Item 5 Council 18 September 2014

Transcription

1 Item 5 Council 18 September 2014 Report on the outcome of the Consultation on the Annual Retention Fee Level for 2015 Purpose of paper Action Private / Public Corporate Strategy Business Plan 2014 Decision Trail Recommendations To report on the outcome of the consultation on the Annual Retention Fee (ARF) level for 2015 To consider Public Deliver cost effective regulation, ensuring maximum efficiency without loss of patient protection Set the annual retention fee at the rate required to deliver regulation of dental professionals, which is balanced over the planning period The Council approved 18 June 2014 the policy approach to the setting of the ARF for Dentists and Dental Care Professionals (DCPs) in the future The Council is invited to: a) consider this paper and attachments; b) note that an independent review of the assumptions underlying the ARF increase proposal is being conducted by KPMG. Authorship of paper and further information Appendices Graham Masters, Director of Finance & Corporate Services Annex 1: Data analysis of responses to consultation Annex 2: Graph of consultation responses Annex 3: Detailed consultation responses Page 1

2 Executive Summary 1. This paper sets out details of the level of response to the consultation on the ARF level, and the key themes arising from it. The consultation ran from 30 June until 4 September 2014.There were 4474 responses in total, 3813 from Dentists, 381 from DCPs, 71 from Dental & DCP students and 209 from other organisations as set out in Annex On 18 June 2014 the Council approved a consultation on the following proposed fee levels for 2015: 945 for dentists and 128 for DCPs. The proposed levels were based on the most up to date information relating to key drivers of costs, including fitness to practise caseload. Throughout the 8 weeks of the consultation, the executive has continued to monitor key drivers of cost and in order to test that assumptions are sound and to finalise a budget for 2015 budget process. In addition, an independent review of those assumptions has been commissioned from KPMG. 3. Analysis of responses was undertaken throughout the consultation and continues in relation to a small number of highly detailed responses received from organisations at the close on 4 September or afterwards. 4. A further report, including the findings of the independent review will be presented to the Council on 30 October 2014, at which point the fee level for 2015 will be set. Background 5. The GDC is required under Section 19 of the Dentists Act 1984 to levy a charge on registrants in order to fund the delivery of our statutory functions. 6. The Annual Retention Fee (ARF) policy was subject to a review over the past 18 months and a number of recommendations were made to the Council in December 2013, with the intention of ensuring that there is clarity about the principles which the GDC applies when setting the ARF. 7. In June 2014 the Council confirmed that following the review of the ARF policy, which was the subject of a full consultation 1, the ARF would be based on the following principles: That registrant groups are charged according to how much it costs the GDC to regulate them; That payment of the annual fee provides registrants with a right to practise ; That the income and individual circumstances of registrants are not taken into account when determining the fee levels for individual registrants. 8. The consultation on the 2015 Annual Retention Fee (ARF) level took into account the approved ARF Policy and also comments received as part of the consultation on the (ARF) Policy, which closed on 4 June Report on the outcome of the consultation on the Annual Retention Fee Policy: %20of%20the%20consultation%20on%20the%20ARF%20policy.pdf Page 2

3 9. The ARF has been frozen for four years. Since the last increase, in 2010, there has been a 110% increase in the number of Fitness to Practise complaints received by the GDC. This unprecedented increase is the primary driver of need for additional resources. 10. The consultation paper on the ARF level set out our estimate of need to raise an extra 18.0 million in fee income to handle the volume of complaints and consequent Fitness to Practise proceedings anticipated in 2014 and This meant that the ARF level for dentists needed to increase to 945 a year and for DCPs to 128, a 64% and a 6.7% increase respectively. The consultation document was ed to all GDC registrants and articles were placed in the dental press, and in the Gazette which is sent to all registrants. We also notified stakeholders, including the professional associations in advance of the consultation and sent reminder s throughout the consultation period. Respondents were given the opportunity to answer YES/NO questions as well as to provide answers in free-text. What we heard 11. We received 4,474 responses in total, including responses from the following professional associations and organisations on behalf of their members and two defence organisations: Associations and organisations a. British Dental Association (BDA) b. British Society of Dental Hygiene and Therapy (BSDHT) c. Dental Technologists Association (DTA) d. Royal College of Surgeons of Edinburgh e. Dental Laboratories Association f. British Association of Clinical Dental Technology g. British Academy of Cosmetic Dentistry h. The Scottish Young Dentists Society i. British Society of Paediatric Dentistry Defence organisations j. Dental Protection Limited k. MDDUS 12. Detail on the breakdown of responses to the consultation can be found at Annex 1 and 2. In summary there were 4,474 responses, of which 85% were from dentists and 8.6% from dental care professionals (DCPs). Of those who responded, 2428 left comments of which 23% suggested savings which could be made; 42% included notes, queries and information requests; 9% requested flexible payment of the ARF by instalments. Some 130 respondents commented on the Dental Complaints Service advert in the Daily Telegraph. Other topics included opportunities for local resolution of complaints, no win no fee for hearing costs, relocation out of Central London and whether the GDC is fit for purpose. Page 3

4 13. Towards the end of the consultation process we also received detailed responses from the BDA, along with comments from Dental Protection and MDDUS. The BDA s submission contained detailed requests for further information, much of which is provided in the 2015 budget proposals. The remainder is being collated. 14. The consultation submissions from the professional associations and organisations can be summarised as follows: a) British Society of Dental Hygiene and Therapy (BSDHT) The BSDHT agreed that the GDC had provided a clear account of our resource needs for 2015 but thought that the GDC should provide more detail on FTP panel costs and whether these could be reduced. It agreed with the proposed fee levels for DCPs and Dentists. It agreed that we had set out how we would keep costs under control. b) British Association of Clinical Dental Technology (BACDT) The BACDT agreed that we had provided a clear account of our resource needs for It stated that further information should be provided to registrants about why costs had increased and what is being done to reduce costs. It raised questions about the adequacy of financial planning. It questioned the use of an advert promoting the Dental Complaints Service (DCS), expressing concern that this may drive up the number of complaints we would receive. It didn t agree that we had explained how we would keep costs under control. It agreed with the proposed level of the DCP ARF. It disagreed with the proposed level of the Dentists ARF. c) Dental Laboratories Association (DLA) The DLA agreed that we had provided a clear account of our resource needs. It stated that more information should be provided on the costs of FTP and referred to an increase in what it claimed were unjustified claims against dentists. It disagreed that we had provided a clear account of what we were doing to keep costs under control. It disagreed with the proposed fee level for Dentists and agreed with the proposed fee level for DCPs. d) Dental Technologists Association (DTA) The DTA agreed that we had provided a clear account of our resource needs and that we have provided a clear account of what we are doing to keep our costs under control and agreed with the proposed fee level for Dentists and DCPs. e) British Academy of Cosmetic Dentistry (BACD) The BACD disagreed that we had provided a clear account of our resource needs for It stated that we were not doing enough to reduce costs. It disagreed that we had provided a clear account of what we are doing to keep our costs under control. It agreed with the proposed fee level for DCPs. It did not agree that a 64% increase for Dentists was appropriate. Page 4

5 f) The Scottish Young Dentists Society (SYDS) The SYDS stated that we had not provided a clear account of our resource needs for Its view was that a fee increase could not be justified and that any increase would deter individuals from entering the profession. It stated that young dentists would not invest in education and training because of the need to pay a higher ARF. It said that the high costs of registration might also deter dentists with young children from returning to work. It disagreed that we had provided a clear account of what we are doing to keep costs under control and opposed the proposed increased fee for Dentists and DCPs. g) British Society of Paediatric Dentistry (BSPD) The BSPD disagreed that we had provided a clear account of our resource needs in It asked for a reduced ARF rate for specialty trainees as they pose less risk to the public. It sought data that details the FTP costs for Trainees in all specialties and in Paediatric Dentistry. It also raised questions about the Specialist fee level and whether this would increase. It sought a subsidised or reduced ARF for young dentists and trainees. It disagreed that we had set out a clear account of what we are doing to keep our costs under control and disagreed with the proposed increased fee for Dentists and DCPs. h) The Royal College of Surgeons Edinburgh (RCS Edinburgh) The RCS Edinburgh disagreed that we had provided a clear account of our resource needs in It stated that it could not see the reasons why a 64% increase in the ARF is necessary and suggested instead an increase in line with inflation. It expressed a desire for more information on the costs of FTP panels and the factors behind the rise in the number of complaints. It disagreed that we had set out a clear account of what we are doing to keep our costs under control and disagreed with the proposed increased fee for Dentists and DCPs. i) The British Dental Association (BDA) The British Dental Association submitted a response consisting of 3 documents a study undertaken by Financial Analysts FTI of the business case for the proposed ARF increase, and a witness statement by Peter Ward the Chief Executive Officer and a draft application for judicial review. The main points raised in the witness statement of the CEO of the BDA are as follows: i) The BDA considers that it has been deprived of important information which would be material to making an informed and intelligent response to the consultation. It claims that the information - in particular with respect to the validity of the financial propositions contained in the consultation document - is materially misleading or inadequately explained and that it provides no proper justification for the proposed fee increases. ii) It sets out a series of requests for further information which would be needed as a minimum to allow an effective and intelligent response. It states that the Page 5

6 assumptions within the consultation document are not justified and that the GDC s reasoning which flows from these assumptions is therefore not justified. iii) It states that the 2014 policy statement which was produced following the consultation on the ARF policy does not fulfil the requirements of a clear and transparent policy against which the proposed fee increase can be justified. iv) It states that the information that was supplied was in significant respects misleading and suggestive of pre-determination. v) It questions whether the GDC s reserves may be used to address any funding gap and whether the GDC has explored all the possible avenues available to it to address a funding gap. vi) It disagreed that we have provided a clear account of our resource needs for 2015, it provides, in the FTI report, a list of information that it says would be useful in determining whether a fee increase, as proposed, is objectively justified. vii) It disagreed that we had provided a clear account of what we are doing to keep costs under control. It disagreed that the proposed fee for Dentists should be 945 and that the ARF for DCPs should be 128. j) Dental Protection Dental Protection did not submit an online response to the consultation and so did not answer the consultation questions directly. Instead it provided a separate note which covered the following issues: i) It does not consider that the GDC s approach to regulation is right touch and proportionate. ii) It considers that the GDC needs to reassess its approach to fitness to practise. iii) It does not consider that there has been an increase in complaints to the GDC (i.e. in the form of allegations) but rather an increase in the amount of information that the GDC receives about registrants but which may not amount to an allegation. iv) It considers that many organisations are referring issues to the GDC to avoid costs to themselves and that the GDC should be firmer. v) It says the GDC should place more emphasis on complaints being resolved at local level. vi) It sees no evidence that the GDC has sought to reduce its expenditure. vii) It questions several aspects of the early stages of the GDC s fitness to practise process, claiming that too many dentists are being investigated, there are too many referrals to the Interim Orders Committee; and too many cases are inappropriately deemed misconduct. It concludes that the GDC should cut its cloth accordingly and reduce the number of nonsense cases. Page 6

7 k) Medical and Dental Defence Union of Scotland (MDDUS) The MDDUS did not feel that we had provided a clear account of our resource needs for 2015 or provided a clear account of keeping costs under control. It did not agree with the fee levels for dentists and DCPs. Its other points included: i) It expressed disappointment that the GDC had decided that the only option was to increase significantly the ARF for Dentists and to increase, in modest terms, the ARF for Dental Care Professionals. It suggested that we should have investigated other options, other than to increase the ARF, as well as taking time to review areas of inefficiency where costs savings could be made. ii) It said the GDC should investigate the costs of Fitness to Practise hearings and look at savings by de-centralising the GDC s Fitness to Practise processes out of central London. iii) The GDC should attempt more local resolution iv) The GDC should review the performance of staff in its fitness to practise department. It questioned the costs of Quality Assurance of Education and Training at the GDC v) It questioned whether the Dental Complaints Service should be funded by the GDC. vi) It said the GDC should reflect on the criticisms by the Professional Standards Authority and improve where necessary. Review of the ARF level consultation 15. Responses to the consultation on the ARF level were monitored from the start. Within two weeks of the consultation opening we had received 3463 responses (77% of the final total). The tone of the responses did not significantly change as the weeks progressed. This consistency enabled us to commence our evaluation in early August. A small number of highly detailed responses were received at the close of the consultation period and the evaluation of these continues. 16. Throughout the consultation also, we monitored a number of external petitions and channels of discussion about the proposed ARF increase. Within the first two weeks of the consultation being open the HM Government ARF GDC e-petition (mostly representing dentists) secured signatures (89% of the total at 4 September). A Drop the annual fees (mostly representing Dental nurses e-petition) secured 1078 signatures (96% of the total at 4 September). There were also active discussions on online forums. Given that we were seeking a substantial increase in the ARF, as expected a significant proportion of responses and comments were very negative of the GDC s proposals to increase the ARF. 17. In addition, during the consultation period, we received 178 Freedom of Information (FOI) requests, of which we estimate over 75% related to the proposals to increase the ARF. The FOI requests were generally seeking clarification of information presented in the ARF level consultation or other details relating to GDC finances and management. A significant proportion of the requests related to information that was already publicly available in the GDC Annual Report & Accounts and the majority of the additional information that was provided by the GDC has subsequently been Page 7

8 quoted directly on public websites or used to support debate in the outlets noted above. 18. The responses to the consultation question 1, 3, 4 and 5 (YES/NO questions) are set out in Annex 1. The responses reflect strong opposition by dentists to the proposed significant ARF increase. 19. Generally free text responses [Annex 3] to the consultation noted a desire for additional information, much of which was already in the public domain. However, we have aimed, through responses to FOI requests to augment the information available. Some further information, as requested in the BDA response on 4 September, is being collated. 20. A copy of the full consultation responses (including from professional associations and organisations) has been given to the Council members. Independent review of assumptions 21. KPMG has been commissioned to review the full range of assumptions underlying the proposal to raise the ARF. This will focus in particular on the projected fitness to practise caseload and is aimed at providing the Council with assurance that the financial and operational assumptions have been reasonably and professionally prepared. A preliminary report from KPMG is due to be received in early October with a final report by mid-october. Recommendations 22. The Council is invited to: a) consider this paper and attachments; b) note that an independent review of the assumptions underlying the ARF increase proposal is being conducted by KPMG. Page 8