This could be taken as a limited focus on quality, but there are a number of themes in the strategy that relate to improvement and safety:
1. Reducing Fear: The GDC strategy recognises what they term ‘a climate of fear’, particularly in relation to fitness to practice. This is important, because staff who do not feel they will be treated fairly avoid reporting problems. Systems that produce problems tend to keep on producing problems, so if staff are frightened to discuss something, the issue is unlikely to be resolved.
Most quality and safety problems involve more than one person. Creating a Just Culture where people feel they will be treated fairly increases willingness to share and may reduce burnout.
2. Recognition that Dentistry is Changing: The report notes both the increase in cosmetic dentistry, and the changes in technology. Surprisingly, the rise of AI is not mentioned directly. The strategy does acknowledge how quickly ‘innovations in digital diagnostics, treatment planning, record keeping, and patient communication’ are happening. The GDC will have to engage with AI in the same way as other organisations, such as Dental Protection are doing, but recognising the speed of change is a good start.
These rapid changes offer benefits, such as better record keeping; improved communication with patients and suppliers; improved diagnostics, and reduced waiting times because of innovations such as 3D printing. The downside is that none of the technologies are, or can be, perfect. Some of the errors in AI supported notes and charting are very difficult to spot and problems with AI supported diagnostics will be similarly challenging. Universities are beginning to include training with and on AIs in their curriculum, but practicing dentists will struggle to keep up with developments.
Other organisations are helping with this. Dental Protection have produced a useful guide on using AI in dentistry. Developments in dentistry have often happened over years: the speed of change now is so fast that the GDC may need to review its processes and guidance to ensure it is keeping abreast of the changes. The strategy states that the GDC will ‘effectively regulate innovation in dentistry‘ but change is happening so quickly that this will be an enormous challenge.
3. Taking account of inequalities: The strategy acknowledges that the dental workforce, and the provision of dental services, is changing in the UK. The number of private dental practices has increased, and the proportion of NHS work in mixed practices has decreased. This risks creating ever larger inequalities in dental care access. Access is a key component of service quality. There is a limit to what the GDC can do about this – most of the levers for change lie with Government – but identifying the risk and keeping track of it is a start.
4. Safety II: Theorists sometimes talk about Safety I – identifying patterns in problems that have already occurred, and taking steps to prevent future occurrence – and Safety II. Safety II is the idea that most care is right most of the time, and that this happens mainly because staff adapt to problems as they occur. Safety II suggests that working out how people manage to avoid problems is at least as useful as cataloguing existing errors. This is not as clearcut a divide as it sounds, but the GDC strategy comments that they will:
Promote patient safety by focusing on what
makes things go right, and how this can be
applied in different contexts
This seems a positive recognition from the GDC that patient safety is affected by culture and organisational systems and behaviours as well as by individual clinical competence. If so, this opens up additional avenues of problem analysis and of training for the GDC and hopefully for its influence on undergraduate training.
5. Continuous Improvement: There is no detail, but the strategy comments that the GDC will:
Help to foster a learning culture, promoting
and encouraging good practice and
continuous improvement to achieve positive
patient outcomes
This suggests a recognition that quality improvement methods have a role in dental quality, although it is difficult to be sure quite what is meant.
The main levers on quality the GDC identifies in its strategy are the quality of undergraduate training; support for dentists in practice including dentists moving to the UK, and effective management of complaints and review of fitness to practice. From a Quality Improvement and Patient Safety perspective, the GDC could also consider:
- Ensuring that patient safety and quality improvement concepts are incorporated into undergraduate training.
- Thinking about other levels of analysis of complaints and problems than individual clinicians alone – are there characteristics of organisations that generate complaints?
- Being as nimble as possible on new technologies to avoid guidance being overtaken by events by the time it is published.
- Thinking about how it can support existing practitioners to embed quality improvement principles in their work to achieve the continuous improvement that the GDC desires.
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Dental Quality Improvement 
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