officers of the GDC, known as case examiners; enable both case examiners and the investigating committee to address concerns about a registrant’s practice by agreeing undertakings with that registrant, which have the same effect as conditions on practice, without the need for a practice committee hearing; introduce a power to review cases closed following an investigation—rules to be made under that power will provide that a review can be undertaken by the registrar if she considers that the decision is materially flawed, or new information has come to light that might have altered the decision and a review is in the public interest—introduce a power to allow the registrar to decide that a complaint or information received did not amount to an allegation of impairment of fitness to practise; introduce a power to enable the investigating committee and the case examiners to review their determination to issue a warning; and ensure that registrants can be referred to the interim orders committee at any time during the fitness to practise process.

Very similar section 60 orders have been laid before Parliament in conjunction and consultation with other regulators, and a great benefit of those orders is that they are about not just protecting the public but supporting the regulators to have more streamlined processes and reducing costs. Of course, when costs are reduced, we would always expect the savings to be passed on to the people who pay the annual fee.

[Sir Paul Beresford]

Is there evidence that the other registering organisations have reduced their fees, or keep them down, in the light of the anticipated savings, which would be sensible?

[Dr Poulter]

If we look at similar organisations, we see that the GMC, for example, has similar practices and processes. The Nursing and Midwifery Council has a very small fee rise, but has seen a similar section 60 process take place. All those regulators, in my view, have taken every step possible to look at their annual fee in the context of the section 60 orders, and with the mindset that any fee rise needs to be fully evidence based and appropriately proportionate. From my conversations, and from the practice of other health care regulators, I think that there is very good evidence that that is a consistent pattern of behaviour. As I said, the GDC’s fee rise is unprecedentedly large, and its behaviour is not consistent or in keeping with that of any of the other health care regulators, from what I can see.

In addition to the GDC-related section 60 order, the Government are taking forward a number of key pieces of secondary legislation in this Parliament to address priority areas that we have identified after discussion with the regulatory bodies and other stakeholders; I mentioned other section 60 orders. We are also working on a response to the Law Commission’s valuable work on proposals for more wide-ranging reforms.

I am aware that the decision not to progress a professional regulation Bill in the current Session has come as a disappointment to interested parties. However, that decision provides an opportunity to invest time in ensuring that that important legislative change is got right, for the benefit of those who will ultimately be affected by it. My hon. Friend outlined very articulately some of the challenges that need to be considered in putting together the Bill. We are committed—I would like to put this on the record again—to bringing forward primary legislation to address wider reforms to the system of professional regulation when parliamentary time allows, but in the meantime, working with the regulators, we have put in place, or have in train, a number of section 60 orders. They are about streamlining processes, providing efficiencies to the regulators and, most important of all, protecting patients and the public.

Let me say a quick word about the GDC’s general performance. It is very important that the GDC manages its rising volumes of complaints as well as the other issues raised by the Professional Standards Authority as part of its annual performance review. In due course, the GDC will need to demonstrate what it has done to address the recommendations made.

Hon. Members may be aware that the Professional Standards Authority is also conducting an investigation of the GDC after claims were made by a whistleblower about the management and support processes of the GDC’s investigating committee. I understand that the Professional Standards Authority has concluded the evidence-gathering phase of the investigation, is in the process of compiling the investigation report, and will provide that report to the Select Committee on Health and publish it on its website in due course.

I have outlined a number of issues and concerns about the unprecedentedly high rise in the GDC fee. As we have discussed, it is out of keeping and inconsistent with the behaviour of many other health care regulators. I am not convinced, from the evidence that I have been presented with, that there is a strongly evidenced case to support that fee rise, and it goes against Government policy, which is to encourage regulators to set appropriate and proportionate fee rises, to show restraint where appropriate and to be mindful of the effects of fees on registrants.

I want to make it clear, in drawing to a conclusion, that I am not raising any doubt about the fact that the GDC continues to fulfil its statutory duties. However, it will need to make significant improvements to meet the challenges set out in the annual performance review undertaken by the Professional Standards Authority. Registrants, patients and the public need to be able to have confidence in the performance of the GDC and to see improvements in its operation, effectiveness and efficiency. I hope that I have answered all the points raised in the debate, and I again thank my hon. Friend the Member for Mole Valley for raising a very important issue that I am sure is filling many MPs’ postbags.

[Mr Philip Hollobone (in the Chair)]

I thank all hon. Members who took part in the debate.