APPENDIX ONE: SUMMARY TABLE OF SURVEY FINDINGS AND ACTIONS TAKEN
ANNUAL PATIENT AND PUBLIC SURVEY 2013: SUMMARY OF KEY FINDINGS
Topic
Awareness of the GDC
Finding
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Action taken/planned
Unprompted awareness of the GDC is low. One in four choose
the GDC when asked who regulates dentistry (BDA 44%,NHS
29%)
20% say they have definitely heard of the GDC, before the
survey, 27% are not sure (-5% since 2013). Ethnic minorities are
less likely to know about the GDC than white members of the
public.
About 7 out of 10 believe there is a publicly available list of
dental professionals and lists of specialists
Most felt the name GDC explained its role and purpose
A patient focussed campaign to promote awareness of our
Standards is being launched in the Autumn and this could be
used to test the efficacy of such activity.
Public generally aware that we hold specialist lists. – but a
significant proportion are not. This has implications for the
way in which we regulate the specialties (currently under
review), Will feed into the Review of regulating the
specialties. 1st phase to go to Council in July 2014
We will be looking at how best to contact a number of hard
to reach groups to best target our efforts.
Satisfaction with Dental Care

Patient satisfaction is high: 96% of patients who visit their
dentistry once a year are satisfied. Ethnic minority patients are
significantly less likely to be very satisfied (41%) than white
patients (63%). The professionalism of the dentist is the main
driver of satisfaction
Whilst patient satisfaction is high, this disguises a number of
issues i.e. patients find it difficult to judge what good quality
dentistry looks like and clear explanations of the cost of
dentistry. The GDC is using research understand these factors
more carefully.
The results have been discussed with the CQC, Healthwatch
and other stakeholders.
Attitudes to regulation

Confidence about dental regulation (77%) is high, and higher
than regulation in general (71%) and healthcare regulation
(70%)
This information will be used to input into our discussions
with the Care Quality Commission as a member of their
Dental Reference Group on their model of regulation
Adherence to GDC standards
Complaining about a dental professional
Patients were asked whether they recalled some of the standards for
dental professionals had been covered when they last visited the
dental professional.

More than three in four patients said that the treatment options
had been discussed with them, and that they were allowed
sufficient time to make a decision about their treatment.
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Two thirds felt they were clear about what treatment was
available through the NHS and what was treatment would have
to be received privately.
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However, they were less positive about adherence to other
standards. Only 41% agreed that there was a simple price list on
display and only 34% recalled seeing information about GDC
regulation.

Few patients complain or even considered complaining making
a formal complaint about a dental professional. 4% said they
had every complained, 8% said they considered making a
complaint. However, the numbers who have considered making
a complaint is up from 5% last year.
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Those who had complained or considered complaining were
most likely to complain to the practice where treatment was
carried out (41%). 9% complained to the GDC and 7% to the
NHS.
A significant number of patients do not know where to complain
More than a quarter (27%) of those who complained or
considered complaining say they weren’t sure to whom they
should complain.
The qualitative research found that there were some key trigger
points that led to complaints. These were a combination of two
factors - the severity of the incident and whether it was a
repeated incident or a one-off.
Many patients said they found it difficult to know when an
incident was sufficiently serious and how to make a complaint.
Considered as part of the monitoring of the implementation
of the new Standards for Dental Professionals which were
introduced in Autumn 2013.
Note that new standards re price lists and displaying
information were only introduced in Autumn 2013 and the
results should be treated with caution and regarded as a
baseline data only. At the time the survey was carried out, it
would be too early to collect robust information about
whether these standards had been implemented. Proposed
to repeat this questions the 2014 survey to gather data that
can be compared to this baseline
Work being undertaken to map complaints system and
provide better information for patients
This information will be used to inform the discussions at the
Tripartite Board between the NHSE, the GDC and the CQC to
ensure that there is a better understanding about patients
attitudes to complaints within the three national
organisations
Work is being carried out to increase patient and public
awareness of the GDC through media and advertising
campaigns. Erasures and Illegal Practice prosecutions are
press released to local media and highlighted to MPs.
It is important that we give consideration to providing
guidance to patients about what they can expect from their
treatment and what they can expect from their treatment
and when it is sufficiently serious for them to complain to us
Choosing a dental practice
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Dealing with poor care or wrongdoing
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Most patients based their choice of dental practice on three
sets of factors. Location and quality of the service provided
were by far the most important group of factors. Location was
the most important factor of all in choosing a dental practice
(44%). Recommendation from friends and family and
experience is the second most important set of factors while
lack of choice and availability was mentioned by some. This
finding was compared to how the public choose other public
services (schools, GP/hospital/social care) and similar choice
factors were identified.
Disciplinary action taken by regulators was not a factor with
only 1% checking to see if action has been taken against them
(however, note that low awareness reported above, means that
many members of the public may not be aware that they can
check the register)
Almost three out of four surveyed, thought that a star rating
system would be useful in choosing their dental care. The
qualitative research found that there were mixed views on how
the star ratings could work. Some favoured patient feedback as
a key component while others were concerned about the
subjectivity and potential for abuse.
Though support for regulation in general is high (see above), the
public are less convinced that regulators will take appropriate
action to address poor care or serious wrongdoing. About 40%
were not confident that appropriate action would be taken to
deal with repeated overcharging of patients or poor care
delivered to disable patient or those in a care home.
Almost two thirds of the public think that health, dental
regulators and the NHS share information effectively with each
other so they can investigate poor treatment.
This information will be used to input into our discussions
with the Care Quality Commission as a member of their
Dental Reference Group on their model of regulation and to
the programme board on dental regulation (GDC< CQC< BSA
and NHSEng)
This will be taken into account as part of considering what
how to empower patients to make good choices by
providing better information about what they can expect
These findings were used as part of the cross-regulatory work
on candour which is a key aspect of the Francis Report Action
plan and the government’s response to Francis.
Regulators are working together to explore how we
communicate standards around candour to patients
This information will be used to inform the discussions at the
Tripartite Board between the NHSE, the GDC and the CQC to
ensure that there is a better understanding about patients
attitudes to regulation
Providing an explanation
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Specialists
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Overseas dental professionals
Dentistry as a business
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Seven out of 10 patients think that dental professionals would
provide an explanation (57% for ethnic minorities) when
something goes wrong. If they don’t, more than 8 out of 10
think they should be disciplined. Ethnic minorities are 4 times as
likely to think no action should be taken (17% compared with
4% of the white population)
Patients were asked to indicate the extent to which they agreed
with the following statements
If I needed to see a dental specialist, such as an orthodontist, I
would prefer my dentist to refer me to one
If I needed to see a dental specialist, such as an orthodontist, I
would prefer to find one myself
Eight out of ten patients surveyed, preferred to receive a
referral to a specialist from their dentists, than find a specialist
themselves (6%). A further 11% agreed with both statements.
A substantial majority (87%) think that cosmetic dentistry
should only be carried out by dental professionals who are
regulated and that there should be clear and accessible
information available to the public about who is qualified to
carry out cosmetic dentistry (89
Just over half of the public believed that overseas dental
professionals are tested to check that they can write and speak
English fluently while about six out of ten believe dental
professionals training overseas, received training about how
patients expect to be treated in the UK
Two in five people believe that dental professionals put their
own profit before the needs of the business. The qualitative
research had not experienced it directly themselves but felt that
there could be pressure on dentists to recommend more costly
treatment in order to make money
Considered as part of the monitoring of the implementation
of the new Standards for Dental Professionals which were
introduced in Autumn 2013.
Used in the Review of regulating the specialties. 1st phase to
go to Council in July 2014
Dental professional are regulated, however, but we do not
have a specialist list specifically for cosmetic dentistry.
This information will be used in discussions with the NHS
about the management of dental practitioners who are
trained outside the UK
GDC is working with the Government on a Section 60 Order
for English language testing.
Stress to registrants need for clear information on costs and
need to provide price lists.
Dental patients as consumers
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The qualitative research identified a continuum of attitudes,
varying from a more ‘traditional’ attitude (unlikely to change
dentist or complain, to some who were ‘consumerist’.
Patients often held a mix of attitudes. In general, participants
thought that patients were becoming more consumerist, and
would want to exercise more choice were there circumstances
change (moving into a new area), they receive poor quality and
where there was media coverage of the quality of dentistry.
Participants saw a role for the GDC in facilitating patient to
make informed choices through information provision.
This evidence will be taken into account when considering
how to empower patients to make good choices by providing
better information about what they can expect
This is being used in the development of the new Corporate
Strategy.
ANNUAL SURVEY OF REGISTRANTS 2013: SUMMARY OF KEY FINDINGS AND ACTIONS TAKEN
Topic
The reputation of the GDC
Finding
Action taken/planned

A quarter of GDC registrants would speak highly of the GDC if asked, 14% would
be critical. 45% would remain neutral. Just one in 20 would speak highly or
critically without being asked. The strength of that agreement has weakened
since 2011, with the proportion who strongly agree declining for each of these
statements and the proportion who agree or neither agree or disagree increasing.

More than half of registrants agree that the GDC:
protects the patient (78%)
had a clear regulatory role (67%)
ensures standards are maintained (66%)
is trustworthy (61%)
is independent of registrants (50%)
acts in a fair and proportionate way (50%)
Promotion of the work of the GDC will continue and
increased contact with the GDC via the website, email and
press releases will be used to demonstrate the work of the
GDC.
The GDC will also assess how it consults with registrants
about changes in policy and will look at ways to make it
easier for registrants to respond.
This information was used to develop the ARF policy review
consultation document and will be used in communicating to
registrants how the ARF is spent.
Less than half of registrants agree that the GDC is:
consults and involves registrants (45%)
is independent of government(44%)
is efficient(44%)
is a powerful influencer of government policy (30%
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The burden/level of regulation
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The qualitative research that those who view the GDC as inefficient cited high
ARF, fitness to practice and central London location. Others find out difficult to
make a judgement as they do not know enough about what the GDC does.
Almost exactly the same proportions of dental professionals think that the level
of regulation is about right (45%) as those who think it is too much (46%).
Perceptions vary significantly by professional groups i.e. Dentists almost twice as
likely to think it is too much (61%) as hygienists (33%). There is a correlation
between length of time on the register and regarding the level of regulation as
too much.
This information will be used to inform the discussions at the
Tripartite Board between the NHSE, the GDC and the CQC to
ensure that there is a better understanding about patients
attitudes to regulation
This will be communicated to the DH who are looking at the
day to day burdens facing health professionals including
dentists as part of the cross-Government Red Tape
Challenge.
How in touch is the GDC with
registrant groups
The Annual Retention Fee and
cost effectiveness
Communication from the GDC
Written CPD Plans
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Appraisal, Evidence Types
(performance management
and continuing assurance of
fitness to practise)
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Registrants think that the GDC is more in touch with the views of Dentists and
patients than DCPs but the overall proportion of respondents who were in touch
with each dental professional group has risen compared with 2011
Overall, most registrants thought the ARF for dentist and DCPs was too high.
However, attitudes to the ARF for dentists are fairly evenly split with two in five
thinking that the ARF is too high, 39% thinking it about right and 4% thinking it is
too low. The proportion thinking it is too high has dropped by 7% since 2011.
60% think that the fee for DCPs is too high with 30% thinking it about right. The
number thinking it is too high has declined by 13% since 2013
A substantial majority of GDC dental professionals (71%) believe that the GDC
communicates effectively with them, an increase of 4% agreeing since 2011.
Dental hygienists were most likely to agree and dental technicians least likely
(43%). The GDC website (61%) and the GDC gazette were the most popular
methods for finding out about the GDC.
40% of dental professionals said that they had a written plan for the CPD that
they intended to carry out in the next year.
The qualitative research found mixed attitudes to a written plan with registrants
citing practical difficulties in developing and adhering to CPD plans or regarding it
as a ‘box ticking exercise. Others were sceptical about its value. Some registrants
thought that it would useful in encouraging registrants to take control of their
training and development and for newer registrants.
Registrants had taken part in the following during the last year
62% had taken part in Clinical Audit
53% in Case based discussion/ assessment
60% in a review of complaints and compliments
61% had participated in a an appraisal
57% in a review of significant events
We have instituted a series of regular stakeholder meetings
with the key DCP professional bodies to seek their views on
the GDC and how best to engage with the DCPs. We have
also introduced a programme of media activity in the DCP
media.
We are also looking at the most efficient way of engaging
with the most numbers of the DCPs.
This information was used to develop the ARF policy review
consultation.
Increased transparency of financial data, such as that
included in the ARF Level consultation is being used to
explain the need for the current and future fee levels.
The GDC website will be subject to a complete overhaul in
2015 (subject to business plan approval) to make it even
more accessible and relevant to registrants and the public.
More “interactive” Gazette editions are planned for the
future.
Survey responses considered as part of developing an Impact
Assessment for Enhanced CPD and triangulated with earlier
research findings relating to preparing written plans/personal
development planning. .
The survey responses are being triangulated with earlier
research findings provided by a Picker Institute Europe study
for the GDC in 2012. They will also be fed into a current
research study into performance management in dentistry
and how evidence from such periodic work place based
evaluations might contribute to a regulatory process for
continuing assurance of fitness to practice (revalidation).
Direct Access

Raising a Concern

Transition to independent
practice
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The number of DCPs who say they would provide services directly is 33% with
40% saying that they would continue to operate under a dentist’s prescription
and 27% saying they don’t know. Most who said they would take up the option,
would do within a year of the option becoming available (53%). The qualitative
research identified a number of barriers for DCPs in taking up Direct Access.
These were: a lack of confidence and experience, particularly for younger DCPs.
Public awareness they can book appointment directly was low. # GDC guidance
needs to be clearer in order to give DCPs the confidence that they had the skills
and experience required. There was a perception that there was a lack of training
available relating to Direct Access. There were concerns expressed difficulties in
providing Direct Access in the NHS and about restrictions about providing local
anaesthetics
The vast majority of dental professionals (88%) said they knew where to go if they
had a concern about poor standards of care. Nearly half of dental professionals
(46%) said they had come across an issue that they feel should have been raised
as a concern. Most registrants raised a concern in their place of work, rather than
with the GDC which was seen as a last resort. The vast majority of dental
professionals agreed that their workplace was a place where staff could raise
concerns openly, concerns are taken seriously, are investigated effectively and
that a justified concern would not be held against them. However those who had
raised a concern were about twice as likely to disagree with the statement as
those had not raised a concern. The qualitative research found that experience
of raising a concern was mixed. Some were effectively resolved while other felt
ostracised and the experience had meant that they would not raise a concern
again. DCPs may be concerned about the consequences of raising concerns on
their employment.
72 % of those who registered in the last five years, were confident about their
preparation for independent practice as a safe beginner while a quarter were not
confident. Of the 72%, only 16% said they were very confident.
Fed into the first year evaluation of Direct Access policy and
implementation.
Direct access information including FAQs for registrants being
reviewed for clarity. Audit of radiography training provided at
various DCP schools being undertaken. Ongoing discussions
with DCP organisations encouraging them to help get
messages across to their members
Further research to understand the barriers and enablers to
raising a concern to be commissioned in Autumn 2014.
Further guidance for registrants will be produced if the
research shows that it would be helpful. There will also work
carried out with FtP and involving the professional
associations to look at how registrants who do raise concerns
can be better supported
In 2013, The council conducted a review of competency of
newly qualified dental graduates and their suitability to
practice independently. The review found that there was not
sufficient evidence or risk to patients to take regulatory
action but to keep these issues under review. These findings
will be fed into the report to Council in Q3 on the outcome of
the review.
Workplace inspections
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The current NHS contract in
England and the new NHS
dental contract.
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69 % had undergone one or more external inspections at their workplace during
the last two years while one third of dental professionals reported that they had
more than two inspections (2%) had five or more. This varies across the
profession. Dental practices were most likely to have an inspection (42%)
compared while 43% of dental laboratories and 16% of community dental
services hadn’t had any inspection. 79% of those who one or more inspection
thought that it had been effective.
In general, participants in the qualitative research viewed inspections as effective.
However many, were critical of CQC/HIW inspections which they felt did not
focus on the most important areas that impacted on patient safety and seen as a
process driven ‘box ticking’ exercise rather than a thorough clinical inspection
and there was a lack of dental expertise among inspectors. PCT and Denplan
inspections were more favourably regarded.
In qualitative research, Dentists were critical of the current contract, particular
that Units of Dental Activity (UDAs) as it disincentivised complex work as it would
have to be done at a loss or encourage dentists to play the system and
encouraged supervised neglect of patient’s oral health. The new contracts focus
on preventative dentistry and on taking a holistic approach rather than ‘drill and
fill’ was welcomed. However, there was concern that their time taken to carry out
oral health assessments means fewer appointments or longer opening hours but
for the same financial reward. Some dentists were concerned that the new
contract had confusing financial mechanisms and has a lack of time management
built in.
There was a perception that the increased roles of DCP’s could ‘erode’ the
authority of dentists and that it could reduce demand for their services as
preventative work could be carried by DCPs.
This information will be used to input into our discussions
with the Care Quality Commission as a member of their
Dental Reference Group on their model of regulation and
also our membership of the HIW reference group on dental
regulation.
To be fed into project that considers the potential impact of
the new contract on professional behaviour. It will also
consider how these changes impact on the performance and
accountability arrangements for NHS dentists and the impact
of this on the regulation of dental registrants.
To be fed into the GDC response to the DH’s consultation on
the NHS contact.
Evidence considered as part of evaluation of Direct Access.