Head of the Dental Complaints Service, Hazel Adams, updates us on how best to deal with complaints.
What is the Dental Complaints Service?
Before addressing the issue of complaints handling, I think it's important to set out for those that might not know, what the Dental Complaints Service (DCS) is and does.
Set up by the General Dental Council (GDC) in 2006, the DCS is now in its eighth year and has proven to be an extremely effective complaints resolution service.
Based in Croydon in south London, the service comprises of ten staff, including myself. We are supported by 75 trained volunteer panelists.
We're here to help patients and dental professionals put things right when problems with private dental treatment arise. Our service is free of charge and completely impartial, and much of our success is down to professionals working with us to find a solution in an often very stressful situation.
It is a key role of all healthcare regulators to ensure the patient's voice is heard. Indeed, it is at the heart of the recommendations by Robert Francis QC in his report published in 2013 in the wake of the Mid-Staffordshire scandal. It's of great importance that bodies like the DCS are known to patients and the GDC works to ensure this is the case.
The types of complaints about private dental care being dealt with by the team at the DCS are not dealt with by any other organisation. Far from increasing the GDC's workload, we are dealing – very effectively – with complaints that might otherwise end up at the door of the GDC's much more costly Fitness to Practise department.
From July 2013 to June 2014 we've dealt with more than 8,500 calls. For the most part they've been from patients and have been about:
Root canal treatments
Pain, service and cost.
How we work
The first thing our advisers will ask any caller is whether they've tried to sort out the problem at the practice already. A clear in-house complaints procedure is key to allowing this to happen and many complaints will be resolved at this point. Indeed the new Standards for the dental team, which was launched last September, includes an entire, stand-alone principle about having ‘a clear and effective complaints procedure’ in place. Not having one in place could in fact become a Fitness to Practise issue.
But if this process has been gone through and either side still isn't happy, then we can step in to act as an impartial third party.
We will not contact a dental professional in relation to a complaint unless the patient has put their complaint in writing detailing their concern and how they would like the dental professional to resolve this.
As a general guideline we would advise patients to anticipate a response within ten working days.
If the patient does not receive a reply within this timeframe or is dissatisfied with the response received, it is at this stage that the DCS would step in to assist.
We would require a signed consent form from the patient giving the DCS authority to speak to the dental professional concerned. We would also request copies of any correspondence that had been exchanged between both parties.
The DCS will contact the dental professional, introduce themselves and give a summary of the complaint that has been raised. The dental professionals will be invited to give their view of the situation, and a discussion may then take place around how the complaint can be resolved.
The DCS would never insist on an immediate answer and will always suggest that the dental professionals contact their indemnifiers for advice. On occasion dental professionals have asked the DCS to contact their indemnifiers directly in order to progress the complaint.
In the majority of cases the complaint is resolved at this stage. However, if this does not happen and if both parties are in agreement, a panel meeting would be held. This is the final stage of our complaints process.
The meeting would be held in a venue which is local to both parties. The panel consists of two lay members (one of these being a Chair) and one dental professional. They will hear both sides of the complaint and work towards facilitating an amicable resolution. If an agreement can't be reached, the panel will make a recommendation in order to resolve the complaint.
The recommendation could be:
Closing the case with no further action
Asking the professional to consider remedial work
Asking the professional to make a contribution towards remedial treatment
Asking them to offer an apology
Asking them to offer a refund.
Further details can be found at: www.gdc-uk.org/sites/dcs/Pages/default.aspx.
Why are complaints increasing?
In the last four years Fitness to Practise complaints (FtP) to the GDC have increased by 110%. This is not the case with the DCS. Complaints to the DCS have been slowing down. That's despite it being an effective service with very high levels of satisfaction from both patients and registrants.
This decrease in complaints is a key reason for trying to ensure that patients and dental professionals know about the service. It's important that, where appropriate, complaints are routed to the DCS rather than to the GDC's much more costly Fitness to Practise department.
Awareness of the DCS is low; only 21% of the public had heard of the DCS in 2012 which was an increase from 13% in 2011.
Promotion and marketing of the DCS is not a new development; we regularly run campaigns to ensure the public and patients, as well as registrants and other advice bodies such as Trading Standards and Citizens Advice, are aware of the service it offers. It is a key role of any regulator (in this case the GDC) to ensure the patient's voice is heard.
At the moment, it would be fair to say that we don't accurately know why complaints to bodies like the GDC are increasing and there are likely to be a wide range of reasons. However, it's important to note that a rise in complaints doesn't necessarily mean a decline in standards – today's patients feel much more empowered to complain and helping them to find the right body to complain to is part of the GDC's work.
It is important to note that most other regulators of healthcare professionals have also seen a rise in the number of complaints since 2011 – including the General Medical Council, Health & Care Professions Council and The Nursing and Midwifery Council.
The GDC is committed to better understanding the reasons for the sharp upward trend in complaints and also ensuring patients have the right knowledge about where best to complain to.
It will look at why complaints are increasing and will be exploring with patients through research as to why this may be the case. There are likely to be a number of contributing factors including a change in attitudes from both professionals and patients – specifically an increase in patient expectations. This research will also feed into the work of the DCS.
Advice to dental professionals
In order to prevent complaints from escalating, our advice to dental professionals is to acknowledge that a complaint has been raised, provide a written reply within ten working days (if this is not possible, send a holding letter confirming the date of when a response will be received), follow through on any arrangements made and also consult with their indemnifiers for advice.
By the end of June 2014, the DCS had received a total of 80,514 calls to its local rate phone number since it first opened. Those calls have resulted in more than 12,000 complaints – an average of 28 complaints a week since we launched. The positive news is that two thirds of those complaints were resolved in less than a week.
The prevention agenda
We believe local resolution is an essential part of any complaints procedure. When the DCS receives a call we routinely check whether the patient has sought to resolve the matter with the dentist or dental care professional (DCP).
The DCS will not take the complaint further until this first step has been undertaken and has failed to resolve the matter. You may not be aware that the majority of cases are resolved at this first stage.
The GDC and the DCS know how good local resolution can be and we actively encourage it. The GDC is working with NHS England and other stakeholders across the UK with a view to encouraging earlier, local resolution of complaints. It will also analyse patterns of complaints and where necessary, will be providing advice to the profession on how to prevent concerns being raised. We know that patients are confused about how to complain and we must have a system in place that works for them.
We can't just respond to complaints, we must understand the reason for the increase as well.