General Dental Council Feedback from Workshop Edinburgh 23rd March 20 Final Report 27 th April 20 www.srcentre.co.uk F I N A L Page
DISCLAIMER This report has been prepared for and only for the General Dental Council (GDC) in accordance with the terms of reference specified to Social Research Centre s (SRC) in January 20 and for no other purpose. The opinions expressed by the participants in this consultation are strictly those of the person (Dentist or Dental Care Professional (DCP)) who gave them and not SRC. SRC does not accept or assume any liability or duty of care for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing. For convenience, this document may have been made available in electronic as well as hard copy format. Multiple copies and versions of this report may therefore exist in different media. Only the final hard copy should be regarded as definitive. www.srcentre.co.uk F I N A L Page 2
Section CONTENTS Page No EXECUTIVE SUMMARY 4 2 INTRODUCTION AND BACKGROUND 5 3 TERMS OF REFERENCE AND METHODOLOGY 6 4 WORKSHOP STRUCTURE 7 5 KEY FINDINGS FROM THE WORKSHOP 8 6 KEY CONCLUSIONS 22 7 NEXT STEPS 22 Appendices: A Summary Information on the Event for Dentists and DCPs B- Scenario Used for Deliberation and Workshop Schedule C- Presentations used by GDC Audio CD To be dispatched separately www.srcentre.co.uk F I N A L Page 3
. EXECUTIVE SUMMARY. BACKGROUND The General Dental Council (GDC) wished to consult with Dentists and Dental Care Professionals (DCPs) in the UK about the possible content for the new standards that are being developed for Dental Professionals. As part of this, four workshops were scheduled across the UK Belfast, Birmingham, Edinburgh and Cardiff. This report sets out the findings from two-hour workshop which took place in Edinburgh on 23rd March 20. The workshop was part of a wider evening event for Dentists and DCPs (See Appendix A)..2 TERMS OF REFERENCE The Social Research Centre www.srcentre.co.uk was appointed by GDC in January 20 to collaborate on the design of a suitable discussion schedule for all four workshops; independently facilitate the sessions; and report the key findings from them..3 SUMMARY OF METHODOLOGY The workshops in Belfast (2 th January 20) and Birmingham (7 th February 20) identified a common core set of themes for the standards. It was mutually agreed that the workshops in Edinburgh and Cardiff, (scheduled for 25 th May 20) would build on the outcomes from the earlier workshops by inviting Dentists and DCPs to deliberate on a scenario, and through this, to identify appropriate themes and possible wording for the new standards. (See Appendix B for details of the scenario devised)..4 KEY FINDINGS The feedback from the workshop suggests that the following 5 themes merit for consideration within the forthcoming standards:. Altruism 2. Communication 3. Transparency 4. Honesty 5. Freedom of Choice 6. Professionalism 7. Dignity 8. Patients Interests 9. Guaranteed Standards 0. Patients Rights. Informed of Cost of Treatment Package 2. Professional Standards for All 3. Two-Way Street 4. Open and Honest Contract 5. Complaints Handling www.srcentre.co.uk F I N A L Page 4
2. INTRODUCTION AND BACKGROUND 2. BACKGROUND AND RATIONALE The existing Standards for dental Professionals were developed in 2006. Much has changed since then and the GDC considered it was timely to update them. In addition, the current standards were developed with input from Dentists only. (In the past, DCPs were not required to register with the Council). Now that DCPs are registrants of the GDC, it was considered essential to include their voice in shaping the new standards. Consequently, the GDC organised a series of events, in each of the four nations of the United Kingdom, to which Dentists and DCPs were both invited. (See below and Appendix A). The 2-hour workshop, which was designed to seek views on the new standards, was part of this larger event. See : http://www.gdc-uk.org/nr/rdonlyres/b66d84-a97-4253-b33- A2DB7F3254DC/0/StandardsforDentalProfessionals.pdf www.srcentre.co.uk F I N A L Page 5
3. TERMS OF REFERENCE AND METHODOLOGY 3. TERMS OF REFERENCE The Social Research Centre www.srcentre.co.uk was appointed by GDC in January 20 to: Collaborate on the design of a suitable discussion schedule for all four workshops; Independently facilitate the sessions; and, Report the key findings from them. 3.2 SUMMARY OF METHODOLOGY GDC adopted a two-stage approach as follows: Stage Exploration of the Issues Via open Questions The Belfast and Birmingham workshops used a common framework and format and, following presentations from GDC representatives, consisted mainly of open questions through which SRC facilitated the identification of the key issues for Dentists and DCPs. Dentist and DCPs worked together in small groups to shape the standards. Each group had a mixture of Dentists and DCPs. Then, using an Electronic Audience Response System (EARS), SRC was able to gauge the relative priority of these themes (i.e. as perceived by Dentists and DCPs.) 2 However, it was clear from the similarity in the nature of the findings between Belfast and Birmingham and in the ranking of the themes emerging - that a further workshop in this format was unlikely to yield new insights. Hence, it was mutually agreed (GDC and SRC) that SRC would adopt a different approach for the remaining two workshops Edinburgh and Cardiff. Stage 2 Exploration of the Issues Via a Scenario This involved inviting Dentists and DCPs to deliberate on a scenario 3, (See Appendix B) and through this, to identify appropriate themes and possible wording for the new standards. 2 For further details, see the individual reports on the Belfast and Birmingham workshops respectively 3 For further details, see the individual reports on Edinburgh and Cardiff and details of the scenario used. www.srcentre.co.uk F I N A L Page 6
4. WORKSHOP STRUCTURE 4. PROFILE OF THE PARTICIPANTS The workshop was attended by 7 Dentists and 27 DCPs. 4.2 PRESENTATIONS FROM GENERAL DENTAL COUNCIL The interactive part of the workshop was preceded by two short presentations from representatives of the GDC: - A Review of the Standards Janet Collins Head of Research; and, - Hearing the Messages Patient and Public Opinion Guy Rubin Research Manager. (See Appendix C for copies of the slides and Audio CD for a voice record of the presentations given). 4.3 THE SCENARIO FOR DELIBERATION SRC then facilitated participants to respond to a specific scenario involving a series of interactions between a patient ( Mrs Smith ) and a dental practice. (See Appendix B for details). The scenario was set out in four parts and in each part, participants were invited to consider and document: THOUGHTS In this situation, what is Mrs Smith likely to be thinking? / expecting? ISSUES - Thinking about the new standards, what issues do these thoughts / expectations raise for you as Dentists and DCPs? Name up to three and write each key issue as a single word as a foundation stone? YOUR SUGGESTION FOR THE STANDARD Select one of the issues you have identified and write a single sentence that would help dentists and DCPs deal appropriately with this issue in a real life situation like this. SRC provided a worked example in advance and participants were encouraged, as far as possible, to identify a unique issue for each part of the scenario. The key findings are set out in Section 5 below. (A voice record of the feedback can also be found on the Audio CD). www.srcentre.co.uk F I N A L Page 7
5. KEY FINDINGS FROM THE WORKSHOP 5. OVERVIEW The tables below summarise the feedback across all 4 groups in relation to each part of the scenario. The most prominent points (i.e. the most frequently cited points across all four groups in relation to each scene) is shown below in bold. Mentions (i.e. points raised by or 2 groups) are shown below the shaded bar. 5.2 SCENE THE ADVERT 5.2. Stimulus The following slide was presented and registrants responded as shown below: www.srcentre.co.uk F I N A L Page 8
5.2.2 Summary of Patient Thoughts / Feelings / Expectations Patient s Thoughts / Feelings / Expectations Cited by this number of groups Cost implications wants to know this 4 Expectations of treatment NHS or Private? 4 Male or female dentist 2 Does the dentist treat children / family? 2 Qualifications / experience/ specialisations 2 o Accessibility - Opening hours (out of office hours?) - Appointment availability? - Disabled access? - Parking? - On a bus route? Previous dental records accessed? 2 2 Apprehension / anxiety re 5 year (lapse) / Wants reassurance that she will have healthy teeth and it won t hurt. Wants to be welcomed Number of patients at the Practice? Type of treatment available - Experience coping with phobic patients? - Sedation? - Cosmetic? - White fillings on the NHS? - Access to NHS Hygienist Reputation of the Practice / individual dentists www.srcentre.co.uk F I N A L Page 9
5.2.3 Summary of Key Issues for Dentists and DCP (across all 4 groups) Issues Arising for Dentists/DCPs Cited by this number of groups Compassion - re approach / empathy 2 Transparency Expect honest, truthful information 2 Professional standards (re range of evidencebased treatments including alternative therapies) 2 Consistency Confidence Integrity Care Altruism Communication (Dental Team s approach to providing empathetic and holistic care) Infrastructure (Facilities as accessible as possible) Competence Registered, trained Allow patient to make an informed choice Availability of appointments www.srcentre.co.uk F I N A L Page 0
5.2.4 Foundations Suggested Wording for New Standards ALTRUISM The whole dental team should demonstrate a consistent, compassionate approach that will instil confidence in the patient who will consider the dental team to demonstrate true professional altruism and integrity, giving them confidence in the care they will receive. COMMUNICATION - [The Dental team] needs to listen to the patient and act on it. TRANSPARENCY - [The Dental team needs to] engage with the patient to provide and gain as much information as possible. HONESTY - Patients expect [and should expect to get] honest, truthful and accurate information in relation to all advertising and published information in relation to a dental practice. www.srcentre.co.uk F I N A L Page
5.3 SCENE 2 TREATMENT REQUIRED 5.3. Stimulus The following slide was presented and registrants responded as shown below: www.srcentre.co.uk F I N A L Page 2
5.3.2 Summary of Patient s Thoughts / Feelings / Expectations Patient s Thoughts / Feelings / Expectations Cited by this number of groups Intimidated - Pressurised - Need time to decide - No time to consider 4 Threatened / Coercion Go elsewhere! 2 Vulnerable / Where else can I access care? 2 Confused - Is white filling NHS? - Is this in my best interests? - Misled / Was advert about NHS places a loss leader to sell private treatment? Informed choice An assumption the filling is necessary Valid if patient was in pain? Options? No NHS option Too little information on options 2 2 2 Want second opinion Disappointed Angry Belittled Abandoned (told to go away) Wants assurances about quality Trapped www.srcentre.co.uk F I N A L Page 3
5.3.3 Summary of Key Issues for Dentists and DCPs Issues Arising for Dentists/DCPs Cited by this number of groups Lack of integrity / honesty 3 Right to informed choice - Misleading information - Patient should be given sufficient time to consider the treatment options - Enough information should be given to the patient so they can make a decision. 3 Communication 2 Professionalism - Patients must be treated with respect throughout their experience Unethical - Patient must not be disadvantaged by their decision making 2 2 Duty of care Choices Dismissive behaviour 5.3.4 Foundations Suggested Wording for New Standards FREEDOM OF CHOICE The Dental Professional must offer all patients options, taking into consideration the patient s needs and preferences. PROFESSIONALISM The Dental Professional should offer patients a range of alternatives and act on their preferences INFORMED CHOICE Decisions should be made in partnership [with the patient] for appropriate treatment, based on ethical and professional standards. DIGNITY The Dental Team should respect the decision of the patient and treat them with dignity at all times www.srcentre.co.uk F I N A L Page 4
5.4 SCENE 3 THE DISTRESS PURCHASE 5.4. Stimulus The following slide was presented and registrants responded as shown below: www.srcentre.co.uk F I N A L Page 5
5.4.2 Summary of Patient Thoughts / Feelings / Expectations Patient s Thoughts / Feelings / Expectations Embarrassed - How can I pay this? - Told by receptionist, embarrassed in public - Feels stupid - I should have asked about the cost?; Is this my fault?; Should I have asked? Cited by this number of groups 4 Misled - Advert was misleading - I didn t know it would be this much! - Lied to / cheated / deceived - Loss of trust Angry - Why was I not told about the cost before the treatment? 4 3 Upset / Tearful 2 Regrets her choice 2 Complain? Who can I complain to? 2 Disappointed Stunned / Disbelief Panic www.srcentre.co.uk F I N A L Page 6
5.4.3 Summary of Key Issues for Dentists and DCPs Issues Arising for Dentists/DCPs Communication / Information - Poor communication - Clarification of NHS dental versus private treatment - Need to provide written estimates and patient consent Cited by this number of groups 4 No informed consent 3 Integrity? / Honesty 2 No freedom of choice Open / transparent? No compassion shown to patient No altruism Greed Consumer has right to walk away and demand refund No treatment plan 5.4.4 Foundations Suggested Wording for New Standards PATIENTS INTERESTS The Dental Professional should always put the patients needs before any financial gain. GUARANTEED STANDARDS The new standards should include a guaranteed standard for patient treatment and clarity of[patient] rights PATIENT RIGHTS The patient should be informed of the cost of treatment, with a written record prior to the commencement of the treatment. INFORMED OF COST OF TREATMENT PACKAGE The patient should be given a clear treatment plan, including details of specific NHS and private care to allow them to give informed consent. www.srcentre.co.uk F I N A L Page 7
5.5 SCENE 4 THE COMPLAINT 5.5. Stimulus The following slide was presented and registrants responded as shown below: www.srcentre.co.uk F I N A L Page 8
5.5.2 Summary of Patient s Thoughts / Feelings / Expectations Patient s Thoughts / Feelings / Expectations Cited by this number of groups Angry / Upset 3 Misled / Cheated / Deceived 3 Lost Where do I go now? (Health Board, Citizens Advice, Trading Standards 3 Let down / used 2 Frustrated A victim Stupid / blames herself Bullied Frightened Vulnerable feels like the situation is outside her control That s final Never go back to that Dentist again! www.srcentre.co.uk F I N A L Page 9
5.5.3 Summary of Key Issues for Dentists and DCPs Issues Arising for Dentists/DCPs Cited by this number of groups Complaints procedure No procedure or knowledge of procedure There should be a clear understanding of patients rights Should be an open complaints procedure. Include within Patient (Bill of) Rights a section on How to Complain All staff should be aware of the complaints procedure 4 2 Behaviour issues re staff /Lack of staff training 4 Honesty / Misrepresentation (re Advert and NHS) 3 Morals and ethics code broken Duty of care towards patient How to make good the damage Offer an appointment? Make good the treatment www.srcentre.co.uk F I N A L Page 20
5.5.4 Foundations Suggested Wording for New Standards PROFESSIONAL STANDARDS FOR ALL The GDC professional standards should apply to all members of the Dental Team [not just the Dentist. TWO-WAY STREET Patients should understand their right to complain and the process for doing so and the Practice must understand and fulfil their obligations under the process OPEN AND HONEST CONTRACT There should be an open and honest contract between the Patient and the Practice with full access to the complaints procedure. COMPLAINTS HANDLING A clear complaints policy should be available to patients on request. All [matters pertaining to a complaint] should be responded to in a timely manner. www.srcentre.co.uk F I N A L Page 2
6. CONCLUSIONS The feedback from the workshop suggests that the following 5 themes merit for consideration within the forthcoming standards:. Altruism 2. Communication 3. Transparency 4. Honesty 5. Freedom of Choice 6. Professionalism 7. Dignity 8. Patients Interests 9. Guaranteed Standards 0. Patients Rights. Informed of Cost of Treatment Package 2. Professional Standards for All 3. Two-Way Street 4. Open and Honest Contract 5. Complaints Handling 7. NEXT STEPS The GDC proposes that the results from this, and the earlier workshops, will be drawn upon in developing the new standards and considered by the Standards Review working group. SRC will prepare a short summary report from all the four workshops highlighting the key themes identified. GDC is providing further opportunities to comment and contribute to the new standards during 20, and details are available on the Consultation and Standards pages of the website. See: http://www.gdcuk.org/aboutus/researchandconsultations/pages/default.aspx www.srcentre.co.uk F I N A L Page 22