APPENDIX ONE: SUMMARY TABLE OF SURVEY FINDINGS AND ACTIONS TAKEN ANNUAL PATIENT AND PUBLIC SURVEY 2013: SUMMARY OF KEY FINDINGS

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1 APPENDIX ONE: SUMMARY TABLE OF SURVEY FINDINGS AND ACTIONS TAKEN ANNUAL PATIENT AND PUBLIC SURVEY 2013: SUMMARY OF KEY FINDINGS Topic Finding Action taken/planned Awareness of the GDC 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 Attitudes to regulation Confidence about dental regulation (77%) is high, and higher than regulation in general (71%) and healthcare regulation (70%) 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. 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

2 Adherence to GDC standards 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. Two thirds felt they were clear about what treatment was available through the NHS and what was treatment would have to be received privately. 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. Complaining about a dental professional 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. 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 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

3 Choosing a dental practice 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. Dealing with poor care or wrongdoing 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

4 Providing an explanation 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) Specialists 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 Overseas dental professionals 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 Dentistry as a business 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 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.

5 Dental patients as consumers 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.

6 ANNUAL SURVEY OF REGISTRANTS 2013: SUMMARY OF KEY FINDINGS AND ACTIONS TAKEN Topic Finding Action taken/planned The reputation of the GDC 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%) 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% Promotion of the work of the GDC will continue and increased contact with the GDC via the website, 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. 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. The burden/level of regulation 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.

7 How in touch is the GDC with registrant groups 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 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. The Annual Retention Fee and cost effectiveness 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 % 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 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. Communication from the GDC A substantial majority of GDC dental professionals (71%) believe that the GDC communicates effectively with them, an increase of 4% agreeing since 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. Written CPD Plans 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. Appraisal, Evidence Types Registrants had taken part in the following during the last year (performance management 62% had taken part in Clinical Audit and continuing assurance of 53% in Case based discussion/ assessment fitness to practise) 60% in a review of complaints and compliments 61% had participated in a an appraisal 57% in a review of significant events 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 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).

8 Direct Access 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 Raising a Concern 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. Transition to independent practice 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 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.

9 Workplace inspections 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. The current NHS contract in England and the new NHS dental contract. 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.

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